Pattern of recurrence of trachomatous trichiasis after surgery: Surgical technique as an explanation

Objective: To evaluate the pattern of recurrence of trachomatous trichiasis (TT) after bilamellar tarsal rotation surgery for trachoma. Design: Observational cohort. Participants: Three hundred eighty-four participants having at least 1 eye that had undergone a single TT surgery a minimum of 18 months before June 2001. The 630 study eyes were divided equally between left (311) and right (319) eyes. Methods: Patients living in Central Tanzania were identified from surgical lists. Participants were screened for recurrence of TT, including evidence of epilation, after surgery. Main Outcome Measures: Detailed information on the location of recurrence was collected, including number of lashes touching the globe and location of trichiatic lashes (nasal, central, or temporal). Results: One hundred seventy-six eyes had evidence of TT recurrence (28%), including 23 eyes having recently undergone epilation. In eyes without epilation, left eyes had a higher rate of recurrence than right eyes (32% vs. 25%; P = 0.05). Among eyes with recurrence originating from 1 location, recurrence was highest centrally (40%). Right eyes had nasal recurrence more often than temporal recurrence (33% vs. 20%). Left eyes had temporal recurrence more often than nasal recurrence (41% vs. 24%). Conclusions: Recurrence of TT after surgery is more common in the left eye and on the left side of the eyelid. The surgical procedure is more difficult to perform on the right side of the eyelid by a right-handed surgeon. This difficulty may lead to an unintentional change in surgical technique on the right, which may result in lower recurrence on that side.