The Time Consuming Lash: An Audit of Trichiasis Management

Abstract

Purpose: : To assess the efficacy, appropriateness and efficiency of treatment for trichiasis.

Methods: : 59 patients with trichiasis were treated between September 05- 06, including 34 males and 25 females with age range 45-98 years and a mean age of 79 years. Their case notes were reviewed. The cause of trichiasis was classified into those with lid malposition and those with lash distortion. In the former group, 5 patients with ocular cicatricial pemphigoid were excluded from analysis as they were treated in a separate clinic.We audited against the following criteria:1. Effective treatment: relief of symptoms which allowed patient discharge.2. Appropriate treatment:1. Three or fewer epilations before treatment review.2. 1-5 aberrant lashes electrolysed.²3. >5 aberrant lashes treated by cryotherapy.³4. All patients with lid malposition referred to the oculoplastic clinic, and listed for surgery.¹3. Efficient treatment: <3 epilations and < 4 electrolysis treatments⁴ or a single operation prior to discharge.

Results: : Lid malposition (N=10)Efficacy: 80% were discharged after one operation whilst 2 are awaiting further surgery.Appropriateness: 80% were listed appropriately. 2 patients with unrecognised lid malposition were treated with epilation and electrolysis.Efficiency: 87.5% patients were efficiently treated.Lash root distorsion (N=44)Efficacy: Those treated with epilation alone and those treated with electrolysis achieved resolution of symptoms in 54% of cases. The remainder continue to attend clinic. Success with cryotherapy was achieved in 78% patients.Appropriateness: Prior to electrolysis, on average a patient attended 10 times for epilation. Cryotherapy was utilized after an average of 3 electrolysis treatments.All patients who underwent cryotherapy were appropriately treated (9/9).Efficiency: The average number of patient visits for epilation was 5, with only 9% patients attending fewer than 3 times. (Range 1-26).The average number of patient visits for electrolysis was 2 (Range 1-6), with 87% of patients being discharged with < 4 treatments.

Conclusions: : Patients with lid malposition were managed well but epilation alone was undertaken inappropriately. Thus the management of trichiasis was inefficient and resulted in unnecessary clinic visits. To improve patient care, an algorithm has been constructed outlining the appropriate patient pathway and this is displayed in all clinic rooms.

Keywords: eyelid • ocular irritants • trachoma