Common eyelid problems that can relate to dry eye disease, Part 1: Bad lashes.
Trichiasis (lashes rubbing on the eye = “Bad Lashes”):
Many of us have had to pull an errant eyelash out of our eye or eyelid at some point. If the lash was totally loose and freely riding on the eye, then this is a common and “normal” occurrence, usually fixed by simple irrigation (either from tearing that washes it out, or by an eye wash rinse). But if the lash is still attached to the lid by its root, while rubbing on the eye, then this is an “abnormal” problem called trichiasis. This can be painful and in severe cases, lead to infections, scarring and loss of vision.
This condition can be a genetic, predetermined problem (often in rows of many such errant lashes) or can occur due to thinning and scarring of the lid (cicatricial), or from the more common cause relating to “Blepharitis” (see my earlier posts on this). Blepharitis can cause one or more lashes to “grow wrong” so that they turn in and rub against the eye. Sometimes just pulling the lash (epilation) and treating the blepharitis will “fix it.” Sometimes it will continue to come back the same way and need further treatment.
While treatment can vary, it is also true that the “root” (the growth “bulb”) can be quite persistent and hard to “kill.” The normal life cycle includes 3-phases of the lash, beginning with a growth phase (Anagen), a dwelling phase (Catagen) and a falling out phase (Telogen), where the lash will eventually fall out and then gradually regrow (approximately a 6 week-long cycle from start to stopping growth and then falling out). To remove a lash effectively and permanently, it is best to target it in the growth phase, when it is strongly connected to its “root.” Laser or IPL of the correct wavelength, electricity or RadioFrequency (RF) can be used to permanently “kill” a lash. Surgery can remove the lash(es) and freezing (cryosurgery) is a more destructive way to permanently remove them – though either can be extremely effective, both of these options tend to be the more painfully invasive.
Skin of color, or those with very blonde, red, white or lighter-gray lashes will generally not respond to light-related (laser or IPL) removal, as the dark skin can prevent light from penetrating deeply into the lid where the root is (essentially shielding the root from the light) and lighter colored lashes have so little “pigment” (the color of the lash) in the root, that the light doesn’t get absorbed in a way that effectively kills the root. When you have light skin and a dark lash, this can be a quick and simple treatment, with little discomfort. This is generally true for hair of all sorts, regardless of the location, and is the basic principle for all so-called “Laser Hair Removal.”
Electricity (as electrolysis) or RF (hyfurcation) are effective alternatives for permanent lash removal of any skin color and in any location. They are also most effective if done while the hair or lash is in the growth phase – or at least the dwelling phase – as once the hair or lash goes into the falling out phase, it disconnects from the root and it is often impossible to treat the root once it is “disconnected.” The principle of killing the root is common to every type of permanent hair removal and the 3-phases of hair growth accounts for the main reason it is often impossible to remove all hair/lashes with one single treatment. If the root is “missed” (due to the hair or lash being disconnected), then it will require a second (and sometimes more) attempt to permanently “remove” it. Because eyelids are sensitive and eyes are close behind the lids, it is common to have an eye doctor help you with this. In the case of electricity or RF, a small amount of numbing is common to help make the brief application of energy comfortable. An insulated “wire” is introduced alongside the lash and a brief application of current will create a burst of energy into the root. Once the lash root is sufficiently damaged, the lash becomes loose and is easily removed. If the root was effectively “killed,” then it won’t allow the lash to grow back.
Again, it may take a monthly series of such treatments to fully remove all the bad lashes, depending on which phase they are treated, how well they are treated and how many are yet to develop and become present to be treated. Uncontrolled blepharitis is also a common recipe for more to come along, so controlling blepharitis is good for the tear glands as well as for the lashes and general health of the lids, lashes, and the eye itself.
For more information on trichiasis, see also:
https://www.aao.org/eye-health/diseases/what-is-trichiasis.
https://www.reviewofophthalmology.com/article/the-annoying-lash-in-the-eye-a-review-of-trichiasis
:max_bytes(150000):strip_icc()/poking-eyelashes-trichiasis-symptoms-causes-and-treatment-3422083-ec865d5103d44b5badb2582d93ae2e61.png){kind=link}