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E.S. West, B. Munoz, W. Alemayehu, M. Melese, S.K. West; Association of Epilation With Corneal Opacity Among Trichiasis Patients in a Trachoma Hyperendemic Area . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5023.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Trachoma remains a leading cause of blindness worldwide, with over 7 million individuals currently blind. Years of repeated infection can lead to trichiasis, inturned lashes which abrade the cornea. If not corrected, continued corneal abrasion may lead to corneal opacity (CO) and eventually blindness. In trachoma hyper–endemic countries, 3% of the entire population is estimated to have trichiasis. In many areas, surgery is available, but surgical uptake is often very low. Community health programs are in need of alternative measures for individuals who refuse surgery, and many programs have suggested epilation as an effective method for preventing corneal opacity. Methods: Trichiasis patients presenting for first surgery were evaluated for previous lid surgery, current trichiasis status, duration of trichiasis, and monocular visual acuity in each eye. Evidence of epilation and number of inturned lashes touching the globe were recorded. With the eye at primary gaze, entropion was graded as: none: all lash bases visible; mild: some lash bases visible in area of lid with trichiasis; severe: all rows of lashes in section of lid with trichiasis not visible. Corneal opacity was assessed according to WHO guidelines. Results: 2623 eyes among 1452 participants had unoperated trichiasis at the time of the study visit. 92% of eyes with unoperated trichiasis reported trichiasis duration of 2+ years. 69% (n=1816) of eyes with unoperated trichiasis had evidence of epilation. 54% of eyes had no entropion, 30% had mild, and 16% had severe entropion. Eyes with entropion were much more likely to have CO than eyes without entropion (p<0.0001). Among eyes without entropion, COdid not differ by epilation status; 9% of eyes with epilation and 11% without epilation had CO. Among eyes with mild or severe entropion, eyes with evidence of epilation were much less likely to have CO ( Mild: age–adjusted OR: 0.49, 95% CI: 0.30–0.80; Severe: age–adjusted OR: 0.24, 95% CI: 0.13–0.45). However, many of these eyes still had CO (21% and 43%, respectively). Conclusions: In many countries, surgery is not performed until trichiasis is severe, and epilation is recommended for mild cases. Our data show that epilation is not helpful for mild cases, and 10% of these eyes may develop CO if trichiasis is not corrected. Among eyes with mild or severe entropion, however, epilation appears to offer some protection against CO. For individuals with severe trichiasis who refuse surgery, epilation may be helpful, although many eyes may still develop CO.
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