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Intervention Review

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Interventions for trachoma trichiasis

  1. David Yorston1,*,
  2. Denise Mabey2,
  3. Sarah R Hatt3,
  4. Matthew Burton4

Editorial Group: Cochrane Eyes and Vision Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 7 NOV 2006

DOI: 10.1002/14651858.CD004008.pub2

How to Cite

Yorston D, Mabey D, Hatt SR, Burton M. Interventions for trachoma trichiasis. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004008. DOI: 10.1002/14651858.CD004008.pub2.

Author Information

  1. 1

    Gartnavel Hospital, Tennent Institute of Ophthalmology, Glasgow, UK

  2. 2

    St. Thomas' Hospital, South Wing Eye Department, London, UK

  3. 3

    Mayo Clinic, Ophthalmology Research, Rochester, USA

  4. 4

    London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK

*David Yorston, Tennent Institute of Ophthalmology, Gartnavel Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006


This is not the most recent version of the article. View current version (13 NOV 2015)



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要


Trachoma is a leading cause of avoidable blindness. The World Health Organization recommends eliminating trachoma blindness by the SAFE strategy incorporating Surgery, Antibiotic treatment, Facial cleanliness and Environmental hygiene.


This review examined the evidence for the effectiveness of different interventions for trachoma trichiasis.

Search methods

We identified trials from the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2005, Issue 3), MEDLINE (1966 to September 2005), EMBASE (1980 to September 2005), PubMed (searched on 21-09-06; last 90 days), LILACS (March 2004) and the reference lists of included studies. We also contacted authors for details of other relevant studies.

Selection criteria

We included randomised trials of any intervention intended to treat trachoma trichiasis and trials comparing different methods of delivering the same intervention.

Data collection and analysis

Two review authors independently assessed trials. We contacted trial authors for missing data when necessary.

Main results

Seven studies met the inclusion criteria. Three studies compared different surgical interventions. These trials suggest the most effective surgery is full-thickness incision of the tarsal plate and rotation of the terminal tarsal strip 180 degrees. One study showed that bilamellar rotation was more effective than unilamellar rotation but the other two studies did not. One trial found double-sided sticking plaster more effective than epilation for the immediate management of trichiasis but required frequent replacement (odds ratio (OR) 0.01, 95% confidence interval (CI) 0.00 to 0.22). Another trial found community-based surgery increased convenience for patients without increasing the risk of complications or recurrence when compared to health centres. One trial found no difference between trichiasis surgery performed by ophthalmologists and integrated eye workers (OR 1.32, 95% CI 0.83 to 2.11). A trial comparing trichiasis surgery with and without concurrent administration of azithromycin found no difference in success rates at one year (OR 0.99, 95% CI 0.67 to 1.46).

Authors' conclusions

No trials show interventions for trichiasis prevent blindness. Certain interventions have been shown to be more effective at eliminating trichiasis. Full thickness incision of the tarsal plate and rotation of the lash-bearing lid margin through 180 degrees is probably the best technique and is preferably delivered in the community. The use of double-sided sticking plaster is more effective than epilation as a temporary measure. Surgery may be carried out by an ophthalmologist or a trained ophthalmic assistant. The addition of azithromycin treatment at the time of surgery does not appear to improve outcomes.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for trachoma trichiasis, in-turning of the upper eye lashes caused by a chronic infectious inflammation of the conjunctiva of the eye that can lead to blindness

Trachoma is a form of chronic inflammation of the transparent mucous membrane that lines the eyelids and covers the white of the eye (conjunctiva). It is a bacterial infection caused by Chlamydia trachomatis that is associated with poverty and is most prevalent in hot dry areas. Repeated infections cause scarring of the conjunctiva of the upper eyelid, which causes the eyelid to turn in (entropion) so that the eyelashes touch the cornea at the front of the eye. This is known as trachoma trichiasis. Every movement of the eye or eyelids causes trauma to the corneal surface so that it eventually turns opaque and the person becomes blind. Improved facial cleanliness and environmental hygiene may reduce the spread of trachoma. Antibiotic treatment may also be useful but surgery to correct the eye lid deformity is the only treatment that is likely to be helpful in the late stages of the disease. The review authors searched the medical literature and identified seven randomised controlled studies (2331 participants) investigating surgical and non-surgical treatments as a way of reducing the recurrence of trichiasis. Three studies compared different surgical interventions. These trials suggested that the most effective surgery requires full-thickness incision and rotation of the edge of the eyelid. Community-based surgery was more convenient for patients by reducing the time and expense of travelling to a conventional hospital and it did not increase the risk of complications or recurrence. Surgery performed by ophthalmologists and by integrated eye workers were both similarly effective. The addition of azithromycin treatment at the time of surgery did not reduce the recurrence of trichiasis in a single study (426 participants). Non-surgical methods included removing the eye lashes (epilation) using electrolysis or cryotherapy and taping the eyelid back. One trial found that the use of double-sided sticking plaster was more effective than removing the eye lashes as a temporary measure but the tape had to be replaced weekly. Destroying the lashes appeared to have low success rates and the equipment required is costly and can be difficult to maintain. The included studies were carried out in China, Gambia, Ethiopia and Oman.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要


砂眼倒睫(trachoma trichiasis)的介入措施





我們從Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (2005年,第3期),MEDLINE (1966至2005年9月) PubMed (於2006年9月21日檢索;持續90天),EMBASE (1980至2005年9月),LILACS (2004年3月)及納入研究的參考文獻確定相關試驗。我們也連絡作者以了解其他相關研究的詳細資料。






7篇研究符合納入標準。3篇研究比較不同手術的介入措施。這些試驗認為最有效的手術是全層切開眼瞼板並180度翻轉眼瞼板末端。一篇研究顯示雙層翻轉比單層翻轉有效,但其他兩篇研究無此發現。一篇試驗發現雙面膠布對即時處理倒睫比清除睫毛有效,但需要經常更換膠布(odds ratio (OR)為0.01,95% confidence interval (CI)為0.00至0.22)。另一篇研究發現相較於健康中心,以社區為基礎的手術可增加病患的便利性同時不會增加併發症或復發的風險。一篇試驗發現由眼科醫師與眼科工作者施行的倒睫手術沒有差異(OR為1.32,95% CI為0.83至2.11)。一篇試驗比較倒睫手術同時給予azithromycin與否,其一年內的成功率沒有差異(OR為0.99,95% CI為0.67至1.46)。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


砂眼倒睫的介入措施,由於眼結膜的慢性感染發炎造成上眼睫毛的內轉而導致失明。砂眼是透明黏膜的慢性發炎,其位於眼瞼並覆蓋於白眼球(結膜)上。它是經由沙眼衣原體(Chlamydia trachomatis)的細菌感染,與貧窮有關且是乾燥地區最盛行的疾病。重複感染造成的上眼瞼結膜結痂會導致眼瞼內翻(entropion),以致於睫毛接觸眼睛前面的角膜。這就是所謂的砂眼倒睫。每次眼睛或眼瞼的移動會造成角膜表面受傷,以致於角膜最後轉變為不透明狀而造成失明。促進臉部清潔與環境衛生也許可以減少砂眼的傳播。抗生素治療也許是有用的,但手術矯正眼瞼畸形是唯一的治療方式,它對於疾病晚期可能是有助益的。回顧的作者檢索醫療文獻並確定了7篇隨機對照研究(2331名研究對象)研究手術及非手術治療作為減少倒睫復發的方式。3篇研究比較不同的手術介入措施。這些試驗認為最有效的手術需要全層切口並翻轉眼瞼的邊緣。以社區為基礎的手術對於病人來說是較便利的,藉由減少時間及到醫院的交通費用,且不會增加併發症或復發的風險。由眼科醫師及綜合的眼科工作者施行的手術兩者同樣有效。一篇研究顯示手術時增加azithromycin的治療不會減少倒睫的復發(426名研究對象)。非手術的方式包括使用電解或冷凍療法來清除眼睫毛(脫毛)並用膠布黏貼在眼瞼的背面。一篇試驗發現使用雙面膠布作為暫時性的步驟比清除眼睫毛有效,但膠布需要每週更換。破壞睫毛的方式的成功率較低且所需的設備成本較高,並難以持續。納入的研究是在中國大陸,甘比亞,衣索比亞及阿曼進行的。