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Trichiasis refers to the condition where eyelashes turn inward, irritating the eyeball, causing pain, tearing, and photophobia, gradually leading to the formation of a nebula membrane.

This condition Yinhai Jingwei calls "trichiasis" Yuanji Qiwei refers to as "the disease of internal urgency and external relaxation"; Puji Fang calls it "inverted eyelashes and spasm"; Shenshi Yaohan , Yixue Gangmu both refer to it as "trichiasis"; "Chinese Medicine Clinical Essentials" calls it "inverted eyelashes". Additionally, there are names like "curled hair inverted waving". Nowadays, it is commonly referred to as "inverted eyelashes".

Inverted eyelashes are often complications of eye diseases such as "eyelid foxtail millet" and "red ulceration of the palpebral margin (marginal blepharitis)" in their late stages [third stage], so when differentiating pattern and treating, other eye diseases must also be considered.

bubble_chart Pattern Analysis

1. Internal Accumulation of Wind-heat︰The main clinical manifestations include red, irritated, and itchy eyes, photophobia, excessive tearing, swollen and tense eyelids, inverted eyelashes, inward pricking of the eyeball, stinging pain and tearing, and frequent blinking. The tongue is red, and the pulse is rapid. It is mostly caused by prolonged accumulation of wind-heat in the zang-fu organs, which internally scorches the liver and spleen and rises to the eyes. The Yizong Jinjian．Yanke Xinfa Yaojue states: "The condition of trichiasis arises from loose skin and tight eyelid margins, hence the trichiasis, inward pricking of the eyeball, gritty discomfort and difficulty in opening the eyes, red and ulcerated eyelids, itching accompanied by pain. This is due to spleen heat and liver wind, combined pathogens rising and congesting." The distinguishing features are the onset due to wind-heat, accompanied by inverted eyelashes, redness, swelling, itching, pain, and tearing. Treatment should focus on dispersing wind and dissipating heat, with the prescription of Asarum Decoction.
2. Lung-spleen Qi Deficiency︰It manifests as slight itching of the eyelids, varying in intensity, with one or several eyelashes curling inward. In severe cases, the skin becomes lax and the eyelid margin tightens, causing most of the eyelashes to turn inward, irritating the pupil, resulting in stabbing pain, tearing, and photophobia with difficulty opening the eyes. The body is weak, lacking strength, and deficient in qi, with a pale tongue and weak pulse. It is often caused by spleen and lung qi deficiency, where qi and blood are insufficient to nourish the eyelids, leading to lax skin and tightened margins, internal tension and external slackness, resulting in this condition. *The Guide to the Silver Sea: Diseases of the Spleen Meridian* states: "Laxity of the upper eyelid with trichiasis, redness, and pain is due to lung qi deficiency with wind involvement; without redness or pain, it is due to sinking of middle qi." The key diagnostic feature of this syndrome, caused by spleen and lung qi deficiency, is the absence of significant redness, swelling, itching, or pain from the inward-turning eyelashes, accompanied by general weakness and qi deficiency. Treatment should focus on replenishing lung and spleen qi, using the Tonify the Middle and Support Yang Decoction.

In addition, if the condition is severe, or caused by scar contraction from prickly-ash-like sore (trachoma) or millet sore (conjunctival folliculitis), or by red ulceration of the palpebral margin (marginal blepharitis) leading to misdirected eyelash growth, and if medication proves ineffective, surgical treatment may be considered.

bubble_chart Documentation

1. Shenshi Yaohan．Spleen Disease: This condition arises from eye diseases mistakenly referred to as "fire eyes," which are not taken seriously. Whether due to alcohol, desire, exposure to wind and frost, or hard labor, without proper precautions, one becomes susceptible to wind pathogens. The skin becomes loose, the eyelid margins tighten, and eyelashes gradually turn inward, inevitably leading to frequent tearing. Constant wiping results in photophobia, and as the eyelashes encroach upon the eye, they scatter cloudy nebula. Treating this with medication is extremely difficult, and as a last resort, a clamping method is used. Once clamped, the focus is on applying medicinal ointments. When the clamp is about to fall off, the scar is immediately treated to ensure preservation. Otherwise, the condition will revert to its original state, rendering the effort futile.