Question of the Week

A 64-year-old caucasian male presents with a history of recurrent eye irritation. He was recently treated with antihistamine eye drops and lid hygiene for blepharitis and allergic conjunctivitis. Despite adhering to treatment, his condition persisted. Examination revealed two sets of eyelashes. The patient states that the extra eyelashes have been there for as long as he can remember. There is no edema present. Extraocular movements, intraocular pressure, and pupillary reflexes are normal. Visual acuity is unchanged from a year ago. A photo of the findings is shown below.

Which of the following is not a treatment option for this condition?

A. Cryotherapy

B. Lid splitting procedure

C. Botox injections

D. Epilation

Answer

The correct answer is C.

This patient has a condition called distichiasis, characterized by an extra set of eyelashes. In a normal eyelid, there is a single row of eyelashes anteriorly and a row of meibomian glands posteriorly. In distichiasis, eyelashes grow in place of the meibomian glands due to abnormal differentiation of basal epithelial cells. This condition can be congenital or acquired. Because of their proximity to the globe, the extra eyelashes can cause recurring irritation, as seen in this patient. A variety of treatment options are available for distichiasis. Hair removal procedures like epilation (Choice D) and electrolysis (Choice E) can be used. Cryotherapy (Choice A) can also be used to freeze and destroy the hair follicles. A lid splitting procedure (Choice B) can be performed, where the eyelid can be surgically split between the anterior and posterior lamella. The surgeon then removes the extra lashes, often using one of the other techniques listed. Botox (Choice C) is not an appropriate choice for this condition. Botox can be used for entropion, where the eyelid is turned inwards towards the globe, causing similar recurrent irritation as seen in distichiasis.

Source: Wendel LJA, Carter KD. Distichiasis: 64-year-old white male with bilateral eye irritation. EyeRounds.org. May 7, 2008; Available from: http://www.EyeRounds.org/cases/84-Distichiasis-Extra-Eyelashes.htm.