In the outpatient department, some babies always rub their eyes and shed tears. Upon examination, it is often found that the real “culprit” is a few “disobedient” eyelashes – trichiasis.
Today, let’s talk about this common problem that troubles many children and answer the top 5 concerns parents have about pediatric trichiasis.
Why do many babies have it?
Eyelashes grow on the anterior lip of our eyelid margin, divided into upper and lower eyelashes. Eyelashes have the functions of shielding light, blocking dust, preventing foreign objects from entering the eye, and beautifying the eyes.
“Trichiasis” means that the direction of eyelash growth is abnormal, not growing outward obediently, but turning in the opposite direction, adhering to or even rubbing against the surface of the eyeball. Trichiasis is more common in children, especially infants and young children.
The main reasons are:
Epicanthal fold(most common)
Babies(especially Asian babies) have not yet fully developed their nasal bridge, and there is often excess skin folds near the inner corner of the lower eyelid(epicanthal fold). This “little fold” pushes the eyelash root inward, causing the eyelash to point towards the eyeball.
This is usually physiological and often improves as the nasal bridge develops.
Entropion
The entire eyelid margin is rolled inward, causing the entire row of eyelashes to point towards the eyeball.
● May be related to the overdevelopment of the orbitalis muscle at the eyelid margin or incomplete development of the tarsus;
● Some children with more chubby faces may also have an increase in the pre-tarsal fat and high attachment of the orbital septum, leading to trichiasis;
● In addition, post-traumatic eyelid scars can also cause entropion and trichiasis.
Other
Eyelid inflammation, swelling(e.g., hordeolum, chalazion) may also temporarily change the direction of local eyelashes.
Most of the trichiasis in young babies, especially a few eyelashes at the inner canthus of the lower eyelid, is often caused by physiological structure not being fully developed, and parents need not be overly anxious.
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How do I know if my child has trichiasis?
What are the signs?
The symptoms of trichiasis are usually caused by the abnormal inward growth of eyelashes, stimulating or rubbing the eyeball, especially the cornea(black part of the eye). The main symptoms and characteristics include:
Eye irritation or pain
Babies may say, “My eyes hurt, something is grinding,” because when eyelashes rub against the eyeball, especially the cornea, it can make children feel persistent foreign body sensation or pain.
Frequent eye rubbing, blinking
This is the most common signal!
Children try to relieve the foreign body sensation and discomfort by rubbing and blinking. Frequent eye rubbing may lead to conjunctivitis, increased secretion, and conjunctival congestion.
Photophobia (light sensitivity)
Corneal injury may be more sensitive to light.
Persistent red eyes, increased discharge
When trichiasis continuously stimulates the conjunctiva and cornea, the conjunctiva may show congestion. If secondary infection occurs, children may have increased eye discharge.
Decreased vision
In severe cases, trichiasis may lead to corneal ulcers or corneal scars, thereby causing a decrease in vision.
If a child exhibits these symptoms, especially if they persist or worsen, it is recommended to take the child to an ophthalmologist in a timely manner for a clear diagnosis and to rule out other eye problems such as conjunctivitis, keratitis, and allergies.
Does the eyelash poking the eye cause significant harm?
Parents are most worried about: will the eyelashes that grow in the opposite direction harm their child’s eyes? The answer is: It is possible, but the degree of harm varies greatly, and the key is whether the cornea is damaged!
Mild friction
May only cause slight foreign body sensation, tearing. As long as the cornea is not damaged, it usually does not affect eye health. Common in babies aged 0-3, during this period, the eyelashes are relatively soft, and although there are a few growing in the opposite direction, they do not damage the cornea.
Persistent, severe friction
If the eyelashes rub against the cornea for a long time, it may lead to:
✅
Superficial corneal epithelial damage:
The superficial cells of the cornea are damaged, and the doctor can see punctate staining under the slit lamp after staining with fluorescein.
✅ Corneal epithelial defect:
The damage deepens, forming small patches of absence.
✅ Corneal inflammation(keratitis):
If corneal injury leads to secondary infection, the risk increases.
✅ Corneal scarring/cloudiness:
This is the most alarming! Long-term repeated injury and inflammation may leave permanent “small scars” on the cornea or make it less transparent. If the scar is exactly in the pupil area (the most critical part for seeing), it may affect vision!
Therefore, the core criterion for determining whether trichiasis requires active intervention is: Is the cornea damaged? Is vision affected? This requires ophthalmologists to assess using slit lamp microscopy and other examinations.
Is it true that trichiasis causes astigmatism?
Astigmatism is mainly related to the shape of the cornea itself, corneal biomechanical properties, and the shape of the lens. Slight trichiasis will not cause astigmatism. However, severe and long-term trichiasis rubbing against the cornea, especially when causing damage, inflammation, or scarring in the central area of the cornea, may cause the corneal surface to become irregular. This irregularity of the corneal surface can cause “irregular astigmatism.”
Not all trichiasis will lead to irregular astigmatism. The highest risk is for those with severe trichiasis that rubs against the central area of the cornea repeatedly and has already caused persistent corneal damage, inflammation, or scarring. This secondary irregular astigmatism caused by corneal problems may affect vision. Timely treatment of trichiasis and protection of corneal health are key to preventing vision problems.
How is trichiasis treated when discovered?
Parents don’t worry too much! It’s common for Asian babies under the age of 3 to have trichiasis, but most cases do not require immediate special treatment. There are two reasons:
Baby’s eyelashes are soft:
The eyelashes of young babies are naturally thin and soft, even if a few grow in the opposite direction, they may not rub against the eyes or damage the cornea (black part of the eye).
Development will improve:
As the baby’s nasal bridge grows and the face develops, many cases of trichiasis will gradually improve.
So, the key to treatment is to see the child’s “degree of discomfort” and “whether the eyes are injured“:
✅ Observation + Lubrication
Suitable for: Children without obvious photophobia, tearing, eye rubbing, or the doctor’s examination the cornea is not injured.
What to do: It is usually recommended to use preservative-free artificial tears (This is like applying a “lubricating protective film” to the eyeball, which can relieve the discomfort caused by friction and protect the cornea.) At the same time, regularly take the child for re-examination, and observe changes in the condition.
✅ Treatment of a few trichiasis (Suitable for older children):
If the child has not improved trichiasis after starting kindergarten and only a few eyelashes are causing trouble, the doctor may consider removing them. However, it should be noted that after removal, the new eyelashes will still grow in the opposite direction.
✅ Surgical indications (Physician’s specific assessment):
● When trichiasis clearly and persistently damages the cornea (e.g., persistent staining, defects, keratitis, corneal opacification/cloudiness);
● The child has obvious entropion (the entire eyelid edge rolls inward, causing half or the entire row of eyelashes to rub against the eyeball).
Summary
If you find that your child often rubs their eyes, blinks, or has red eyes, parents should take their child to an eye examination in a timely manner, do not pull out eyelashes on your own to avoid increasing stimulation or infection. Even if the symptoms of trichiasis are mild and no treatment is needed for the time being, regular re-examination and monitoring are also necessary.
Cultivate good eye habits in children, pay attention to eye hygiene , and treat eyelid inflammation in a timely manner, all of which can help improve the problem of trichiasis.
The core of surgical decision-making is to prevent corneal damage. Doctors will make a strict assessment, parents need not fear surgery excessively, nor should they delay necessary treatment due to hesitation.
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