Interventions for trachoma trichiasis, in-turning of the upper eye lashes caused by a chronic infectious inflammation of the conjunctiva of the eye that can lead to blindness

Trachoma is a form of chronic inflammation of the transparent mucous membrane that lines the eyelids and covers the white of the eye (conjunctiva). It is a bacterial infection caused by Chlamydia trachomatis that is associated with poverty and is most prevalent in hot dry areas. Repeated infections cause scarring of the conjunctiva of the upper eyelid, which causes the eyelid to turn in (entropion) so that the eyelashes touch the cornea at the front of the eye. This is known as trachoma trichiasis. Every movement of the eye or eyelids causes trauma to the corneal surface so that it eventually turns opaque and the person becomes blind. Improved facial cleanliness and environmental hygiene may reduce the spread of trachoma. Antibiotic treatment may also be useful but surgery to correct the eye lid deformity is the only treatment that is likely to be helpful in the late stages of the disease. The review authors searched the medical literature and identified seven randomised controlled studies (2331 participants) investigating surgical and non-surgical treatments as a way of reducing the recurrence of trichiasis. Three studies compared different surgical interventions. These trials suggested that the most effective surgery requires full-thickness incision and rotation of the edge of the eyelid. Community-based surgery was more convenient for patients by reducing the time and expense of travelling to a conventional hospital and it did not increase the risk of complications or recurrence. Surgery performed by ophthalmologists and by integrated eye workers were both similarly effective. The addition of azithromycin treatment at the time of surgery did not reduce the recurrence of trichiasis in a single study (426 participants). Non-surgical methods included removing the eye lashes (epilation) using electrolysis or cryotherapy and taping the eyelid back. One trial found that the use of double-sided sticking plaster was more effective than removing the eye lashes as a temporary measure but the tape had to be replaced weekly. Destroying the lashes appeared to have low success rates and the equipment required is costly and can be difficult to maintain. The included studies were carried out in China, Gambia, Ethiopia and Oman.