What is the DIfference Between Trichiasis and Distichiasis?
By Space Coast Daily // July 22, 2022
Trichiasis and distichiasis are both abnormal eyelash growths, yet they have slight differences. Extra eyelashes grow where they shouldn’t, around the edge(s) of the eyelid(s). This genetically inherited condition is widespread throughout several breeds. Even though some people with distichiasis will have pain, many don’t exhibit any clinical symptoms, and others don’t even need to be treated.
In trichiasis, hairs that should be directed away from the eyeball or the cornea are instead found in normal locations surrounding the eye. Trichiasis is a prevalent condition in breeds with long facial hair, such as Shih Tzus. As the hairs work as a wick to draw the tears out of the eye, trichiasis is a typical cause of excessive crying and tear stains down the face.
If unwanted hairs are causing discomfort, itching, chronic wetness, or infections, they can be permanently eliminated by freezing the hair follicles. Although we frequently employ lasers, if there are several aberrant hairs present, they may be excessively damaging to the eyelid margin.
Etiopathogenesis
Lashes can be misdirected by any disorder that results in tarsal plate and conjunctival scarring. The following categories apply to the causes:
Trauma :
■ Eyelid damage
■ Thermal burns on the lids and face
■ Post-operative modifications, such as ectropion repair,
Infection :
■ Trichrome: Trachoma is the eighth most prevalent illness that causes blindness globally and the most common infectious cause of blindness. 2 It is endemic at the moment in 57 nations, most of which are in Asia and Sub-Saharan Africa. 3 Trachomatous trichiasis, also known as the Arlt’s line in pathology, is brought on by repeated infections with Chlamydia trachomatis beginning in childhood. This condition causes persistent inflammation and scarring of the tarsal conjunctiva.
■ Zoster herpes: Commonly, herpes zoster ophthalmicus affects the eyelids. Patients may develop blepharitis, which can cause trichiasis, scarring, and secondary bacterial infections.
Treatment for trichiasis
The treatment of trichiasis does not necessitate any diagnostic techniques. However, if trachoma or SJS is suspected, a conjunctival biopsy can be carried out.
Medical management: Surgery is the mainstay of trichiasis treatment. Medical interventions work to treat the underlying illness while regulating the symptoms.
■ Lubricants offer relief from the irritating effects of lash rubbing, such as artificial tears and ointments.
■ OCP and SJS are treated with immunomodulatory treatment and supportive systemic therapy.
■ Those who have trachoma, along with every member of their family, should receive antibiotics. The preferred course of treatment is a single dosage of azithromycin (20 mg/kg up to 1 g).
■ In trachoma-endemic regions, a single dosage of azithromycin also reduces surgical trichiasis recurrence rates by one-third in comparison to topical tetracycline.
■ By changing matrix remodeling and contraction by conjunctival fibroblasts, doxycycline may help trachoma patients avoid the return of trichiasis after surgery.
Surgical treatment:
Trichiasis treatment methods come in a variety of forms.
■ Using forceps to mechanically remove misplaced lashes is a quick and temporary solution, but the lashes will regrow in three to six weeks. Broken cilia frequently irritate the cornea more than fully developed, lengthy eyelashes. Despite these downsides, patients typically accept epilation as a form of treatment since it is affordable and quick.
■ Electrolysis, which involves applying a high-frequency electrical current to remove a few isolated lashes, has a lot of disadvantages. It can also be tiresome for both the patient and the surgeon, has a high recurrence rate, and leaves the neighboring eyelid edge scarred.
■ Radiofrequency ablation of lashes and follicles is a simple yet effective method that can be performed under local anesthesia. A small gauge wire is introduced alongside the lash down to the follicle. The radiofrequency signal is delivered for about 1 second with the lowest power setting in cut/coag mode to destroy the hair follicle. Application of 0.02% mitomycin C in conjunction with radiofrequency ablation may help to improve the success rate of radiofrequency ablation treatment.
■ Under local anesthesia, radiofrequency ablation of the lashes and follicles is a quick and efficient procedure. Alongside the lash, a thin gauge wire is inserted all the way to the follicle. To kill the hair follicle, the radiofrequency signal is supplied for approximately 1 second in the cut/coag mode with the lowest power level. The combination of radiofrequency ablation with 0.02 percent mitomycin C application may increase the success rate of radiofrequency ablation treatments.
■ Using cryotherapy to treat segmental trichiasis is beneficial. The affected portion is subjected to the cryoprobe for roughly 25 seconds, then the area is allowed to defrost before being refrozen for 20 seconds (double freeze-thaw technique). After that, forceps are used to mechanically extract the lashes. Edema, necrosis, loss of skin pigmentation, harm to the meibomian glands, and loss of goblet cell function are among the concerns.
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Laser therapy:
1. A) A few isolated lashes can be removed using an argon laser photocoagulation procedure. In this procedure, the laser is used to cauterize the follicle at the base of the errant lash before it is extracted from the eyelid. Consequently, people with pigmentation respond well to this therapy. Mild hypopigmentation and lid notching are complications.
2. B) A useful tool for treating trichiasis. The utilized pulse has a length of around 50 ms and an energy density of about 50 J/cm2. There may be a need for four to five appointments spaced four to six weeks apart.
3. C) Ruby laser epilation is another effective and quite good method for treating trichiasis symptoms.
4. The lash follicles are sliced with a 1.0 mm micro trephine during the new procedure known as trephination. This procedure is simple, quick, and safe with minimal problems and scars.
5. For segmental trichiasis that has not responded to prior treatments, surgery may be performed using a full-thickness pentagonal resection or an anterior lamellar rotation excision.
6. For severe trichiasis, a straightforward surgical approach has been reported in which the anterior lamella is excised and the eyelid is allowed to heal by spontaneous granulation.
Treatment of Distichiasis:
The abnormal second row of lashes can be removed by mechanical epilation, electrolysis, radiosurgery, or cryosurgery. Distichiasis’ cilium shaft, in contrast to trichiasis lashes, travels in a convoluted fashion from the bulb to the surface, making an epilating needle’s destruction uncertain. Effective procedures include internal lash excision behind a skin-muscle flap or a mixture of cryotherapy and lid splitting.
