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Sandra Cassard, Shannath Merbs, Jennifer Harding, Beatriz Munoz, Sheila West, Emily Gower; The Epidemiology of Lower Eyelid Trachomatous Trichiasis among Upper Eyelid Trichiasis Surgery Patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):869.
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© ARVO (1962-2015); The Authors (2016-present)
Little is known about the epidemiology of lower eyelid trachomatous trichiasis. This study was conducted to determine risk factors for the development of lower eyelid trichiasis within 1 or 2 years of initial upper eyelid trichiasis surgery.
Participants enrolled in the Partnership for the Rapid Elimination of Trachoma Surgery Trial were examined 1 and 2 years after surgery to correct upper eyelid trichiasis. Ocular exams included assessment of the presence of lower eyelid trichiasis. Participants with and without lower eyelid trichiasis at 2 years after upper eyelid surgery were compared on demographic and baseline ocular characteristics. In addition, participants with lower eyelid trichiasis at 1 year and 2 years following upper eyelid surgery were compared to those who developed it between 1 and 2 years (incident lower eyelid trichiasis). Multivariable models, controlling for within participant correlations, were constructed to assess risk factors for lower eyelid trichiasis.
2718 eyes of 1673 participants were evaluated 2 years after upper eyelid trichiasis surgery. 316 eyes (11.6%) had lower eyelid trichiasis at the 2 year follow-up visit. Of these, 218 (69.0%) also had lower eyelid trichiasis at 1 year and 98 (31.0%) developed it between the 1 and 2 year follow-up visits. The likelihood of lower eyelid trichiasis at 2 years increased with increasing baseline severity of upper eyelid trichiasis (p<0.0001). Trichiatic lashes originating from the nasal aspect of the upper eyelid at baseline were independently associated with an increased risk of lower eyelid trichiasis at 2 years after controlling for locations of other trichiatic lashes at baseline, age, gender and baseline severity of upper eyelid trichiasis (p=0.0009). Presence of nasal upper eyelid trichiatic lashes at baseline and older age were independently associated with having lower eyelid trichiasis by 1 year compared to those with incident lower eyelid trichiasis between 1 and 2 years (p=0.024 and p=0.048, respectively), controlling for other baseline covariates noted above.
Surgical programs to correct trachomatous trichiasis typically are aimed at rectifying upper eyelid trichiasis. Lower eyelid trichiasis is common and should be integrated into surgical programs and trichiasis research. Upper eyelid trichiasis in the nasal aspect may predict future development of lower lid trichiasis.
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