Lid splitting and posterior lamella cryosurgery for congenital and acquired distichiasis

Congenital distichiasis is a rare condition with an accessory row of lashes at the Meibomian gland orifices. We suggest "acquired distichiasis" as an appropriate term for the accessory row of lashes in or near the Meibomian gland orifices, occurring as a result of such conditions as Stevens-Johnson syndrome, ocular pemphigoid, or chemical and physical injuries. We report a new treatment technique in which the eyelid is divided along the gray line then followed by cryotherapy to the posterior lid lamella. This removes the distichiatic lashes without damaging the normal lashes in the anterior lid lamella and avoids depigmentation. Histologic examination demonstrates the aberrant lashes result from a metaplasia of tissues in or around the Meibomian glands. Thirteen eyelids with acquired distichiasis and four eyelids with congenital distichiasis have been followed up for eight to 48 months. All have been greatly improved.