Treatment of Trichiasis Following Modified Hughes Flap Surgery Using a Tarsoconjunctival Graft

Reconstruction of full-thickness lower eyelid defects remains challenging. The modified Hughes flap is a reliable technique with favorable outcomes, although complications such as entropion, ectropion, and trichiasis may occur. Trichiasis is particularly problematic due to its potential to cause ocular irritation and corneal damage, yet its management after Hughes flap surgery is scarcely addressed in the literature. The authors report a 75-year-old woman who developed trichiasis of the right lower eyelid after modified Hughes flap reconstruction for basal cell carcinoma. Six weeks after flap division, she presented with ocular irritation and foreign-body sensation. A tarsoconjunctival graft harvested from the contralateral upper eyelid was implanted after excision of the affected segment. The donor site healed without complication. Postoperative follow-up showed complete symptom resolution and restoration of eyelid anatomy, with no recurrence at 3 months. This seems to be the first reported case of trichiasis after Hughes flap successfully treated with a tarsoconjunctival graft.