title: Epilation for trachomatous trichiasis and the risk of corneal opacification.
abstract: OBJECTIVE
  Eight million people have trachomatous trichiasis (TT). The World Health Organization (WHO) recommends entropion surgery for TT regardless of severity. However, epilation is widely practiced for treating minor TT (1-5 lashes touching the globe). We report the frequency and effectiveness of patient-initiated epilation and its relationship to corneal opacity.
  
  
  METHODS
  Cross-sectional baseline data of individuals recruited to 2 randomized, clinical trials.
  
  
  METHODS
  We included 2556 individuals (4310 eyes) with previously unoperated TT in ≥ 1 eye.
  
  
  METHODS
  A single ophthalmologist examined all participants for signs of trachoma using WHO grading systems with additional assessment of entropion grading, location and number of trichiatic lashes, and evidence of epilation. A questionnaire enquired about epilation practices.
  
  
  METHODS
  The association between epilation and degree of corneal opacity. Epilation practices of TT patients.
  
  
  RESULTS
  Central corneal scarring was present in 1436 (33%) eyes. Entropion was absent/mild in 2328 (54%) eyes, moderate in 1259 (29.2%), and severe in 723 (16.8%). The median number of lashes touching the eye was 2 (interquartile range, 1-5; range, 0-133). There was clinical evidence of epilation in 3018 (70%) eyes, of which 738 (24%) were successfully epilated (no lashes touching globe). Epilation was performed frequently (at least monthly in 3311 [76.8%] eyes), by someone other than the patient (92.8%), and using locally made forceps (88.9%). Controlling for age and degree of entropion, successful epilation was associated with less corneal opacity (odds ratio [OR], 0.61; 95% confidence interval [CI]. 0.43-0.88; P = 0.007). The association was only significant in patients with severe entropion (OR, 0.07; 95% CI, 0.02-0.25; P<0.005).
  
  
  CONCLUSIONS
  We found an association between successful epilation and less central corneal opacity. This indicates the importance of preventing eyelashes from touching the cornea, particularly in individuals with severe entropion. This is a cross-sectional study; therefore, a causative relationship cannot be concluded. However, the results suggest that among patients who decline or are unable to access surgery, and perhaps in minor TT where the management remains controversial, the provision of high-quality forceps and epilation training may be beneficial.
  
  
  BACKGROUND
  The authors have no proprietary or commercial interest in any of the materials discussed in this article.
authors.affiliation: The London School of Hygiene and Tropical Medicine, London, United Kingdom. Saul.Rajak@Lshtm.ac.uk
authors.forename: Saul N
authors.initials: SN
authors.lastname: Rajak
authors.forename: Esmael
authors.initials: E
authors.lastname: Habtamu
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Amir
authors.initials: A
authors.lastname: Bedri
authors.forename: Teshome
authors.initials: T
authors.lastname: Gebre
authors.forename: Asrat
authors.initials: A
authors.lastname: Genet
authors.forename: Peng T
authors.initials: PT
authors.lastname: Khaw
authors.forename: Robin L
authors.initials: RL
authors.lastname: Bailey
authors.forename: David C W
authors.initials: DC
authors.lastname: Mabey
authors.forename: Clare E
authors.initials: CE
authors.lastname: Gilbert
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Burton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003318:Corneal Opacity / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005140:Eyelashes / Q000473:pathology; D005260:Female; D006204:Hair Removal; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014141:Trachoma / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D016896:Treatment Outcome; D058457:Trichiasis / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*