Causes of Trichiasis and Distichiasis and Their Management with Carbon Dioxide Laser Ablation.

Background: Many techniques have been used to treat trichiasis and distichiasis, but none of them are consistently successful, without complications, or effective in different severities. In addition, etiologic factors and their relationship with the severity or prognosis have not been identified in the non-trachoma-endemic area.

Methods: In this retrospective consecutive study, the authors enrolled patients with trichiasis or distichiasis who had undergone carbon dioxide laser ablation in their tertiary medical center between November of 2013 and May of 2022. Surgical success was defined as no regrowth of misdirected eyelashes for at least 3 months postoperatively. The authors recorded the success rate within 3 months and 1 year after 1 treatment session, and within 3 treatment sessions. The authors also investigated the relationship between etiologic factors, severity, and the success rate.

Results: The authors enrolled 216 eyelids of 137 patients (average age, 69.4 years; mean follow-up duration, 22.9 months). The major underlying causes of trichiasis and distichiasis were idiopathic (64.4%) and prior eyelid surgery (20.8%). More major trichiasis and distichiasis cases were observed among patients aged younger than 60 years than in patients aged 60 years or older (43% versus 21%; P < 0.01), and among patients with an underlying cause of prior eyelid surgery compared with patients with an idiopathic cause (42.2% versus 23.0%; P < 0.01). The success rates within 3 months, within 1 year after 1 treatment session, and within 3 treatment sessions were 87.5%, 76.2%, and 94.4%, respectively.

Conclusions: The authors demonstrate that idiopathic cause and prior eyelid surgery are common causes of trichiasis and distichiasis. Carbon dioxide laser ablation is a safe, effective, and efficient treatment modality.

Clinical question/level of evidence: Therapeutic, IV.