Sections
Distichiasis
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Sections Distichiasis
- Overview
- Background
- Pathophysiology
- Epidemiology
- Prognosis
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- Presentation
- History
- Physical
- Causes
- Complications
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- DDx
- Workup
- Treatment
- Medical Care
- Surgical Care
- Consultations
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- Medication
- Medication Summary
- Ophthalmic lubricants
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- Media Gallery
- References
Overview
Background
Distichiasis is a rare disorder defined as the abnormal growth of lashes from the orifices of the meibomian glands on the posterior lamella of the tarsal plate. [1]
This picture demonstrates distichiasis of the lower lid. From Principles and Practice of Ophthalmology by Jakobiec.
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The term distichiasis is derived from "distrix," describing the splitting of the ends of hairs, originating from the Greek words dis (two) and thrix (hair). [1]
Two types of distichiasis can be identified, acquired and congenital. In the acquired form, most cases involve the lower lids. Lashes can be fully formed or very fine, pigmented or nonpigmented, properly oriented or misdirected. The congenital form often is dominantly inherited with complete penetrance. It can be isolated or associated with ptosis, strabismus, congenital heart defect, or mandibulofacial dysostosis. This defect may be related to the failure of epithelial germ cells to differentiate completely to meibomian glands; instead they become pilosebaceous units. [1]
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Pathophysiology
Distichiasis can affect the lower and upper lids (see following images). When these abnormal lashes come in contact with the cornea, they may cause severe irritation, epiphora, corneal abrasion, or even corneal ulcers.
This picture demonstrates distichiasis of the lower lid. From Principles and Practice of Ophthalmology by Jakobiec.
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This picture demonstrates distichiasis of the upper lid. From Ophthalmic Plastic Surgery: Prevention and Management of Complications by Dortzbach.
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Epidemiology
Frequency
United States
Distichiasis is a rare disorder.
Race
Distichiasis has been seen in all ethnic backgrounds.
Sex
This condition shows no sex discrimination.
Age
Distichiasis has been seen in all ages.
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Prognosis
Fine lashes are usually well tolerated, but thicker eyelashes can threaten the integrity of the corneal epithelium.
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Clinical Presentation
References
Singh S. Distichiasis: An update on etiology, treatment and outcomes. Indian J Ophthalmol. 2022 Apr. 70 (4):1100-1106. [QxMD MEDLINE Link].
Traboulsi EI, Al-Khayer K, Matsumoto M, Kimak MA, Crowe S, Wilson SE, et al. Lymphedema-distichiasis syndrome and FOXC2 gene mutation. Am J Ophthalmol. 2002 Oct. 134 (4):592-6. [QxMD MEDLINE Link].
Allen RC. Genetic diseases affecting the eyelids: what should a clinician know?. Curr Opin Ophthalmol. 2013 Sep. 24(5):463-77. [QxMD MEDLINE Link].
Butler MG, Dagenais SL, Garcia-Perez JL, Brouillard P, Vikkula M, Strouse P, et al. Microcephaly, intellectual impairment, bilateral vesicoureteral reflux, distichiasis, and glomuvenous malformations associated with a 16q24.3 contiguous gene deletion and a Glomulin mutation. Am J Med Genet A. 2012 Apr. 158A(4):839-49. [QxMD MEDLINE Link]. [Full Text].
Alkatan HM, Galindo-Ferreiro A, Maktabi A, Galvez-Ruiz A, Schellini S. Congenital distichiasis: Histopathological report of 3 cases. Saudi J Ophthalmol. 2017 Jul-Sep. 31 (3):165-168. [QxMD MEDLINE Link].
Moosavi AH, Mollan SP, Berry-Brincat A, et al. Simple surgery for severe trichiasis. Ophthal Plast Reconstr Surg. 2007 Jul-Aug. 23(4):296-7. [QxMD MEDLINE Link].
Pham RT. Treat of trichiasis using 810 nm diode laser: an efficacy study. Paper presented at: Annual Meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery; New Orleans, La. October 22-23, 2004.
McCracken MS, Kikkawa DO, Vasani SN. Treatment of trichiasis and distichiasis by eyelash trephination. Ophthal Plast Reconstr Surg. 2006 Sep-Oct. 22(5):349-51. [QxMD MEDLINE Link].
Anderson RL. Surgical repair for distichiasis. Arch Ophthalmol. 1977 Jan. 95(1):169. [QxMD MEDLINE Link].
Bosniak S. Principles and Practice of Ophthalmic Plastic and Reconstructive Surgery. WB Saunders Co; 1996. Vol 1: 409.
Dortzbach RK. Ophthalmic Plastic Surgery: Prevention and Management of Complications. Lippincott-Raven Publishers; 1994. 42-8.
Fein W. Surgical repair for distichiasis, trichiasis, and entropion. Arch Ophthalmol. 1976 May. 94(5):809-10. [QxMD MEDLINE Link].
Hill JC. Trichiasis and distichiasis. Can J Ophthalmol. 1976 Oct. 11(4):353-4. [QxMD MEDLINE Link].
Pham RT, Biesman BS, Silkiss RZ. Treatment of trichiasis using an 810-nm diode laser: an efficacy study. Ophthal Plast Reconstr Surg. 2006 Nov-Dec. 22(6):445-7. [QxMD MEDLINE Link].
Scheie HG, Albert DM. Distichiasis and trichiasis: origin and management. Am J Ophthalmol. 1966 Apr. 61(4):718-20. [QxMD MEDLINE Link].
Media Gallery
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This picture demonstrates distichiasis of the lower lid. From Principles and Practice of Ophthalmology by Jakobiec.
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This picture demonstrates distichiasis of the upper lid. From Ophthalmic Plastic Surgery: Prevention and Management of Complications by Dortzbach.
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This picture demonstrates the cryotherapy of the lower lid with distichiasis. From Ophthalmic Plastic Surgery: Prevention and Management of Complications by Dortzbach.
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Contributor Information and Disclosures
Author
Jitander Dudee, MD, MA(Cantab), FACS, FRCOphth Ophthalmologist, Medical Vision Institute, PSC
Jitander Dudee, MD, MA(Cantab), FACS, FRCOphth is a member of the following medical societies: American Academy of Ophthalmology, Kentucky Medical Association, Royal College of Ophthalmologists
Disclosure: Nothing to disclose.
Specialty Editor Board
Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society
Disclosure: Nothing to disclose.
Chief Editor
Hampton Roy, Sr, MD † Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.
Additional Contributors
Soheila Rostami, MD, FAACC Director, Rostami Ophthalmic Plastic Consultants
Soheila Rostami, MD, FAACC is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association
Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Eclipse, Galderma, Mertz.
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