Upper eyelid entropion and dry eye in cicatricial trachoma without trichiasis

Purpose: to evaluate the position of the upper eyelid margin and eye surfacestatusin cicatricial trachoma without trichiasis (TS).Methods: Slit-lamp biomicroscopy was employed to evaluate the location of theupper lid mucocutaneous transition of 156 eyes of 78 patients with trichiasis and of130 eyes of 65 control subjects. For each eye the position of the upper lid mucocutaneousjunction was graded with respect to the line of meibomian gland orifices into3 categories: a) anterior, b) at the line, and c) posterior to the line. Ocular surface dyestaining with lissamine green was performed in all eyes. All participants answereda questionnaire with queries on the presence and intensity of dry eye symptoms. Results: In the eyes with trichiasis the location of the mucocutaneous transitionwas posterior to the meibomian gland line in 55 (35.3%), at the line in 77 (49.4%)and anterior to the line in only 24 (15.4%). In the control group these figures were:5 (3.8%); 42 (42%) and 83 (63.8%). Lissamine staining and dry eye symptoms werealso associated with trichiasis. Conclusion: Different degrees of upper lid entropion are already present in cicatricialtrachoma even in the absence of trichiasis. Trichiasis is associated withlissamine green staining and dry eye symptoms. Conjunctivalization of the upperlid margin may play a role in the development of trachomatous dry eye.