treatment plan

Incorporating Electroepilation Into Your Practice

BY WILLIAM D. TOWNSEND, OD
OCTOBER 1999

Electroepilation is a useful procedure for treating mild to moderate cases of trichiasis, which increase in number as the population ages. Due to the aging population and the fact that very few other providers are performing electroepilation, my office's utilization of this procedure is increasing dramatically.

Most providers find it easier to have their patients come in every 6 weeks for conventional epilation, but by the time many of these patients actually make it to my office, they have significant keratitis caused by rubbing their lashes or they have become infected from epithelial breaks caused by trichiasis.

The Unit of Choice

The Perma Tweez (General Medical Company) is the unit of choice in our office. It's easy to use, simple in design, cost efficient and very effective at permanently destroying lash follicles.

The Perma Tweez consists of an electrode and a main unit, which contains a 9-volt battery and a very fine wire probe on a spring-loaded shaft.

It's connected by a wire to an electrode which, when placed in the patient's hand, completes the circuit.

Electrical current flows through the probe, into the follicle and through the body to the electrode then back to the unit. While one probe is being used, an extra one can be sterilized. A suitable topical anesthetic, such as lidocaine, cotton-tipped applicators, saline and a hypertonic solution or ointment are also needed to perform the procedure.

Preparing for the Procedure

First, educate the patient about the procedure and tell him that he may experience some discomfort. You may even want to have him sign a consent form.

Then, using a cotton-tipped applicator, apply lidocaine to the lid margin to minimize undue discomfort. In rare situations, an injectable anesthetic may be necessary to reduce discomfort.

Next, clean the lid surface around the lashes that are to be removed with a product such as Ocusoft Lid Scrub (Ocusoft, Inc.). This does not eradicate, but rather reduces the number of bacteria on the lid surface, thereby minimizing the likelihood of secondary infection.

Seat the patient at the slit lamp and while viewing them at low or medium magnification, have them blink in a natural manner. This affords you the opportunity to identify the lashes that rub against the eye and mark them with a nonpermanent marker.

Performing the Procedure

Have an assistant hold the electrode while you gently slide the probe down the lash follicle along the lash until it contacts the bottom of the follicle, at which point, the probe will automatically retract. Keep the probe in the follicle for 20 seconds while the patient holds the electrode. Within a few seconds, you should see small bubbles coming out of the follicle.

If you can remove the lash with little or no resistance, the procedure was successful. If the lash resists removal, re-treat.

If within 5 seconds of the patient holding the electrode, you do not see any bubbles, you either have a weak or dead battery, have failed to insert the probe to the bottom of the follicle or do not have a good electrical connection.

If a patient has dry hands, it may be necessary to moisten their palm with an electrolyte such as saline. In some cases, good electrical contact requires a stronger electrolyte such as Muro 128 (5% ointment) or EKG gel.

Incorporating electroepilation into your armamentarium can be both rewarding for your patients and a good source of income for your practice.

Dr. Townsend is in private practice in Canyon, Texas, and is a consultant at the Amarillo VA Medical Center. (drbill@1s.net)