Study finds a pair of common surgeries equally effective for treating blinding condition of the eyelid

On a normal eyelid (left), eyelashes are turned outward away from the cornea. Eyelids affected by trichiasis (center) have eyelashes touching the eye. Surgery for eyelids affected by trichiasis (right), rotates the eyelash away from the cornea, returning them to their normal anatomic position. (Image credit: National Eye Institute)

A large comparison trial funded by the National Institutes of Health has count that trachomatous trichiasis, a potentially blinding condition where inward-turned eyelashes scratch the front of the eye, can successfully be treated by either of the 2 most common types of eyelid surgery.

Amid earlier, smaller studies, which offered that one of the commonly used surgery types had poorer outcomes, this study provides reassurance that either technique can treat the condition. The study (NCT03100747), published in PLOS Neglected Tropical Diseases, was supported by the National Eye Institute (NEI), part of NIH.

“Some studies have reported post-operative trichiasis rates of 30% or higher for patients with trachomatous trichiasis following surgery, and repeat surgeries are more difficult,” said Emily Gower, PhD, University of North Carolina at Chapel Hill. “This trial sought to determine if we could decrease the risk of post-operative trichiasis by modifying the surgical procedure. We found that existing approaches result in better outcomes.”

According to the study, trachomatous trichiasis affects approximately 1.7 million people worldwide, mostly in poor and rural areas of Africa. The condition arises after repeated or chronic eye infections with the bacteria Chlamydia trachomatis, which is spread by person-to-person contact. The researchers pointed out that trachoma is more common in hot, dry areas of the world, and repeat infections can eventually lead to scarring and malformation of the eyelid. The issue can cause the edge of the eyelid to draw inward. When this happens, the eyelashes scratch the eye. If the condition goes without medical attention, trichiasis can result in corneal clouding, and eventually blindness.¹

According to the researchers one effective option for treating for trichiasis is surgery to correct the inward turn of the eyelid. This usually is performed in 1 of 2 different surgical options. A few smaller studies indicated that 1 of the surgery methods, posterior lamellar tarsal rotation (PLTR), could prove to be more effective, so some programs in Africa began retraining surgeons there to be proficient in performing that option.

An earlier review of eyelids that were surgicaly corrected with bilamellar tarsal rotation (BLTR), suggested that placing the surgical incision slightly further from the edge of the eyelid (5 millimeters above the lid margin instead of 3 mm) might lead to fewer recurrences. However, the researchers noted that this change had not been tested. The current study directly compared these three surgery approaches and evaluated the risk of post-operative trichiasis.

The researchers noted the study, which took place in southern Ethiopia, enrolled 4914 patients with trichiasis in one or both eyes (6940 eligible eyes). The participants were randomized to receive BLTR at 3 mm incision height, BLTR at 5 mm incision height, or PLTR.¹

Researchers rechecked the patients for post-operative trichiasis at six weeks and again at 12-18 months. On average, approximately 17% of eyelids had post-operative trichiasis. They found that there was no difference in the risk of post-operative trichiasis between the 2 opptions, with a 3 mm incision height, while those who received the 5 mm incision height BLTR were significantly more likely to have post-operative trichiasis. The results indicate that the current standard surgeries – either method at 3 mm – are better options for trichiasis treatment than the 5 mm method.¹

Reference

1. Gower EW, Sisay A, Bayissasse B, Seyum D, Weaver J, Munos B, Keil AP, Bankoski A, Sullivan KM, Kana H, Admassu F, Tadesse D, and Merbs SL. “The impact of modified incision height and surgical procedure on trichiasis surgery outcomes: Results of the Maximizing Trichiasis Surgery Success (MTSS) Randomized Trial.” PLOS NTD. September 17, 2024; Accessed September 20, 2024. https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0012034