Trichiasis and Distichiasis

Specialty: Ophthalmology.

• eyelashes diverted
• double row of eyelashes
• abnormal eyelash growth

Why it occurs

• Chronic blepharitis with recurrent inflammation of the eyelid hair follicles
• Sequela of chronic scarring conjunctivitis (Stevens-Johnson syndrome, scarring pemphigoid, conjunctival burns)
• Previous trauma or laceration of the free margin of the eyelid with abnormal healing
• Congenital distichiasis (growth of an abnormal row of eyelashes from the meibomian glands, autosomal dominant inheritance)
• Chronic ocular trachoma infection

Initial workup

Slit lamp examination with focused illumination and high magnification to identify whether the eyelashes arise from normal follicles (trichiasis) or from the openings of the meibomian glands (distichiasis); Corneal epithelial staining with sodium fluorescein eye drops; Corneal sensitivity test using the Cochet-Bonnet filament or a fine cotton swab to assess the trigeminal reflex arc.

Standard management

• Artificial tears in 0.2% Carbomer gel or 0.4% Sodium Hyaluronate — apply 4 to 6 times a day to create a viscoelastic mattress that mitigates the abrasive aggression of the eyelashes on the corneal epithelium
• Tobramycin in ophthalmic ointment (apply every 8-12 hours as a protective lubricant and bacterial preventative). The definitive eradication treatment consists of mechanical (temporary) hair removal, argon laser hair removal, follicle cryotherapy or electrolysis under local eyelid anesthesia.