Eyelash Epilation in the Absence of Trichiasis: Results of a Population-Based Prevalence Survey in the Western Division of Fiji

Abstract

BackgroundThe WHO definition of trachomatous trichiasis (TT) is “at least one eyelash touching the globe, or evidence of recent epilation of in-turned eyelashes”, reflecting the fact that epilation is used as a self-management tool for TT. In Fiji’s Western Division, a high TT prevalence (8.7% in those aged ≥15 years) was reported in a 2012 survey, yet a 2013 survey found no TT and Fijian ophthalmologists rarely see TT cases. Local anecdote suggests that eyelash epilation is a common behaviour, even in the absence of trichiasis. Epilators may have been identified as TT cases in previous surveys.MethodsWe used a preliminary focus group to design an interview questionnaire, and subsequently conducted a population-based prevalence survey to estimate the prevalence of epilation in the absence of trichiasis, and factors associated with this behaviour, in the Western Division of Fiji.ResultsWe sampled 695 individuals aged ≥15 years from a total of 457 households in 23 villages. 125 participants (18%) reported epilating their eyelashes at least once within the past year. Photographs were obtained of the eyes of 121/125 (97%) individuals who epilated, and subsequent analysis by an experienced trachoma grader found no cases of trachomatous conjunctival scarring or trichiasis. The age- and sex- adjusted prevalence of epilation in those aged ≥15 years was 8.6% (95% CI 5.7–11.3%). iTaukei ethnicity, female gender, and a higher frequency of drinking kava root were independently associated with epilation.ConclusionEpilation occurs in this population in the absence of trichiasis, with sufficient frequency to have markedly inflated previous estimates of local TT prevalence. Individuals with epilated eyelashes should be confirmed as having epilated in-turned eyelashes in an eye with scarring of the conjunctiva before being counted as cases of TT.

Serology reflects a decline in the prevalence of trachoma in two regions of The Gambia

“…Using a serological tool we showed that 53/66 (80%) of the cases of TF that we observed were in people who were serologically negative for prior Ct infection 10 . Clinical signs of trachoma were also a poor indicator for the need to deploy antimicrobials in Fiji, where the high prevalence of TT cases could be better explained by socio-epidemiological practices of eyelash depilation than by Ct infections 11 . The current WHO guidelines would recommend MDA in both Fiji and the Solomon Islands, but the evidence from more detailed surveys makes an argument against the likelihood that the use of antimicrobials would be effective.…”

A systematic review of historical and contemporary evidence of trachoma endemicity in the Pacific Islands

“…It was subsequently shown that a common sociocultural practice of eyelash epilation was prevalent in the Western Division of Fiji. A 2017 study [ 56 ] demonstrated that many Fijians who epilated (and who would have been classified as TT cases) in fact had no signs of scarring or entropion and were unlikely to be self-treating for the condition.…”

The simplified trachoma grading system, amended

“…This definition implies that all epilated eyelashes were in-turned, although data suggest that field graders may have difficulty determining whether or not an epilated eyelash was in-turned before it was pulled out. 38 The meaning of “recent” within this context has never been defined, but has been interpreted by users of the system as the appearance of broken eyelashes or empty eyelash follicles.…”