title: The clinical phenotype of trachomatous trichiasis in Ethiopia: not all trichiasis is due to entropion.
abstract: OBJECTIVE
  Trachomatous trichiasis (TT) is usually described as a cicatricial entropion of the upper lid; however, other forms of trichiasis have been reported. This variation in clinical phenotype is potentially important for treatment guidelines. Therefore, this study was conducted to investigate the range of disease type and severity encompassed by TT.
  
  
  METHODS
  Individuals presenting with TT to surgical treatment campaigns were examined by a single ophthalmologist using the Detailed WHO Trachoma Grading System. Additional features were graded, including type of trichiatic lashes (metaplastic, misdirected, and entropic), lower lid trichiasis, entropion severity, and lid margin mucocutaneous junction (MCJ) position.
  
  
  RESULTS
  Recruited were 2556 individuals with previously unoperated TT in at least one eye (4310 eyes). The median number of lashes touching the eye was 2 (range, 0 [epilating]-133). Entropion was absent or mild in 2328 (54.0%) eyes, moderate in 1259 (29.2%) eyes, and severe in 723 (16.8%) eyes. Trichiatic lashes were predominantly metaplastic or misdirected (80.2%), rather than secondary to entropion; 4204 (97.7%) had anteroplacement of the MCJ; and lower lid trichiasis was present in 494 (11.5%). Entropion was more severe among those with a low BMI, those who were female, those aged less than 50 years, and those with moderate to severe conjunctival inflammation, central corneal opacity, and severe conjunctival scarring.
  
  
  CONCLUSIONS
  Many patients with TT have minimal or no entropion. The trichiasis is frequently attributable to metaplastic or misdirected eyelashes. The results of tarsal rotation surgery in TT patients without manifest entropion should be investigated and potentially alternative treatment strategies evaluated.
authors: The London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Saul N
authors: SN
authors: Rajak
authors: Esmael
authors: E
authors: Habtamu
authors: Helen A
authors: HA
authors: Weiss
authors: Amir
authors: A
authors: Bedri
authors: Teshome
authors: T
authors: Gebre
authors: Robin L
authors: RL
authors: Bailey
authors: David C W
authors: DC
authors: Mabey
authors: Peng T
authors: PT
authors: Khaw
authors: Clare E
authors: CE
authors: Gilbert
authors: Paul M
authors: PM
authors: Emerson
authors: Matthew J
authors: MJ
authors: Burton
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004774:Entropion / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005002:Ethiopia / Q000453:epidemiology; D005140:Eyelashes / Q000473:pathology; D005143:Eyelids / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D010641:Phenotype; D015995:Prevalence; D012720:Severity of Illness Index; D014141:Trachoma / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D058457:Trichiasis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery