Eyelashes usually grow outwards and away from the eye and help to protect it. However, in some cases the eyelashes grow inwards and this can be a painful problem, which left untreated, could lead to scarring of the cornea in the worst cases.
In European countries, including the UK, the commonest cause is blepharitis (eyelid inflammation) which leads to the inturning of what were originally normally growing eyelashes. There are other causes, with Trachoma being the commonest cause in Sub- Saharan Africa. This eye infection causes scarring of the eyelid which then causes the edge of the eyelid and eyelashes to turn inwards.
Less commonly in the UK, the in growing eyelashes are abnormal eyelashes which grow vertically from the very back edge of the eyelid and point inwards. The normal position of eyelashes is at the front of the eyelid, with the eyelashes pointing forwards.
The simplest treatment of ingrowing eyelashes is to pluck them out. This can be straight forward if there are only one or two and they are easily seen. However, there can often be several eye lashes growing inwards and they may be very short, fine lashes which are difficult to see.
The options for more permanent treatment include using electrolysis or laser treatment to try to destroy the root of the eyelash directly. Each eyelash is treated individually and so if there are only a few, this can work well. However, if there are several in growing lashes this can take a long time. Local anaesthetic is often used to numb the eyelid before treatment.
If larger areas need to be treated, then the options are cryotherapy or surgery. With cryotherapy, the tip of a probe (which looks like a pencil) is placed on the eyelid where the in growing lashes are situated. Liquid nitrogen then passes into the tip to make it very cold, and this freezes the area of skin around the probe. The probe is then removed and the skin is left to slowly warm up. As eyelash follicles are more sensitive to the cold than normal skin cells, the eyelash will not grow again once adequately frozen, but the skin will return to normal. Larger areas are treated with surgery, where the edge of the eyelid is turned outwards and encouraged to stay in a better position with temporary stitches. Both cryotherapy and surgery require local anaesthetic, with sedation if necessary.
With any of these treatments there is always the issue that they may need to be repeated. This is in part due to the tough nature of eyelashes, which can be persistent despite treatment, and the fact that the eyelashes will be at different stages in their growth cycle. As some lashes are treated, there may be more growing through, which then need to be treated as well.
If a local anaesthetic has been used then the eyelid may be a little bruised after the treatment. There is usually more bruising and swelling associated with cryotherapy treatment or if lid surgery has been performed. Antibiotic drops or ointment are usually prescribed after these treatments and the eye may be padded if significant bruising is expected.
It is important to be seen in the clinic after treatment to see if any new lashes are growing through, with the potential to cause irritation.