eMedicine Specialties > Ophthalmology > Lid

Distichiasis

Author: Soheila Rostami, MD, Consulting Staff, Ophthalmic Plastic Consultants
Contributor Information and Disclosures

Updated: Jul 8, 2008

Introduction

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 (see Media file 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 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 epithelial germ cells failure to differentiate completely to meibomian glands, instead they become pilosebaceous units.

Pathophysiology

Distichiasis can affect the lower and upper lids (see Media files 1-2). When these abnormal lashes come in contact with the cornea, they may cause severe irritation, epiphora, corneal abrasion, or even corneal ulcers.

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.

Clinical

History

Physical

  • Abnormal lashes from the meibomian gland orifices are noted on slit lamp examination.
  • The corneal epithelium should be evaluated at the slit lamp after instillation of fluorescein for any defects or abnormalities.

Causes

The congenital form of distichiasis is autosomal dominant with complete penetrance. The metaplasia of meibomian glands and abnormal growth of lashes from these glands, secondary to severe chemical burn, Stevens-Johnson syndrome, OCP, or chronic blepharoconjunctivitis, can cause acquired distichiasis.

More on Distichiasis

Overview: Distichiasis
Differential Diagnoses & Workup: Distichiasis
Treatment & Medication: Distichiasis
Follow-up: Distichiasis
Multimedia: Distichiasis
References
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References

  1. Moosavi AH, Mollan SP, Berry-Brincat A, et al. Simple surgery for severe trichiasis. Ophthal Plast Reconstr Surg. Jul-Aug 2007;23(4):296-7. [Medline].

  2. 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.

  3. McCracken MS, Kikkawa DO, Vasani SN. Treatment of trichiasis and distichiasis by eyelash trephination. Ophthal Plast Reconstr Surg. Sep-Oct 2006;22(5):349-51. [Medline].

  4. Anderson RL. Surgical repair for distichiasis. Arch Ophthalmol. Jan 1977;95(1):169. [Medline].

  5. Bosniak S. Principles and Practice of Ophthalmic Plastic and Reconstructive Surgery. Vol 1. WB Saunders Co; 1996:409.

  6. Dortzbach RK. Ophthalmic Plastic Surgery: Prevention and Management of Complications. Lippincott-Raven Publishers; 1994:42-8.

  7. Fein W. Surgical repair for distichiasis, trichiasis, and entropion. Arch Ophthalmol. May 1976;94(5):809-10. [Medline].

  8. Hill JC. Trichiasis and distichiasis. Can J Ophthalmol. Oct 1976;11(4):353-4. [Medline].

  9. Pham RT, Biesman BS, Silkiss RZ. Treatment of trichiasis using an 810-nm diode laser: an efficacy study. Ophthal Plast Reconstr Surg. Nov-Dec 2006;22(6):445-7. [Medline].

  10. Scheie HG, Albert DM. Distichiasis and trichiasis: origin and management. Am J Ophthalmol. Apr 1966;61(4):718-20. [Medline].

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Further Reading

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Keywords

abnormal eyelash growth, extra eyelashes, meibomian glands

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Contributor Information and Disclosures

Author

Soheila Rostami, MD, Consulting Staff, Ophthalmic Plastic Consultants
Soheila Rostami, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jorge G Camara, MD, Professor of Ophthalmology, Department of Surgery, University of Hawaii John A Burns School of Medicine; Chairman, Department of Ophthalmology and Otorhinolaryngology, Director of Fellowship Training Program, St Francis Medical Center
Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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