CONJUNCTIVALIZATION OF LID SKIN FOLLOWING CRYOTHERAPY FOR TRICHIASIS

Cryotherapy is a useful tool in the management of eyelid disorders suc h as trichiasis, distichiasis and cutaneous malignant diseases. The ra pid freeze-thaw cycles cause ischemic necrosis of tissue, selectively destroying cells such as lash follicles and melanocytes. Large blood v essels, nerves, tarsus and the lacrimal system are relatively cryoresi stant.(1,2) Because malignant cells are relatively more cryosensitive than surrounding eyelid tissue, cryotherapy has been advocated for the treatment of cutaneous malignant disorders such as basal cell carcino ma.(3-6) But many ophthalmic surgeons feel that lesions involving the ocular adnexal structures need to be excised using frozen section cont rol since the consequences of inadequate tumour management can he deva stating.(7,8) Trichiasis and distichiasis, whether congenital or acqui red, are a challenge to manage because of the cosmetic and functional consequences involved with any eyelid procedure. Epilation, electrolys is, radiotherapy, lid resection and cryosurgery are all available to t he ophthalmic surgeons, with varying degrees of success and complicati ons.(9,10) Aggressive lubrication is a reasonable primary manoeuvre an d can be supplemented by epilation. More severe cases usually require cryotherapy if the problem is diffuse, or lid resection if it is well localized. Destruction of the lash follicle is the ultimate goal. The success rare of cryotherapy in the treatment of trichiasis is as high as 90%, with a complication rate between 10% and 20%.(8,9,11). The mos t frequent complications include lid edema, hypopigmentation, pseudoep itheliomatous hyperplasia, pain and lid scarring. Less common problems include reactivation of herpes zoster, corneal damage and xerosis. Pa tients with conjunctival shrinkage disorders, such as ocular cicatrici al pemphigoid, present a unique challenge because they often require t reatment for trichiasis, yet cryotherapy tends to be associated with m any more complications in this group. Wood and Anderson(8) advise caut ion when treating these patients as the therapy can exacerbate the con junctival shrinkage. Caution should also be exercised when treating pa tients who have had previous radiotherapy or extensive lid reconstruct ion, especially if they are receiving chemotherapy at the time of trea tment.(12) We describe a previously unreported complication of cryothe rapy.