title: Eyelash Epilation in the Absence of Trichiasis: Results of a Population-Based Prevalence Survey in the Western Division of Fiji.
abstract: The WHO definition of trachomatous trichiasis (TT) is "at least one eyelash touching the globe, or evidence of recent epilation of in-turned eyelashes", reflecting the fact that epilation is used as a self-management tool for TT. In Fiji's Western Division, a high TT prevalence (8.7% in those aged ≥15 years) was reported in a 2012 survey, yet a 2013 survey found no TT and Fijian ophthalmologists rarely see TT cases. Local anecdote suggests that eyelash epilation is a common behaviour, even in the absence of trichiasis. Epilators may have been identified as TT cases in previous surveys.
  
  
  
  We used a preliminary focus group to design an interview questionnaire, and subsequently conducted a population-based prevalence survey to estimate the prevalence of epilation in the absence of trichiasis, and factors associated with this behaviour, in the Western Division of Fiji.
  
  
  
  We sampled 695 individuals aged ≥15 years from a total of 457 households in 23 villages. 125 participants (18%) reported epilating their eyelashes at least once within the past year. Photographs were obtained of the eyes of 121/125 (97%) individuals who epilated, and subsequent analysis by an experienced trachoma grader found no cases of trachomatous conjunctival scarring or trichiasis. The age- and sex- adjusted prevalence of epilation in those aged ≥15 years was 8.6% (95% CI 5.7-11.3%). iTaukei ethnicity, female gender, and a higher frequency of drinking kava root were independently associated with epilation.
  
  
  
  Epilation occurs in this population in the absence of trichiasis, with sufficient frequency to have markedly inflated previous estimates of local TT prevalence. Individuals with epilated eyelashes should be confirmed as having epilated in-turned eyelashes in an eye with scarring of the conjunctiva before being counted as cases of TT.
authors.affiliation: Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Colin
authors.identifier: 0000-0002-8119-8391
authors.initials: C
authors.lastname: Macleod
authors.affiliation: Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Yalen
authors.affiliation: Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Butcher
authors.affiliation: Ophthalmology Department, Lautoka Hospital, Lautoka, Fiji.
authors.forename: Umesh
authors.initials: U
authors.lastname: Mudaliar
authors.affiliation: Ophthalmology Department, Lautoka Hospital, Lautoka, Fiji.
authors.forename: Kinisimere
authors.initials: K
authors.lastname: Natutusau
authors.affiliation: World Health Organisation, Fiji Country Office, Suva, Fiji.
authors.forename: Mere
authors.initials: M
authors.lastname: Rainima-Qaniuci
authors.affiliation: Department of the History of Science and Ideas, Uppsala University, Uppsala, Sweden.
authors.forename: Chris
authors.initials: C
authors.lastname: Haffenden
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Conall
authors.initials: C
authors.lastname: Watson
authors.affiliation: Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Naomi
authors.initials: N
authors.lastname: Cocks
authors.affiliation: Ophthalmology Department, Lautoka Hospital, Lautoka, Fiji.|Department of Communicable Diseases, Ministry of Health, Suva, Fiji.
authors.forename: Luisa
authors.initials: L
authors.lastname: Cikamatana
authors.affiliation: Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Chrissy H
authors.initials: CH
authors.lastname: Roberts
authors.affiliation: Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.|Hospital for Tropical Diseases, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Marks
authors.affiliation: Department of Communicable Diseases, Ministry of Health, Suva, Fiji.
authors.forename: Eric
authors.initials: E
authors.lastname: Rafai
authors.affiliation: Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: David C W
authors.initials: DC
authors.lastname: Mabey
authors.affiliation: Department of Communicable Diseases, Ministry of Health, Suva, Fiji.
authors.forename: Mike
authors.initials: M
authors.lastname: Kama
authors.affiliation: Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.|Hospital for Tropical Diseases, London, United Kingdom.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Solomon
mesh_terms: D000293:Adolescent; D000328:Adult; D005140:Eyelashes / Q000002:abnormalities*; D005260:Female; D005367:Fiji / Q000453:epidemiology; D006204:Hair Removal / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011795:Surveys and Questionnaires; D014141:Trachoma / Q000453:epidemiology / Q000628:therapy; D058457:Trichiasis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult