Trichiasis is an acquired condition in which the eyelashes are misdirected posteriorly toward the conjunctiva and/or the cornea. When there is contact with the conjunctiva, it produces a foreign body sensation and can also produce pain and photophobia. In all cases, excessive tearing is very common and, hence, causes blurry vision. Chronic inflammatory diseases of the eyelids and/or the conjunctiva are the major etiologic reasons for trichiasis. This includes chronic cicatricial pemphigoid, erythema multiform, chemical injury, trachoma, chronic blepharitis, and chronic allergies. Trauma and surgical procedures that involve the lid margin are also major reasons for the development of trichiasis. Patients with severe chronic trichiasis are some of the most difficult patients to manage in ophthalmology.