title: The association between epilation and corneal opacity among eyes with trachomatous trichiasis.
abstract: OBJECTIVE
  To examine the association between epilation and corneal opacity (CO) among trichiasis patients presenting for surgery.
  
  
  METHODS
  Cross sectional data from the STAR trial were utilised. Patients presenting for trichiasis surgery in Wolayta Zone, Ethiopia, were evaluated for current trichiasis status. Number of inturned lashes, evidence of epilation, level of entropion, trichiasis duration, and CO were collected. The primary outcome was prevalence of CO, stratified by entropion and epilation status.
  
  
  RESULTS
  Approximately 10% of eyes with mild entropion had CO, regardless of epilation status. Among eyes with moderate entropion, epilated eyes were less likely to have CO than non-epilated eyes (21% v 34% p = 0.002). The same association was seen in eyes with severe entropion: 43% of epilated eyes while 74% of non-epilated eyes had CO (p<0.0001). Presence of CO increased with age. Adjusted models showed a protective effect of epilation in eyes with moderate or severe entropion (OR: 0.51; 95% CI: 0.32 to 0.83 and OR: 0.24; 95% CI: 0.13 to 0.45, respectively). Among eyes with mild entropion there was no difference in the prevalence of CO comparing eyes that were epilated with those that were not epilated.
  
  
  CONCLUSIONS
  Entropion was the most significant predictor of CO. Cross sectional associations suggest that epilation may not be helpful for eyes with mild entropion, but may offer protection against CO in eyes with moderate to severe entropion. Epilation should not be a substitute for trichiasis surgery, however, as 43% of eyes with severe entropion that were epilated still had CO.
authors.affiliation: Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, 116 Wilmer Building, 600 N Wolfe Street, Baltimore, MD 21287, USA. ewest@jhsph.edu
authors.forename: E S
authors.initials: ES
authors.lastname: West
authors.forename: B
authors.initials: B
authors.lastname: Munoz
authors.forename: A
authors.initials: A
authors.lastname: Imeru
authors.forename: W
authors.initials: W
authors.lastname: Alemayehu
authors.forename: M
authors.initials: M
authors.lastname: Melese
authors.forename: S K
authors.initials: SK
authors.lastname: West
mesh_terms: D003318:Corneal Opacity / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004774:Entropion / Q000150:complications / Q000382:microbiology / Q000628:therapy; D005140:Eyelashes; D005141:Eyelid Diseases / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006204:Hair Removal / Q000379:methods; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D014141:Trachoma / Q000150:complications* / Q000628:therapy