Abstract
BackgroundTrachomatous trichiasis (TT) needs to be managed to reduce the risk of vision loss. The long-term impact of epilation (a common traditional practice of repeated plucking of lashes touching the eye) in preventing visual impairment and corneal opacity from TT is unknown. We conducted a randomized controlled trial of epilation versus surgery for the management of minor TT (fewer than six lashes touching the eye) in Ethiopia. Here we report the four-year outcome and the effect on vision and corneal opacity.Methodology/ Principal Findings1300 individuals with minor TT were recruited and randomly assigned to quality trichiasis surgery or repeated epilation using high quality epilation forceps by a trained person with good near vision. Participants were examined six-monthly for two-years, and then at four-years after randomisation. At two-years all epilation arm participants were offered free surgery. At four-years 1151 (88.5%) were re-examined: 572 (88%) and 579 (89%) from epilation and surgery arms, respectively. At that time, 21.1% of the surgery arm participants had recurrent TT; 189/572 (33%) of the epilation arm had received surgery, while 383 (67%) declined surgery and had continued epilating (“epilation-only”). Among the epilation-only group, 207 (54.1%) fully controlled their TT, 166 (43.3%) had minor TT and 10 (2.6%) had major TT (>5 lashes). There were no differences between participants in the epilation-only, epilation-to-surgery and surgery arm participants in changes in visual acuity and corneal opacity between baseline and four-years.Conclusions/ SignificanceMost minor TT participants randomised to the epilation arm continued epilating and controlled their TT. Change in vision and corneal opacity was comparable between surgery and epilation-only participants. This suggests that good quality epilation with regular follow-up is a reasonable second-line alternative to surgery for minor TT for individuals who either decline surgery or do not have immediate access to surgical treatment.
Highlights
IntroductionTrachomatous trichiasis (TT) is the late stage scarring sequelae of repeated conjunctival Chlamydia trachomatis infection and inflammation in which the upper eyelid is distorted and rolled inwards (entropion) and the eyelashes turn towards the eye [2]
Trachoma is the leading infectious cause of blindness worldwide [1]
We found no difference between the epilation and surgery groups in terms of change in vision and corneal opacity between baseline and four years
Summary
Trachomatous trichiasis (TT) is the late stage scarring sequelae of repeated conjunctival Chlamydia trachomatis infection and inflammation in which the upper eyelid is distorted and rolled inwards (entropion) and the eyelashes turn towards the eye [2]. Trachoma leads to visual impairment through the damaging effect of trichiasis on the cornea. The clinical phenotype ranges from a single aberrant eyelash touching the eye (without entropion) to the whole eyelid rolled inwards [7]. The long-term impact of epilation (a common traditional practice of repeated plucking of lashes touching the eye) in preventing visual impairment and corneal opacity from TT is unknown. We conducted a randomized controlled trial of epilation versus surgery for the management of minor TT (fewer than six lashes touching the eye) in Ethiopia. We report the fouryear outcome and the effect on vision and corneal opacity
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