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PURPOSE To assess the safety, efficacy, and patient satisfaction of a newly described technique for the treatment of mild to moderate lash ptosis performed as augmentation to upper eyelid blepharoplasty. METHODS Patient medical records for 27 consecutive cases of upper eyelid blepharoplasty between January 2016 and June 2017 and 19 consecutive cases of upper eyelid blepharoplasty with the laser lash tilt procedure between July 2016 and January 2017 performed by the senior author were retrospectively reviewed. Lash position in preoperative and postoperative photographs was graded in a randomized masked fashion on a 4-point scale by 5 oculoplastic surgeons. RESULTS There was a significant improvement in mean lash position scores for the control group (0.52 ± 0.34, p < 0.001) with mean lash score improving from 1.14 ± 0.46 before surgery to 0.62 ± 0.46 after blepharoplasty alone. There was also significant improvement in mean lash position scores for the laser lash group (0.98 ± 0.52, p < 0.01) with mean lash score improving from 1.66 ± 0.62 before surgery to 0.68 ± 0.50 after blepharoplasty with laser lash treatment. The improvement in lash position seen in the laser lash group was significantly greater than the improvement seen in the control group (p = 0.001). There were no complications and all patients were satisfied with their results. CONCLUSIONS Compared with upper eyelid blepharoplasty alone, the addition of the CO2 laser lash tilt technique provides a significant improvement in the upward tilt of the eyelashes as they emerge from the eyelid margin.

PURPOSE To characterize the normal eyelash mediolateral angular direction of the lower eyelid in different age groups. METHODS Sixty patients were divided into 3 groups: G1 - 6 to 12 years; G2 - 20 to 35; and G3 - 60 to 85. Digital photographs were obtained and eyelids were divided in lateral, central, and medial portions. Eyelash mediolateral angular direction relative to a baseline was measured and data were compared between portions and groups. RESULTS The mean eyelash mediolateral angular direction in the medial portion were: G1: 133.79° ± 17.56° SD; G2: 137.74° ± 10.5° SD; and G3: 116.05° ± 26.71° SD. The mean difference in angle between G1 and G3 was 17.74° (p = 0.015) and between G2 and G3 was 21.69° (p = 0.000). The mean eyelash mediolateral angular direction in central portion were: G1: 64.36° ± 12.58° SD; G2: 77.07° ± 12.17° SD; and G3: 84.9° ± 18.48° SD. The mean difference between Group 1 and 2 was 12.71° (p = 0.001) and between Group 1 and 3 was 20.54° (p = 0.000). The mean eyelash mediolateral angular direction in the lateral portion were: Group 1: 40.57° ± 6.78° SD; Group 2: 37.21° ± 5.69° SD; and Group 3: 38.48° ± 8.35° SD. CONCLUSION This study identified that lashes in the lateral portion of lower eyelid tend to maintain the same angular position throughout life. On the central and medial portions it tends to approach a 90° angle with age. The authors believe that this modification throughout life may be related to factors, such as involutional horizontal eyelid laxity and orbicular muscle modifications.

A 68-year-old man presented with significant, asymptomatic, unilateral eyelash poliosis, not associated with any ophthalmic or systemic conditions. He reported that this started about 40 years ago with a few lashes in the central portion of his eyelid and that adjacent eyelashes subsequently became involved over the next 4 to 5 days. He had normal ophthalmologic and neurologic examinations with no other relevant medical history reported. The case might be an unusual presentation of a halo nevus. To the best of the authors' knowledge, this is the first such case reported regarding the eyelashes. The case and relevant literature are presented.

Preoperative patient questionnaires enquiring about the presence of prosthetics are routine. Eyelash extensions are not part of standard preoperative questionnaires. This case illustrates how this impacts patient safety during minor eyelid surgery.

Alopecia areata can affect only the scalp (alopecia totalis) or whole body (alopecia universalis). The authors report a case of eyelash regrowth induced by a minor surgical procedure in a 44-year-old Caucasian man with alopecia universalis. The mechanism of the regrowth of eyelashes after a surgical procedure remains unanswered and further studies may help elucidate this phenomenon.

Purpose To describe and report results of a modified frontalis suspension technique utilizing direct fixation to tarsus, lash margin rotation, eyelid crease fixation, conservative blepharoplasty, and rhomboidal configuration. Methods A retrospective chart review of frontalis suspension patients over a 28-year period was performed. Results Data from 171 eyelids in 93 patients were reviewed. Ages ranged from 1 to 84 years with a median age of 16. The indications for surgery included the following: congenital ptosis in 107 eyelids (62.6%), chronic progressive external ophthalmoplegia in 17 (9.9%), jaw winking ptosis in 14 (8.2%), blepharophimosis in 12 (7.0%), cranial nerve III palsy in 10 (5.8%), traumatic ptosis in 9 (5.3%), and myasthenia in 2 (1.2%). Autogenous fascia lata was utilized in 156 lids (91.3%), while silicone rods or banked fascia was used in 11 (6.4%) and 4 (2.3%) lids, respectively.Average follow up was 11.7 months (range 2 to 108 months). An excellent result was defined as ≤1 mm asymmetry in primary gaze and an eyelid position of 2.5 mm or less below the superior limbus. Eighty-nine of 93 patients (95.7%) achieved excellent results. Six lids in 4 patients (3.5%) were undercorrected. No patients were overcorrected. Only 2 patients with autogenous fascia lata (3.4%) required a secondary bilateral frontalis suspension at the 2- and 3-year time intervals. Conclusions The authors believe that technique modifications including direct eyelid crease incision and tarsal fixation, conservative fat removal blepharoplasty even in children, lash margin rotation, and rhomboidal configuration with single midline brow incision give improved results of frontalis suspension when compared with conventional techniques.

Purpose To characterize the clinical and pathologic features of central lower eyelid thinning with trichiasis and discuss the management of this unique subset of entropion in elderly patients. Methods Retrospective study of patients with central lower eyelid thinning with trichiasis who presented between July 1996 and March 2006. Evaluation of management, including surgical intervention, using a modified Quickert "4-snip" block excision combined with lower eyelid retractor plication. Results Forty-one lower eyelids in 25 patients (22 men, 3 women; age range, 65-92 years; mean age, 79.6 +/- 6.6 years). All lower eyelids had medialization of the lateral eyelashes progressing posteriorly to frank trichiasis in the thinnest central zone. Seventeen patients (68%) had blepharitis. Twenty lower eyelids (48.8%) were refractory to initial treatment or presented with more severe disease and required incisional surgery; 16 of these were considered to have a successful postoperative outcome. Pathology reports from the specimens obtained frequently revealed the absence of meibomian glands, subconjunctival fibrosis, and tarsal scarring. Conclusions Central lower eyelid thinning with trichiasis is a distinct subset of entropion in elderly patients. Its management differs from the usual treatment for entropion in this age group. Surgeons should be aware of this unique condition to optimize diagnosis and treatment.

Purpose To describe a simple surgical technique for the definitive treatment of severe trichiasis, where the eyelid position is adequate. Methods Five anterior lamellar excision procedures are reported, with wounds left to heal by the laissez-faire technique. Results Postoperatively, all patients were symptom free. No recurrences have been seen with a mean follow-up of 17 months. Conclusions Wound healing by secondary intention for periocular defects is not commonly described. Combined anterior lamellar excision and laissez-faire technique shows promising results for trichiasis.

The association of uveitis and vitiligo has long been established in specific disease entities: Vogt-Koyanagi-Harada syndrome and sympathetic ophthalmia. We report an unusual case of topical chloramphenicol allergy associated with an anterior uveitis with subsequent poliosis and periocular vitiligo, following anterior approach levator advancement surgery.

Eyelash loss has many causes. The absence of lashes is frequently cosmetically objectionable for patients. Many techniques have been used to improve cosmesis, including tattooing and transplantation of cilia. This is a report on the result of individual hair follicle transplantation to the upper eyelids with a suboptimal outcome.

PURPOSE To determine the efficacy of an 810-nm diode laser in the treatment of trichiasis. METHODS Noncomparative interventional prospective study of 87 patients, providing 153 eyelids with darkly pigmented trichiatic eyelashes, treated with the 810-nm diode laser. The number of trichiatic eyelashes was counted before and after treatment. Patients were followed for 6 months with monthly examinations. RESULTS Immediately after laser treatment, the average number of trichiatic eyelashes per patient was reduced from 3.50 (standard deviation, 4.20) to 0.40 (standard deviation, 1.0). Forty-one patients were followed for 3 or more months (minimum of 90 days; maximum, 443 days; standard deviation, 77.23 days). Among these patients, the average number of eyelashes per patient was reduced from 3.58 (standard deviation, 4.15) to 0.73 (standard deviation, 1.60). The paired t tests demonstrated a statistically significant difference between numbers of eyelashes before and after laser treatment irrespective of gender, age, or location of eyelashes. CONCLUSIONS The 810-nm diode laser is an effective tool in treating trichiasis.

Purpose To describe the methods and results of a new technique of eyelash trephination for treatment of trichiasis and distichiasis. Methods The medical records of all patients who underwent eyelash trephination by the authors to treat trichiasis or distichiasis were reviewed. Gender, diagnosis, number of eyelids treated, follow-up time, and surgical outcome were recorded. The technique involves boring of the affected lash follicle with a microtrephine, followed by removal of the follicle. Results The procedure was performed on 41 eyelids of 26 patients (15 females and 11 males). Patients were followed for 6 to 51 months after surgery. No recurrence was observed in 16 patients (62%) during this period. There were no adverse effects of the therapy. Conclusions Eyelash trephination is a safe, quick, and effective method of treatment for trichiasis and distichiasis.

Purpose: To determine risk factors for early failure of the bilamellar tarsal rotation procedure in trachomatous trichiasis. Methods: This was a prospective study in which the bilamellar tarsal rotation procedure was performed on 638 eyelids in Menofiya governorate in Egypt over a 4-year period. An analysis was performed to determine the incidence of early surgical failure (defined as one or more lashes touching the eyeball) after 8 weeks and to determine the risk factors for these failures. Results: Follow-up data were available on 599 eyes at 8 to 10 weeks after surgery. Considering all eyes, failure (one or more lashes touching the eyeball) was noted in 98 eyes (16.4%). Failure was associated with preoperative corneal staining (RR, 3.27; 95% CI, 2.34 to 4.57), preoperative corneal opacity (RR, 1.64; 95% CI, 1.15 to 2.34), the use of silk sutures (RR, 54.82; 95% CI, 7.72 to 389.4), and the use of 4 or more sutures (RR, 1.24; 95% CI, 1.04 to 1.48). Conclusions: The finding that specific sutures or needles was associated with early failure of the bilamellar tarsal plate rotation procedure for trachomatous trichiasis was unexpected and deserves further study.

A previously unreported complication of the use of prostaglandin analog medications for glaucoma therapy is described. A patient with monocular open-angle glaucoma had trichiasis, a condition associated with the use of a prostaglandin analog. The patient was treated with radiofrequency cautery and is now asymptomatic. The unmedicated eye remains asymptomatic to date. Increased lash length, thickness, and pigmentation are well-documented side effects of prostaglandin analog glaucoma drops. Physicians must consider this when prescribing these medications for patients with misdirected eyelashes.

We describe a case of a 32-year-old man who presented with a visually apparent but otherwise asymptomatic mass in the right lateral fornix. Computerized tomography demonstrated the mass adjacent to the lacrimal gland. The mass was surgically removed, and histopathologic examination was consistent with a dacryolith of the lacrimal ductule. There were several cilia isolated from the dacryolith. This entity should be considered in the differential diagnosis of patients presenting with a localized mass in the region of the lacrimal gland.

Purpose: To evaluate the success of internal eyelash bulb extirpation in the management of trichiasis. Methods: The procedure was performed on 26 consecutive eyelids. Results: Our technique was successful in all cases, with no recurrence of signs or symptoms. Conclusions: Internal eyelash bulb extirpation is a safe and effective technique to remove trichiatic lashes, while avoiding injury to the conjunctiva.

Conjunctival entrapment of cilia is form of ocular irritation that to our knowledge has not yet been described. Scarring predisposes the conjunctiva to this phenomenon by creating blind recesses in which loose cilia can become entrapped. Once caught, the rigid cilia can act as a mechanical irritant or act as a nidus for microbial growth. We present herein three patients with entrapped cilia and discuss their pathophysiology and management. The symptoms in all three patients resolved with conjunctivoplasty and removal of the cilia.

We describe the treatment of focal trachomatous trichiasis with argon green laser. We treated 70 eyelashes in 17 patients with 80% success and found this treatment modality convenient both for the patient and the practitioner.

Trichiasis is a common condition of multiple etiologies. Cryosurgery has been advocated as an effective means of treatment but may be associated with serious complications, including scar, skin depigmentation, and lid notching. We treated eight consecutive eyelids with the argon laser. At the end of a 3-month follow-up period, no recurrence was noted. The only observed complication was mild eyelid notching in one eyelid. Histopathologic evaluation of two specimens obtained 10 days and 5 weeks after laser treatment confirmed the highly localized coagulative effect of the laser with minimum destruction of adjacent tissues. Orientation of the eyelid so that the laser beam and the lash follicle are coaxial and careful measurement of the depth of vaporization of the lash follicle are important in confirming complete treatment and minimizing recurrence.

The goal of trichiasis treatment is to eliminate misdirected cilia that irritate the eyeball. Established methods for removal of the eyelashes include epilation, electrolysis, and cryotherapy. Cryotherapy is currently the most effective method in widespread use, but has as potential posttreatment complications “visual loss, lid notching, corneal ulcer, acceleration of symblepharon formation, xerosis, cellulitis, activation of herpes zoster, skin depigmentation, and severe soft tissue reaction.‘’ (Wood JR, Anderson RL. Complications of cryosurgery. Arch Ophthalmol 1981;99:460–3.) The use of an argon laser allows more precise placement and control of the treatment, with better overall results. We reviewed the clinical course of 77 patients with a diagnosis of trichiasis, and 1 with distichiasis. We have found treatment of trichiasis with an argon laser with the patient under local anesthesia to be an effective office procedure.

Lid margin splitting at the gray line with resection of the lash-bearing anterior lamella of the eyelid is a simple and effective treatment for cicatricial entropion and trichiasis. Twenty-six patients underwent this procedure with good results.

I have discussed a technique for grafting hard palate mucous membrane to the lid margin as a treatment for trichiasis. Because of the resistance of this material to shrinkage and recurrence of trichiasis, it forms an excellent barrier to recurrence of trichiasis.

The repair of severe upper eyelid entropion with trichiasis was reported early in ophthalmological literature; a historical review of the main operative techniques is provided. The aim of treatment is to bring the eyelashes away from the lid margin. Recent procedures use an upward transposition of the anterior lamella, which is performed by a lid split technique. The free anterior tarsal surface must be covered by a free, autologous skin graft or mucous-membrane graft to stabilize the free lid margin and to prevent the tarsal plate from shrinking. A fibrin-sealing method is used for the fixation of the graft on the tarsus, thus making sutures unnecessary. The anterior tarsal surface is covered by the fibrin-glued transplant, which prevents the posterior lamella from shrinking and does not allow the lashes to descend to the lid margin again. The results of using this new method on seven patients are presented.