Definition: A condition where there is more than four lashes maldirected (Directed backwards) rubbing against the cornea and conjunctiva, with the eyelid margin normal in position.
N.
B.
Rubbinu lashes: Only four lashes or less are maldirected and rubbing against the globe.
Etiology 1.
Congenital: Often in all the four lids.
Distichiasis is a congenital condition in which there is an extra row of lashes in the place of meibomian glands (Behind the gray line).
2.
Acquired a.
Traclioina (commonest).
b.
Ulcerative blepharitis.
c.
Burns d.
Diphtheritic conjunctivitis.
Symptoms 1.
Foreign body sensation.
2.
Conjunctival hyperaemia.
3.
Photophobia.
4.
Lacrimation.
5.
Blepharospasm.
Signs 1.
Maldirected, rubbing lashes.
2.
Signs of complications.
Complications 1.
Conjunctival: a.
Chronic conjunctivitis.
b.
Conjunctival ulcer.
c.
Epithelial plaque.
2.
Corneal: a.
Recurrent comeal ulceration comeal opacities.
b.
Superficial vascularization.
c.
Epithelial plaque.
Treatment 1.
Rubbing lashes: (Permanently destroy the hair follicle).
a.
Diathermy: Thermal coagulation.
b.
Electrolysis: Chemical coagulation 0% c.
Cryocoagulation d.
Epilation Not a permanent treatment, as the lash grows again in 4-6 weeks.
2.
Trichiasis: d.
In the upper lid: Van Millengen's operation Principle: Place a buccal mucous membrane graft into the gray line displacing the rubbing lashes away from the cornea.
Indicated in cases of pure trichiasis of the upper lid.
e.
In the lower lid: Webster's operation Principle: Place a buccal mucous membrane graft into the sulcus subtarsalis straightening the tarsus and lengthening the palpebral conjunctiva.
Indicated in lower lid cicatricial cntropion or trichiasis.
N.
B.
Snellen's operation is indicated in Upper lid trichiasis with cicatricial entropion.
3.
Distichiasis: Splitting of the lid margin and cryo application to destroy the hair follicles of the extra row of lashes.