Management of Trichiasis and Distichiasis
Nicole A. Langelier, MD, MBE
DISEASE DESCRIPTION
Definition (Figure 17.1)
Trichiasis — acquired misdirected lashes with normal eyelid position
Distichiasis — aberrant growth of lashes from the meibomian gland orifices or the posterior lamella. Can be congenital or acquired
Pseudotrichiasis — lashes are misdirected due to eyelid malposition (ie, entropion, epiblepharon). Managed by correcting the eyelid malposition
 FIGURE 17.1. Distichiasis secondary to Stevens-Johnson syndrome. A, Cicatrix of the upper eyelid palpebral and bulbar conjunctiva causing inward rotation of the otherwise normally positioned eyelashes. B, Cilia on the upper eyelid emerging from the meibomian gland orifices or posterior lamella. C, Pseudotrichiasis. This young boy has bilateral lower eyelid epiblepharon. Correction of the eyelid malposition results in correction of the misdirected lashes. |
Etiology
Idiopathic
Congenital
Trauma (laceration or burns)
Infectious (trachoma, herpetic)
Autoimmune (ocular cicatricial pemphigoid, Stevens-Johnson syndrome)
Inflammatory (chronic blepharitis, inflammation from prostaglandin analog products)
Inflammation often plays a role in the etiology and continued progression of trichiasis; controlling inflammation helps control the disease and may be essential in preventing recurrence of misdirected lashes, entropion, and symblepharon.
MANAGEMENT OPTIONS
Nonsurgical — treatment of eyelash malposition is mostly surgical. Nonsurgical treatment options are used for symptom management.
Topical lubrication (artificial tears, ophthalmic ointment)
Bandage contact lens
Stop any inciting medications (prostaglandin analog glaucoma drops and lash growth serums will promote lash growth).
Immunomodulatory therapy as needed for autoimmune mucosal disease
Surgical — discussed later in this chapter
Management of corneal disease from trichiasis/distichiasis:
Monitor cornea for and treat corneal epithelial defects.
Monitor cornea for and treat infectious corneal infiltrates.
Consider coordination of care with a cornea specialist in severe cases.
INDICATIONS FOR SURGERY
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