Cryotherapy for trichiasis in ocular cicatricial pemphigoid

Area of Science:

• Ophthalmology
• Dermatology

Background:

• Trichiasis is a sight-threatening complication of ocular cicatricial pemphigoid, often resulting from cicatricial entropion.
• Effective management of trichiasis in this patient group is crucial for preserving vision.

Purpose of the Study:

• To evaluate the long-term success and complication rates of eyelid cryotherapy for trichiasis in patients with ocular cicatricial pemphigoid.
• To identify factors contributing to treatment failure.

Main Methods:

• A retrospective review of case records from Moorfields Eye Hospital (1980-1992) for patients with ocular cicatricial pemphigoid.
• Eyelid cryotherapy using an Amoilette cryoprobe, with each eyelid divided into three horizontal zones.
• Definition of failure as eyelash regrowth or keratopathy, and assessment of complications.

Main Results:

• Ninety-two lid zones in 25 eyelids of 12 patients were treated.
• Cumulative success rates declined from 40% at 1 year to 34% at 4 years.
• Complications included lid notching, tarsal atrophy, altered lid contour, and transiently elevated intraocular pressure. No increase in conjunctival disease activity was observed.

Conclusions:

• Eyelid cryotherapy for trichiasis in quiescent ocular cicatricial pemphigoid has an acceptable complication profile.
• The primary cause of trichiasis recurrence is inadequate freezing of eyelash follicles.
• Long-term success rates are limited, necessitating further investigation into alternative or adjunctive treatments.