Dr Ben Wild
Overview |
Trichiasis and distichiasis are two conditions that result in eyelashes being directed into the eye and causing discomfort.
Front view of healthy eyelashes.
Trichiasis occurs when the normal eyelashes, which are located on the outside of the eyelid margin, curl inwards towards the eye instead of curling outwards away from the eye. These lashes can scratch the cornea and/or conjunctiva and cause ocular irritation. This can be noticed at birth but is usually acquired.
Frontal view of an eye with trichiasis, eyelashes being misdirected towards the eye on both eyelids.
Distichiasis occurs when a second row of eyelashes, which are usually much smaller and thinner, grow much closer to the eye right on top of the eyelid margins. They often become misdirected and curl towards the eye. It can present as a full or partial second row of lashes and can be seen right at birth or can be acquired. When seen at birth, distichiasis usually is seen as an entire 2nd row of lashes but usually does not become irritating until around 5 years old. Acquired distichiasis is usually seen as only a few extra slow growing lashes, however, are usually more symptomatic.
Frontal view of an eye with distichiasis, a second row of lashes on both eyelids.
Signs and Symptoms |
Signs
Trichiasis | Normal lashes misdirected inwards towards the eye. |
Distichiasis | A full or partial second row of eyelashes closer to the eye misdirected towards the eye. |
Both | Red eyes, corneal abrasions, mucous discharge, fibrovascular tissue growing over cornea, ulceration of the eye. |
Symptoms
Both: Irritation worse when blinking.
Causes and Risk Factors |
Both: Inflammation from blepharitis, shingles, trauma, eyelid surgery, thermal/chemical burns, Stevens-Johnson syndrome, ocular cicatricial pemphigoid and more auto-immune related skin conditions.
Prevention and Treatment |
Prevention
Control inflammation.
Treatments
· Epilation (tweezing lashes every 1-2 months).
· Electrolysis of the lash follicle.
· Laser ablation of the lash follicle.
· Cryotherapy of the lash follicle.
Prognosis |
Epilation is the easy fix, but more often than not, the lashes regrow. Electrolysis, laser hair removal or cryotherapy usually are more permanent solutions. If this condition is treated properly, there should be no permanent vision loss.