Dear Editor,

We have read with keen interest the article on trachomatous trichiasis by Bowman et al. We fully endorse the authors' observations that Trachoma and its sequelae are on the decline even in developing countries as we are witnessing similar trends in south-east Asia,particlarly India. However,we would like to raise a few pertinent issues.

It is our considered opinion that self-epilation of trichiatic eyelashes should not be encouraged as it requires a considerable degree of patient education and training.In patients with compromised vision due to corneal opacities,prebyopes and those with poor training skills,it can prove to be a fairly risky proposition as the patient may inadvertantly damage vital stuctures such as the cornea and eyelid margin.

Secondly, even in cases which the authors have classified as minor forms of trichiasis,repeated epilation may not be a preferable option as the eyelashes which regrow after epilation are usually short with extremely sharp tips and carry a greater potential for corneal damage than the longer,unepilated eyelashes.Repeated epilation could lead to alteration in morphology of the sharp posterior lid margin,which is so crucial for tear film dynamics and lacrimal pump function.

Therefore,in our experience,we feel that patients with trichiasis,whether major or minor,should be subjected to a definitive procedure after the active trachomatous process has been controlled.This would entail surgical intervention if associated with a marked degree of entopion,or electrolysis if the trichiatic component alone is predominant.