Trichiasis
Introduction
Introduction to trichiasis Trichiasis: refers to the abnormal growth of the eyelashes to the rear, so as to touch the eyeball. Trichiasis is a common external eye disease among children, adolescents and the elderly, mainly due to the abnormal growth direction of the eyelashes. Eyelashes with abnormal growth direction, especially the eyelashes that grow on the surface of the cornea, often rub the corneal epithelium, causing foreign body sensation, fear of light, tearing and other symptoms, and can cause eyeball congestion, conjunctivitis, corneal epithelial shedding, keratitis, cornea Vasospasm, corneal ulcers, corneal leukoplakia, which in turn affects vision. Normal eyelashes grow on the anterior lip of the eyelid margin and develop from the epithelial surface of the ectoderm. They are arranged in 2 to 3 rows with short, curved hairs. The eyelashes are protected from light, block the dust, prevent external foreign matter from entering the eye and the beauty of the eye. The slender, black and upturned eyelashes play an important role in modifying the appearance of the person. The upper eyelashes have a large number of eyelashes, ranging from 100 to 150, and the average length is 8 to 12 mm. The angle of the upper eyelashes is 110 to 130 when looking at the eye, and 140 to 160 when closing the eyes. There are 50 to 80 eyelashes, and the average length is about 6 to 8 mm. The blink of the lower eyelashes is 100 to 120 inches. The hair roots of the eyelashes are deep in the connective tissue and muscles, where there are metamorphosed sweat glands and sebaceous glands, and the catheter is open to the eyelash sac. The posterior lip of the eyelid margin has a plurality of small holes arranged in a row. These small holes are openings of the meibomian gland duct, and the meibomian glands themselves are located in the tarsal plate. The abnormality of the tilt angle of the eyelashes may be caused by a change in the angle of growth of the eyelashes or a disease of the eyelids. basic knowledge The proportion of illness: the incidence rate is about 0.02% - 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: conjunctivitis
Cause
Cause of trichiasis
Congenital factors (30%):
Children and adolescents are mainly caused by the abnormal growth direction of the eyelashes, the squatting of the lower jaw, sometimes the lower suede combined with the internal suede, and the congenital eyelid varus.
Physiological factors (30%):
There are two main causes of trichiasis, including trichiasis without eyelid varus and trichiasis with eyelid varus. Eyelid varus must cause trichiasis, but trichiasis may not always be accompanied by eyelid varus, trichiasis can exist alone. Entropion refers to an abnormal state in which the gingival rim is wound in the direction of the eyeball.
Disease factor (30%):
Middle-aged and elderly people are mainly caused by inflammation of the conjunctiva of the eyelids and scar contraction of the gingival margin, as well as eyelid varus caused by various reasons.
Prevention
Trichiasis prevention
1. After the operation, the eye pad is covered with eye pads. If both eyes are operated at the same time, they need to be covered for several days. The eyes can't see things, and there will be a lot of inconvenience in life. Therefore, the family needs careful care. The order of the objects in the home should be in order, and the commonly used objects should be placed in the place where they should be used.
2, pay attention to the diet to give fresh vegetables and fruits rich in vitamin C, in order to facilitate the early healing of the wound.
Complication
Trichiasis complications Complications conjunctivitis
(1) Inflammation of the conjunctiva: Because the eyelashes repeatedly stimulate the conjunctiva and the cornea, conjunctivitis is more difficult to cure, and it is often easy to recurrent, tearing, and secretions often appear. When the conjunctival inflammation is repeated and long-term unhealed, some patients have conjunctival scars, and a few have local sacral adhesions.
(2) corneal changes: trichiasis can cause corneal epithelial punctate or diffuse lesions, corneal epithelial shedding, corneal superficial opacity, corneal vasospasm, corneal epithelial keratinization, corneal ulcers, corneal leukoplakia, which in turn affects vision.
(3) Others: In addition to corneal lesions affecting vision, trichiasis can sometimes cause astigmatism and can affect vision. In children, if astigmatism is obvious, a small part can also cause amblyopia.
Symptom
Trichiasis symptoms Common symptoms Corneal ulcers Foreign body sensation Eye pain Corneal turbid tears Eyes red
When examining the lower eyelids, the paralyzed patient looks down to find out if the eyelashes touch the cornea. Patients often have pain, red eyes, tears, fear of light, persistent foreign body sensation, and increased secretions from the eyes. Children are more reluctant to look up, afraid that the light is not willing to cooperate with the flashlight or slit lamp inspection. Under long-term friction of the eyelashes, conjunctival hyperemia, corneal epithelial punctate or diffuse injury or partial peeling of the corneal epithelium, corneal superficial opacity, corneal neovascularization, corneal vasospasm, corneal epithelial thickening, corneal epithelial keratinization, corneal ulcer, Corneal leukoplakia causes vision loss or even severe blindness.
Examine
Trichiasis check
When examining the lower eyelashes, the paralyzed patient looks down to find out if the eyelashes touch the cornea. If there is contact with the cornea, it is the lower eyelid. The disease refers to the growth of the eyelashes to the back, which can be diagnosed by routine visual inspection and ophthalmologic examination. Children are unwilling to look up, afraid that light is not willing to cooperate. To check with a flashlight or slit lamp.
Diagnosis
Diagnosis of trichiasis
It means that the eyelashes grow to the back, and can be diagnosed by visual inspection and ophthalmology.
Disease classification
1. Trichiasis without eyelid varus: just because the growth direction of the eyelashes is abnormal, or because the skin of the lower suede is pressed, the eyelashes are swept toward the cornea.
2. Trichiasis with eyelid varus
(1) congenital entanglement (congenital entropion)
More common in infants and young children, only occurs in the lower jaw, Asians have a higher incidence, prone to occur in the lower eyelid near the internal position. Pathogenesis: Most of them are caused by internal ecdysis, excessive development of orbital rim muscle or dysplasia. Some infants and young children are relatively fat, and the development of the nasal roots is not full, the roots of the nose are very flat, and with the inner and lower suede, it can also cause varus varus. Congenital eyelid varus should be distinguished from epiblepharon, which is inwardly curled inward, while the latter is a rare congenital anomaly with an extra skin fold on the inside of the lower jaw. The inner side of the eyelid is pulled inwardly, in contact with the cornea and the conjunctiva, but the rim itself is not inverted.
(2) Degenerative entanglement (senile entropion)
Degenerative valgus varus, also known as chronic spastic palsy or senile valgus varus, occurs mostly in the lower jaw. Pathogenesis: a. rupture of the inferior tibiofibular aponeurosis, weakness of the inferior condylar muscle; b. relaxation of horizontal tension in the eyelid, relaxation of the septum and chin, loss of contraction of the orbicularis muscle, resulting in under the tarsal plate In addition to the tendency of the edge, the rim of the rim is inward; c. the slight invagination of the eyeball, the reduction of fat in the elderly, the lack of sufficient support behind the eyelid; d. the overlap of the orbicularis oculi muscle, the orbicularis tendon, the muscle fiber The upper eye is curled up, and the eyelids are overlapped before the eyelids, causing the eyelids to varus and causing trichiasis.
(3) scar ( (cicatricial entropion)
Scar varus, caused by scarring of the conjunctiva and tarsal scar, causing the eyelids to fall back to the eyeball, both upper and lower sputum can be involved. It is mainly caused by diseases such as trachoma scar, conjunctival burn, chemical injury, conjunctival pemphigus and diphtheria conjunctivitis.
Pathogenesis: The contraction of the scar causes the posterior layer of the eyelid to be significantly shorter than the anterior layer, causing the gingival margin to curl inward, causing scarring varus.
(4) spastic entropion
More common in the lower jaw, due to eye rim tendon spasm. Pathogenesis: common in acute inflammation of the eye, injury or internal eye surgery (such as cataract extraction), because the stimulation causes the orbicularis oculi muscle, especially the periorbital sacral muscle fiber reflex sputum, which leads to the formation of the gingival margin. Eyelids are inverted. Since the jaws of the lower jaw are thin and narrow, there are many chances of occurrence of defects, and the upper jaw is wider and less inversion occurs. This type of varus is temporary, and once the stimuli disappear, most of them can disappear on their own.
Differential diagnosis
1. Distianasis: refers to a row or part of the eyelashes opening in the meibomian glands or slightly behind them. This abnormal eyelash is shorter or lacks pigmentation.
2. Metaplastic lashes: The lashes originate from the meibomian glands, and the growth direction of the eyelashes is disordered. This disease occurs mostly in long-term scarring conjunctivitis.
