ConditionEyes & vision
Trichiasis (Ingrown Eyelashes)
Trichiasis is a condition in which one or more eyelashes grow inward, toward the eye, so they rub against the cornea and the white of the eye. It causes a scratchy, foreign-body feeling, redness, tearing and light sensitivity. Common causes are chronic eyelid inflammation (blepharitis), eyelid injury or surgery, an inward-turning eyelid (entropion), and scarring diseases such as trachoma. Untreated, lashes can scratch and scar the cornea and damage vision. Treatment ranges from plucking to permanently destroying lash follicles or surgery.
Also called: Ingrown eyelashes, misdirected eyelashes, inward-growing eyelashes
At a glance
- What it is
- Eyelashes growing toward the eye and rubbing its surface.
- Common causes
- Blepharitis, eyelid trauma or surgery, entropion, trachoma, scarring diseases.
- Symptoms
- Scratchy or gritty feeling, redness, tearing, light sensitivity, pain.
- Risks
- Corneal abrasions, ulcers, infection and scarring.
- Treatment
- Lubricating drops, plucking (epilation), electrolysis, freezing, laser or eyelid surgery.
When to get help
See a doctor within a day or two
- Increasing eye pain, a white spot on the cornea, discharge, or reduced vision (possible corneal ulcer)
- Severe light sensitivity and redness that is getting worse
- Eye symptoms after a chemical, thermal or blistering skin reaction affecting the eyes
Book a routine appointment
- A persistent scratchy or gritty feeling in one eye with lashes that seem to touch the eye
- Lashes that regrow inward after plucking
- An eyelid that turns inward
- Recurrent red, irritated eyes with crusting at the lash line
Usually safe to manage at home
- A single stray lash touching the eye that you can see, with mild irritation, while waiting for an appointment (use lubricating drops)
How trichiasis differs from related conditions
| Condition | What happens | Lid position |
|---|---|---|
| Trichiasis | Lashes grow from normal positions but point toward the eye | Normal |
| Entropion | The whole eyelid margin turns inward, so normal lashes rub the eye | Turned in |
| Distichiasis | An extra row of lashes grows from oil gland openings, often inherited | Normal |
| Epiblepharon | A fold of skin pushes lashes toward the eye, common in East Asian children | Normal, extra skin fold |
Trichiasis and entropion often occur together, and treatment depends on which is present.
Causes
- Blepharitis: chronic inflammation of the eyelid margins, the most common cause in developed countries
- eyelid injury, burns or lacerations
- eyelid surgery or previous trauma causing scarring
- Trachoma: repeated chlamydial eye infections causing scarring of the inner eyelid. It is the world's leading infectious cause of blindness and the most common cause of trichiasis globally, especially in parts of Africa, the Middle East and Asia
- scarring conditions: ocular cicatricial pemphigoid, Stevens-Johnson syndrome, chemical burns
- shingles affecting the eye
- aging, as eyelid tissues loosen
- chronic eye rubbing
Symptoms
- a feeling of something in the eye (foreign-body sensation)
- scratchiness, grittiness or pain
- redness of the eye
- excessive tearing
- light sensitivity
- blinking frequently
- blurred vision if the cornea is damaged
Symptoms are often worse when blinking or looking down.
Complications
Constant rubbing damages the cornea:
- corneal abrasions (scratches)
- corneal ulcers and infection
- scarring and clouding of the cornea
- abnormal blood vessels growing into the cornea
- permanent vision loss in severe or untreated cases
Diagnosis
An eye doctor examines the eyelids and lashes with a slit lamp microscope. They check:
- which lashes are misdirected and how many
- whether the eyelid is turned inward
- the health of the cornea, using fluorescein dye to show scratches
- signs of blepharitis, scarring or trachoma
Treatment
Short-term relief
- lubricating eye drops or ointment to protect the cornea
- bandage contact lens in some cases
- treating blepharitis with warm compresses and lid hygiene
Removing or destroying lashes
- Epilation (plucking): quick and done in the clinic, but lashes usually regrow within 4 to 6 weeks, sometimes thicker and more irritating
- Electrolysis: an electric current destroys individual lash follicles. Good for a few lashes
- Radiofrequency ablation or laser: destroys follicles precisely
- Cryotherapy (freezing): for many lashes in one area, though it can cause skin depigmentation and lid notching
Surgery
- eyelid surgery to correct entropion
- wedge resection or lid margin repair for segmental trichiasis
- bilamellar tarsal rotation surgery for trachomatous trichiasis, the procedure recommended by the WHO
Trachoma control
In endemic areas, the WHO SAFE strategy combines Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement to eliminate trachoma.
Outlook
Most people get relief once misdirected lashes are removed or the eyelid is corrected. Plucking alone often needs repeating. Permanent treatments and surgery reduce recurrence. Protecting the cornea early prevents lasting vision problems.
Frequently asked questions
What is trichiasis?
Trichiasis is a condition where eyelashes grow inward toward the eye instead of outward. The lashes rub against the eye, causing irritation, redness, tearing and, if untreated, damage to the cornea.
What causes ingrown eyelashes?
The most common causes are blepharitis, eyelid injury or surgery, an inward-turning eyelid (entropion), and scarring diseases. Worldwide, trachoma, a chronic eye infection, is a major cause.
Can I pluck an ingrown eyelash myself?
It is better to have an eye doctor remove it, as plucking at home risks scratching the eye or infection. Plucked lashes usually grow back within weeks, so recurring trichiasis often needs a more permanent treatment.
Is trichiasis serious?
It can be. Constant rubbing can scratch the cornea, leading to ulcers, infection, scarring and vision loss. Early treatment of misdirected lashes and the underlying cause prevents these complications.
What is the difference between trichiasis and entropion?
In trichiasis, the eyelid is in a normal position but some lashes grow toward the eye. In entropion, the whole eyelid edge turns inward, pushing normal lashes against the eye. Treatment differs, so an eye exam is needed.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Trichiasis (EyeWiki); Blepharitis
- World Health Organization: Trachoma fact sheet; SAFE strategy
- American Society of Ophthalmic Plastic and Reconstructive Surgery: Entropion and trichiasis
- MedlinePlus (US National Library of Medicine): Eyelid disorders
- Royal College of Ophthalmologists: Patient information on eyelid surgery