Oral abstract presentation times

Purpose

Eyelid margin assessment is essential for the differential diagnosis between trichiasis and entropion, particularly in cases classified by the WHO as trachomatous trichiasis (TT). This study aims to describe the clinical findings of the superior eyelid margin in an indigenous population with a history of TT who practice cultural eyelash epilation.

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Methods

This observational study was conducted following a nationwide survey that evaluated 3,247 adult indigenous individuals. After the survey, 38 subjects were selected for ophthalmologic reevaluation due to a small number of eyelashes touching the cornea.The ophthalmologic examination (using a 2× magnifying loupe) included assessment of the position of the mucocutaneous junction of the upper eyelid. It was classified into three categories according to its relationship with the meibomian gland line (MGL): 0 – conjunctiva anterior to the MGL; 1 – conjunctivalization up to the MGL; 2 – conjunctivalization beyond the MGL. The ocular surface was examined with fluorescein and cobalt blue light. All study procedures were approved by the institutional ethics committees.

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Results

Among the 38 cases initially identified as TT, 28 cases (56 eyes) had only metaplastic eyelashes touching the cornea, without any sign of upper eyelid entropion. The degree of eyelid margin conjunctivalization could be assessed in 43 eyes in this sample. In 26 eyes, the position of the mucocutaneous junction was normal (grade 0); in 13 eyes, there was a mild anterior displacement of the junction (grade 1); and in only 4 eyes was the conjunctivalization beyond the meibomian gland line (grade 2).

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Conclusion

Traditional eyelid margin assessment, which is based on the relationship between the eyelashes and the ocular surface, is not feasible in communities practicing cultural eyelash epilation. Therefore, the position of the mucocutaneous junction relative to the meibomian gland orifices becomes the key semiological parameter for identifying entropion.
In conclusion, metaplastic eyelash touching the cornea cannot be assumed to be a sign of TT in communities practicing cultural eyelash epitlation

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Additional Authors

First name	Last name	Base Hospital / Institution
Antonio Augusto	Velasco e Cruz	Hospital de Clínicas de Ribeirão Preto
Ricardo	Morschbacher	Hospital Banco de Olhos de Porto Alegre

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