Trichiasis is a condition where eyelashes grow back towards the eye and touch the cornea and conjunctiva, causing irritation. It is most commonly seen in adults and is usually caused by trachoma, an eye infection. Surgical treatments like electrolysis, cryotherapy, or epilation are used to remove misdirected eyelashes. Nursing care focuses on minimizing pain, reducing anxiety, and preventing injury by ensuring a safe environment and providing eye protection and rest. With proper treatment, prognosis is generally good, though complications like recurrent corneal abrasions can occur if left untreated.
Trichiasis is a condition where eyelashes grow back towards the eye and touch the cornea and conjunctiva, causing irritation. It is most commonly seen in adults and is usually caused by trachoma, an eye infection. Surgical treatments like electrolysis, cryotherapy, or epilation are used to remove misdirected eyelashes. Nursing care focuses on minimizing pain, reducing anxiety, and preventing injury by ensuring a safe environment and providing eye protection and rest. With proper treatment, prognosis is generally good, though complications like recurrent corneal abrasions can occur if left untreated.
Trichiasis is a condition where eyelashes grow back towards the eye and touch the cornea and conjunctiva, causing irritation. It is most commonly seen in adults and is usually caused by trachoma, an eye infection. Surgical treatments like electrolysis, cryotherapy, or epilation are used to remove misdirected eyelashes. Nursing care focuses on minimizing pain, reducing anxiety, and preventing injury by ensuring a safe environment and providing eye protection and rest. With proper treatment, prognosis is generally good, though complications like recurrent corneal abrasions can occur if left untreated.
Roll no.: 27 SMTC Introduction Trichiasis is a common eyelid problem or lid abnormality. It is a medical term for abnormally positioned eyelashes that grow back towards the eye, touching the cornea and conjunctiva. In the trichiasis, there is an anatomic misalignment of eyelashes. Trichiasis can occur in all ages however, it is most commonly seen in adult age. Definition: It is defined as the ingrowths or introversion of the eyelashes in which the lashes rub against the cornea, the conjunctiva and the inner surface of the eyelids. This cause the irritation in the eye. Incidence Africa is the worst affected continent, as 18 million cases of active trachoma and 3.2 million cases of trichaisis are thought to exist in 29 out of the 47 countries in african region (World Health Organization [WHO], 2012). Causes 1. The exact cause of trichiasis is unknown. 2. Trachoma : It is a Commonest cause of the trichiasis. As, it is a severe eyelid infection that can impact the eyelashes and even cause blindness. A repeated cases of trachoma may cause trichiasis. 3. Trauma to the eyelid: Scar tissue that develops after an injury or trauma can cause eyelashes to grow in different direction. Eye surgery may also have this effect. Cont.. 4. Infection and inflammation of the eyelid 5. Developmental changes: The eyelashes and hair follicles may temporarily change shape as a child grows. Any resulting trichiasis is usually temporary. 6. Chronic Blepharitis: This is a common and ongoing condition. Chronic blepharitis involves inflammation and irritation of the eyelid in which the eyelids become swollen and oily particles and bacteria coat in the base of the eyelashes. Cont.. 7. Entropian : This condition causes the eyelid to fold inward, which can lead to trichasis. Age related muscle weakness, tissue weakness and infection or injury can cause entropian. 8. Herpes of the eye: Herpes can infect the eye and damage the eyelid causing trichiasis. Sign and symptoms • The eye becomes red and irritated. • Foreign body sensation with irritation in the eye. • Sometimes pain when exposed to the light. • Watery eyes • Blurry vision • Ocular discomfort • Itching • Conjunctival congestion • If the condition persists, scarring of cornea can occur. Diagnostic Procedures • No Specific diagnostic procedures are required in the management of trichiasis. Some diagnostic procedures are: 1. History Taking 2. Physical Examination 3. Slit lamp examination: It is performed to assess the distribution of trichiatic eyelashes, to elucidate the underlying cause and rule out differential diagnosis. Treatment Treatment of trichiasis is primarily surgical. Medical management are aimed at controlling the symptoms and treating the underlying causes. Ocular lubricants, such as artificial tears and ointments provide relief form the irritant effects of lash rubbing. A single dose of Antibiotics i.e, athizthromycin 20 mg/ kg up to 1g is the treatment of choice in those affected patients. Doxycycline may prevent the recurrence of trichiasis following surgery in the patients. Surgical Management The surgical management for trichasis involves: 1. Mechanical Epilation: The mechanical epilation with forceps is a simple temporary method of removing misdirected eye lashes, but the lashes grow back in 3 to 6 weeks so, patients should be advised that lashes will regrow, therefore epilation may need to be repeated. As, broken cilia are often more irritating to the cornea than mature long eyelashes. Despite these drawbacks, epilation is cheap and is generally acceptable to patients as treatment modality. Cont.. 2. Electrolysis: It is a procedure done by using a high electrical current for few isolated lashes, but has a number of drawbacks. It is also the destruction of lash follicle by passing electric current into the lash root. It works by passing a small amount of current through a very fine needle into the hair follicle. This produces heat, destroying the cells that produce hair at the base of the follicle. It has a high recurrence rate causing scarring of the adjacent eyelids margin. It can be tedious for the patient as well as for the surgeon. Cont.. 3. Cryotherapy: It is a freeze treatment used to treat number of eye problems especially retina conditions. The cryoprobe is applied to the affected segment for approximately 25 seconds, allowed to thaw and then refrozen for 20 seconds. Then the lashes are mechanically removed with forceps Cont.. This removes the eyelashes and follicles by freezing them. It is effective but has the potential for complications. It is the extreme use of cold in surgery to destroy abnormal or diseased tissue. Freon or nitrous oxide is used to destroy the follicles by freezing them. The complication include: edema, necrosis, loss of skin pigmentation and loss of globet function. Prognosis • Prognosis is generally good in the trichiasis. Frequent follow up care and immediate attention to complications, recurrence or corneal complications improve the long term prognosis. • A single dose of oral azithromycin 1 g after surgery can help to prevent recurrence rates to 1 year. Complications 1. Recurrent corneal abrasions. 2. Superficial corneal opacities. 3. Corneal vascularisation. 4. Non healing corneal ulcers. Nursing Management • Assessment 1. Assess the patients ability to see and perform the activities. 2. Assess the subjective findings like blurring of the vision, watery eyes, lacrimation etc. 3. Assess the patients knowledge of the disease process and anxiety about the diagnosis. 4. Assess the motivation to participate in the surgical treatment or procedure. 5. Assess the history and physical examination findings. Nursing Diagnosis 1. Acute pain related to inflammation of the eyelid. 2. Anxiety related to surgical procedure and its outcome. 3. Risk for injury related to decreased and blurry vision. Nursing Intervention A. Minimizing pain 1. Provide cold compress in every 2 to 3 times a day to manage pain and swelling. 2. Antihistamine agents such as benadryl should be used according to physician prescription. 3. Pain may occur when exposed to bright light so, it should be minimized. 4. If there is mild cases of eye discomfort then provide rest to the eyes and take pain relievers medication such as Advil or acetaminophen. B. Reducing Anxiety 1 . Provide emotional and psychological support to reinforce a positive self image. 1. Keep the environment simple, familiar and noise free, limit changes. 2. Remain calm and unhurried while performing any procedures or tasks to the patients. 3. Explain the surgical interventions to the patients and patients visitors adequately. 4. Provide adequate rest and comfortable sleep. C. To prevent from injury 1. Assess the patient for degree of visual impairment. 2. Ensure the room environment is safe with adequate lighting. Remove all the objects that could be potentially hazardous. 3. Keep patients glasses and call bell within easy reach. 4. Instruct patient or family regarding safe lighting. 5. Patient should provide sunglasses to reduce glare. Evaluation 1. Minimized pain 2. Reduced anxiety levels 3. Free from the injury References 1. Wiliam L and Tandon R. Lippincott Manual of Nursing Practice, 9th edition. 2. Williams and Williams. Brunner and siddharths Textbook of Medical and Surgical Nursing, 12th edition. 3. Neil J and Kaiser k; Review of Opthalmology, 2nd edition. Thank you