European Journal of Ophthalmology / Vol. 10 no. 4, 2000 / pp.


Treatment of trichiasis with argon laser
Department of Ophthalmology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul - Turkey

P URPOSE . In this prospective study, argon laser photocoagulation was used to eliminate mis-
directed cilia. The cases were followed up to see the results and recurrences with this treat-
M ETHODS . 60 eyelids of 45 patients with trichiasis were treated with the argon laser. After
topical anesthesia a blue-green argon laser was used with 1 watt power, for 0.20 seconds,
with 100 micrometer beam diameter. The beam was directed coaxially to the lash follicle to
create a 2-3 mm crater and vaporization was observed. After crater formation, the laser pa-
rameters were changed to 1.2 watt power, for 0.20 seconds, with 200 micrometer beam di-
ameter, to destroy residual follicular tissue. Up to five lashes were treated in one session.
At the end of each session an antibiotic ointment was used t.i.d. for a week.
R ESULTS . Patients have been followed for 4-12 months (mean 6 months). Recurrences have
been seen in 15 of 60 eyelids (25%). Laser treatment has been used with the same proto-
col for the cases with recurrence and results have been successful in eight of them. Post-
operatively severe pain, hemorrhage, scar formation, neovascularization of lid margin, or
infection were not seen in any patient. In three cases mild hypopigmentation and in three
other cases mild lid notching were observed.
C ONCLUSIONS . Argon laser lash ablation can be done as an effective office procedure with
topical anesthesia. The advantages include low recurrence and complication rates in care-
fully selected patients and minimal postoperative discomfort. (Eur J Ophthalmol 2000; 10:

K EY W ORDS . Blue-green argon laser, Trichiasis, Lash ablation
Accepted: January 19, 2000


Trichiasis is an acquired condition in which the lash- Our study involved 60 lids of 45 patients (31 women,
es are directed posteriorly toward the surface of the 14 men) who underwent argon laser treatment for trichi-
eye. Symptomatic trichiasis has been treated with elec- asis involving the upper lid, the lower lid or both. Their
trolysis, cryotherapy, mechanical epilation and surgi- age ranged from 35 to 82 with a mean of 55 years. In
cal methods. Some of these methods have high re- all, 135 lashes were treated.
currence rates and some have serious complications. Prior to treatment a detailed history was taken for
Since 1979 the argon laser has been used for the treat- each patient and a general ophthalmologic examina-
ment of trichiasis with considerable advantages, (1, 2). tion was done including fundoscopy. Electrolysis had
In this prospective study, we investigated the ef- been done for 12 patients and lid surgery for two be-
fects of argon laser treatment of 60 lids of 45 patients fore the argon laser treatment. The other patients had
with trichiasis who were referred to the Ophthalmol- only undergone mechanical epilation. The etiology of
ogy Department at the Cerrahpaşa Medical Faculty trichiasis was ocular pemphigoid for 3 cases, trachoma
between March 1997 and April 1998. for 2, previous lid surgery for 2 and chronic blephar-

© by Wichtig Editore, 2000 1120-6721/273-03$01.50/0

exposure time 0. and surgical procedures are the main causes the base of eyelash. No protective plastic lens. antibiotic ointment was used dai. cessive scarring of the treated eyelid. Sharif et al re- DISCUSSION ported 67. Steven- ed lash with the laser beam. The as idiopathic. The formation or conjunctival inflammation. corneal edema. ocular cicatricial pemphigoid. surgical procedures have been used and many dif- No patient complained of intolerable pain either at ferent results are reported. and the surgical method is the most important prog- riod. Argon laser thermoablation involves re- popigmentation was visible in three patients (5%). 15 of the 60 cases showed of inflammation (8-10).9% success for 21 patients after approxi- mately two consecutive laser sessions and stated that Trichiasis can be a most irritating eyelid problem for the number of aberrant lashes per lid dictated the num- both the patient and the ophthalmologist because of ber of treatment sessions required (18). Patients were followed has a high recurrence rate too and may cause ex- up at regular intervals for 4-12 months (mean 6 months). chemical exposure time 0. tophobia. The laser beam (spot size 100-200 µm. A non-narcotic analgesic was used for only five nostic factor for these cases. In view of the high burns were applied for one lash. Selection of the patient the time of laser ablation or in the postoperative pe. Radiotherapy is anoth- cases.20 sec. For eight of sue destruction than argon laser in rabbit models. scar formation and exacerbation lashes per treated eyelid. erythema multiforme. these successful results were obtained with the same For cases with anatomical lid abnormalities many protocol after approximately three sessions. electrolysis. and tient was placed in front of the blue-green argon laser scarring. mechanical epilation cannot be con- Postoperatively. Acetominophen was used for only struction of the lash follicle with electrical current. unit. Chronic blepharoconjunctivitis. lid notch- Recurrence was defined as regrowth of one or more ing. All eye. and can finally lead to serious visual loss. recurrence rate. trauma. epithelial defects.2 watt. It offers selective follicle abla- were treated without any exacerbation of symblepharon tion without damage to the pilosebaceous units. Cryotherapy leads to more tis- recurrence after the first session (25%).5 mm (16). In some cases a small cotton pled. ton-tipped applicator to align the root of the misdirect. The pa. Mild peated application of argon laser burns to the hair notching occurred in the three pemphigoid cases. especially for severe cases (11-13). and power 1. loss of mei- bomian gland secretion. drug-induced es were used. skin depigmentation. surgery methods (5-7). It five cases to relieve the pain. The remaining 26 eyes were accepted the annoying symptoms and its recurrent nature. Electrolysis is the de- ly for one week. To ensure destruction of the whole Many therapeutic modalities have been tried like me- lash folicle. Cryotherapy gives more satisfactory results but may produce many complications such as the loss of all lashes – both Findings normal and abnormal – in the frozen area. Jonhson syndrome. lids healed smoothly within six weeks after treatment The argon laser was first used for trichiasis by Berry without any scarring or vascularization. they abrade the cornea and may produce linear Regional infiltration anesthesia was not used. the laser settings were changed to spot size chanical epilation. patient’s activities and lifestyle are limited by the pain We used 4% oxybuprocaine hydrocloride eye drops and discomfort of foreign body sensation and pho- for topical anesthesia.Treatment of trichiasis with argon laser itis for 12 cases. er strategy. cryotherapy and 200 µm. who root and follicle (15). Compbell reported 80% success for 15 patients in 1990 (17). at the base of the lash. Vari- occurred. pemphigoid (pseudopemphigoid). ous results have been reported for the treatment of trichiasis with the argon laser. No infections suggested depth of ablation is 2-2. All these methods have some Lashes were treated individually and approximately 20 disadvantages and complications. power 1 watt was focused at injury. corneal ulcer. Patients with entropion were excluded.20 sec. Bleeding was not seen in any patient. Trichiatic lashes are most bohersome when get soaked with the same agent was applied for 1 minute. trachoma. 274 . The first application created a crater of trichiasis (2-4). viral conjunctivitis. sidered for long-term results. eyelid edema. The eyelid was rotated slightly outwards with a cot. Faint hy. in 1979 (14).

61: 718-20. 113: 71-4. Wykes WC . In: Keates RH. Neldler KH. Emel Başar the main factor in the development of trichiasis (2). 15. Oshry T. Ophthalmologica 1993. Baltimore. Districhiasis and trichiasis. Forstat SL. Argon laser treatment of trichiasis. 8: 50-5. Arslan et al reported 76. Oshry et destruction and chronic inflammation. Ophthalmic Surg 1992. Wingfield DL. Brightwell JR. tion in the treatment of recurrent trichiasis. ed. 8. the treatment of trichiasis. Yassur Y. Türk 17. 192: 20-2. A controlled trial of surgery for trachomatous Eye 1991. Aust NZ J Ophthalmol 1990. 120: 2. Reacher MH. results. Triki. Gosmann DM. The treatment of re- 7. 14. 509-19. Gossman reported 11. Recurrent trlchiasis treatment with laser pho- si 1993.6% recurrence and underlined Şahinler Apt. Newton C. 21. pion. These properties mean patients (20). Schei HG. X-ray epilation for 23: 179-82. Use of argon laser photocoagula- 1998. In: Roy FH. Complications of cryosurgery. Elder MJ. of trichiasis as an office procedure. asis. Berlin AJ. Arslan AK. Ar- lid cryprobe. 1: 21-5. Experimental comparison of laser thal Plastic Reconstr Surg 1992. Fraunfelder FT. Lowry JC. Huneke JW. No. Taylor HR. 5: 591-5. Berry J. Türk Oftalmoloji Gazete. Anatomy and physiology of eyelash follicules: Wilkins. trauma and previous surgical procedure were the main etiological factor in Reprint requests to: unsuccessful cases and atypical follicular position was Prof. Akmut T. Anderson RL. Campbell DC. In Arslan’s study. Vergados J. gon green laser photoepilation in the treatment of tra- 9. and 90. relevance lash ablation procedure. Sullivan JH. Ladas ID. 10. 3. Am J Ophthalmol 1992. Haltzler J. Arch Dermatol 1984.9% after the treatment of recur. 13 trauma as the main etiological factor (21). Oba E. 13. 10: 36-8. constr Surg 1997. tocoagulation. Possible complications sec. Gossman DM. 12. Johnson RLC. Söylev M. 275 . Albualy current trichiasis with argon laser photocoagulation. chomatous trichiasis. Rosenthal G. 454-9. 23: 274-7. Munol B. Trikiazis olgularinda uygu. Cemil Aslan Güder Sok. Ophthalmic Surg 1992. trichiasis of the upper lid. using the argon laser. Ophthalmic Surg 1979. Surgery of the eye. Er H. Turkey REFERENCES Origin and management. Br J Ophthalmol 1985. Prospective evaluation of the argon laser in the treat- 11. Arch Ophthalmol 1992. Arafat AF. Duman S. Steinkogler FJ. Alghassony A. 10: 47-55. 427-30. 10/Daire.4% success with that this laser can be recommended for the treatment one session. Shami L. ondary to cryotherapy. Brigtwell JR. Bartley GB. Treatment of trichiasis with a 20. 18. Yunh R. Damanakis A. Trichiasis. azisin argon lazer ile tedavisi. ment of trichiasis. 18: 6. Eggler S. Thermoablation treatment for trichiasis Oftalmoloji Gazetesi 1993. Daar AS. 110: 19. Churchill Livingstone. and cryosurgical cilia destruction. Kasim R. Trichiasis and distichiasis. ed. Am J Ophthalmol 1966. Argon laser treatment of trichi- 667-74. 620-5. Ophthalmic Surg 1979. 1. Oph- Yung R. Gayrettepe Our impression is that argon laser treatment leads Istanbul. London. Surgical aspect of the upper lid entro. 23: 183-7. Collin JR. Lifshitz T. Williams & 16. Theodsosiadis GP. Huntington AC. 207: 90-3. Sharif KW. Acar M.Başar et al In 1992 de Bartley et al reported 59% success for to less tarsal tissue thinning. Klin Monatsbl Augenheilkd 1988. Long term 4. ladig˘ imizcerrahi tedavi yöntemleri ve sonuçlari. Master tech. Ophthal Plast Re- 5. 66: 460-3. Ophthal Plast Reconstr Surg 1994. Arch Ophthalmol 1982. Karamaunas N. 23: 406-9. 1995. 69: 267-70. and has some al achieved 80% of successful results in 17 trachoma capillary coagulation effect too. Kaltreider SA. Albert DM. causes limited tissue 44 patients with only one laser session (19). nique in Ophthalmic Surgery. Wood JR. M. rent cases (2). 10: 253-5.