Trichiasis Epilation Procedure Note

Header Block

Date/Time of Procedure: [Date and time]

Patient: [Name, MRN, DOB]

Proceduralist: [Name, credentials]

Location: [Clinic/Office / ED / Bedside]

Procedure Summary

Procedure: Epilation of trichiatic/misdirected eyelashes

Eye(s): [OD / OS / OU]

Eyelid(s): [RUL / RLL / LUL / LLL] (List all lids involved)

Pre-Procedure Diagnosis: Trichiasis [with associated condition if applicable, e.g., entropion, blepharitis, cicatricial disease]

Post-Procedure Diagnosis: [Same as pre-procedure / Updated diagnosis if new findings]

Indication: [1–2 line description of symptoms and/or ocular surface compromise prompting epilation]

Method: [Forceps/mechanical epilation / Electrolysis / Radiofrequency / Cryotherapy / Laser]

Chief Symptoms

[Patient-reported symptoms such as foreign body sensation, tearing, photophobia, redness, pain; include functional impact if relevant] (If symptoms were not elicited, state that explicitly. Include a direct patient quote only if it clarifies severity.)

Pre-Procedure Examination / Lash Mapping

(Document objective findings and lash locations for each offending cluster. Do not imply assessments that were not performed.)

• [Eye: OD/OS] [Eyelid: RUL/RLL/LUL/LLL] [Segment: medial/central/lateral]: [Number] lash(es) contacting [cornea / conjunctiva]; [Lash characteristics: thick/stiff/fine, broken cilia, distichiasis, entropion, scarring]; [Ocular surface status if assessed: corneal/conjunctival staining, epithelial changes, injection]
• [Additional eyelid/segment as applicable]

Consent

Consent obtained from [patient / legal representative]. Discussion included the nature of the procedure (temporary lash removal), material risks (discomfort, bleeding, infection, corneal abrasion, incomplete relief, recurrence/need for repeat), and alternatives (observation/lubrication, bandage contact lens, definitive treatments such as electrolysis, cryotherapy, laser, or surgical correction if lid malposition). Questions were answered and the patient agreed to proceed. (If consent not obtained, document reason and applicable policy/urgency context.)

Time-Out Verification

• Patient identity verified
• Procedure confirmed
• Correct eye and eyelid(s) confirmed
• Time-out performed immediately prior to procedure
• [Site marking not required per policy for this procedure / Site marked per policy]

Anesthesia

[Topical: agent and concentration / Local infiltrative: agent, volume, location / None]

Procedure Technique

[Positioning and visualization method] used for [Eye(s): OD/OS/OU]. Using [instrument, e.g., jeweler's forceps, cilia forceps], the offending lash(es) on the [Eyelid(s): RUL/RLL/LUL/LLL, segment] were isolated, grasped at the base, and removed with steady traction. Complete removal was confirmed. [Adjunct steps if performed: fluorescein staining, lubrication, antibiotic ointment application, bandage contact lens placement] (Do not include steps not performed.)

Lashes removed per lid:

• [Eye: OD/OS] [Eyelid: RUL/RLL/LUL/LLL]: [Number] lash(es) removed
• [Additional treated lid as applicable]

Outcome

Tolerance: [Tolerated well / Tolerated with difficulty: specify]

Complications: [None observed / Specify: corneal abrasion, bleeding, vasovagal episode, incomplete removal, broken lash remaining] (Always document explicitly; do not leave blank.)

Post-Procedure Exam: [No lash–globe contact confirmed; ocular surface status if reassessed] (Only document what was assessed.)

Post-Procedure Plan

Medications/Care: [Lubricating drops/ointment: specify prescribed vs OTC; Antibiotic drops/ointment if indicated: agent, frequency, duration; Bandage contact lens precautions and removal plan if placed] (Include only what was actually ordered or recommended.)

Counseling: Epilation provides temporary relief; lashes commonly regrow within weeks. [If applicable: discussed definitive options such as electrolysis, radiofrequency, cryotherapy, laser ablation, or lid surgery for frequent recurrence, multiple lashes, scarring, or lid malposition.] Return precautions reviewed: worsening pain, redness, discharge, decreased vision, persistent foreign body sensation, or photophobia.

Follow-Up: [Timeframe or PRN with triggers, and follow-up service] (If not arranged, document why.)