Is post-operative trichiasis a problem?Completely successful trichiasis surgery is defined as:
- No eyelashes rubbing on the eyeball (without the need for epilation or further surgery), and
- No complications (such as infection) and no severe eyelid contour abnormalities, eyelid closure defects, granulomata, or necrosis of lid margin
The four S’s: Key factors associated with post-operative trichiasis
- The severity of a patient’s trichiasis before surgery is a major factor associated with whether trichiasis will redevelop. The more severe the trichiasis before surgery the more likely it is to recur following surgery.
- The surgical method used is important. Some procedures are associated with higher post-operative trichiasis rate than others.
- The skill of the surgeon is very important – research has found that recurrence rates vary significantly between different surgeons. This suggests that there are subtle variations in how the procedure is performed that can influence the outcome.
- Excessive scarring – contraction of the healing tissue from more aggressive post-operative wound healing may be related to some recurrent trichiasis. Post-operative trichiasis developing later may be due to progressive scarring of the conjunctiva from trachoma.
Impact of post-operative trichiasisFailure to provide a good quality service with acceptable outcomes for patients will undermine progress towards eliminating trachoma. If people with trichiasis see others receiving poor quality surgery, they will be much less inclined to accept the treatment themselves. Good follow up of patients and feedback to the community will also strengthen health promotion and community mobilisation for other trachoma elimination activities – mass drug administration and interventions for facial cleanliness and environmental improvement.
Managing post-operative trichiasisIndividual patients should be advised by the surgical team that trichiasis can return after surgery, especially in patients who had severe trichiasis before the operation. Patients should be told to seek medical help if they develop symptoms of trichiasis again. When a patient does seek help, someone familiar with treating post-operative trichiasis should assess them.Trichiasis surgeons should carefully assess all patients found to have post-operative trichiasis and determine whether or not they need additional treatment.
- If the trichiasis is mild, with only a few lashes touching the peripheral parts of the eye, epilation can be considered
- If the lashes are central and regularly coming into contact with the cornea, then repeat surgery may be needed. Ideally the patient should be assessed by an ophthalmologist or by the most experienced trichiasis surgeon available.
Want to keep
London School of Hygiene & Tropical Medicine online course,
- Patients should be followed up and assessed for post-operative trichiasis at least 6 months after surgery
- Surgical outcome must be recorded; follow-up data on any post-operative trichiasis should also be systematically collected and collated. For quality assurance purposes, these data should ideally be analysed for each surgeon.
- Monitor surgical outcomes, including data on the appearance of eyelids and recurrence of trichiasis after surgery, across districts
- Assess whether rates of post-operative trichiasis are affecting acceptance of surgery in the community. To do this, programmes need to put quality assurance systems in place to track data. Trends on post-operative trichiasis rates at the 6-month follow-up can be used as a measure of quality.
Data collection for monitoring trichiasis surgeryAt each outreach campaign or static unit the following information on trichiasis surgery should be collected by the team:
- Number of patients operated per outreach
- Surgeon and type of surgery done
- Number of patients with post-operative trichiasis at 6 weeks
- Number of patients with post-operative trichiasis at 6 months
Our purpose is to transform access to education.
We offer a diverse selection of courses from leading universities and cultural institutions from around the world. These are delivered one step at a time, and are accessible on mobile, tablet and desktop, so you can fit learning around your life.
We believe learning should be an enjoyable, social experience, so our courses offer the opportunity to discuss what you’re learning with others as you go, helping you make fresh discoveries and form new ideas.
You can unlock new opportunities with unlimited access to hundreds of online short courses for a year by subscribing to our Unlimited package. Build your knowledge with top universities and organisations.