Kanski Ophthalmology

1. DISORDERS OF LASHES
1. Trichiasis
2. Metaplastic lashes
3. Distichiasis
4. Phthiriasis palpebrarum
6. Poliosis
5. Madarosis

2. Trichiasis
• Posterior misdirection of normal lashes
• Most frequently affects lower lid
Complications
• Inferior punctate epitheliopathy
• Corneal ulceration and pannus
Signs

3. Treatment Options for Trichiasis
1. Epilation - but recurrences within few weeks
2. Electrolysis - but frequently repeated treatments required
3. Cryotherapy - for many lashes
4. Laser ablation - for few scattered lashes
5. Surgery - for localized crop resistant to other methods

4. Metaplastic lashes
Cicatrizing conjunctivitis (ocular pemphigoid,
Stevens-Johnson, chemical burns)
Aberrant lashes arising from meibomian
gland orifices
Signs Causes

5. Distichiasis
• Second row of lashes arising
from meibomian gland orifices
• Congenital • Cryotherapy to posterior lamella
• Division into anterior and posterior
lamellae
• Reapposition of lamellae
TreatmentSigns
• Occasionally dominantly inherited

6. Phthiriasis palpebrarum
• Infestation of lashes by pubic crab louse and its ova (nits)
• Typically affects children in poor hygenic conditions
Treatment - removal, destruction and delousing
Lice gripping base of lashes Nits and empty shells adhere to base of lashes

7. Madarosis
Local causes
• Chronic anterior
lid margin disease
• Infiltrating tumours
• Burns, radiotherapy
or cryotherapy
Systemic causes
• Generalized alopecia
• Myxoedema
• SLE
• Syphilis
• Leprosy
Following removal
Decrease in number or complete loss of lashes

8. Poliosis
Premature localized whitening of hair
Ocular associations
• Chronic anterior blepharitis
• Sympathetic ophthalmitis
• Vogt-Koyanagi-Harada
syndrome
• Waardenburg syndrome
Systemic associations