Distichiasis (Accessory Eyelashes)
Distichiasis is an eyelid disorder where an additional row of eyelashes develops from abnormal locations along the eyelid margin, commonly near the meibomian gland openings. These accessory lashes may irritate the ocular surface and cause corneal complications.
What Is Distichiasis?
Distichiasis is a condition where a second row of eyelashes develops from the posterior eyelid margin near the openings of the meibomian glands.
Unlike normal eyelashes that grow from the anterior eyelid margin and point away from the eye, accessory eyelashes may point toward the ocular surface.
Some individuals have mild distichiasis without symptoms, while others develop significant irritation when accessory lashes touch the conjunctiva or cornea.
Distichiasis may be congenital due to genetic abnormalities or acquired from chronic inflammation, scarring, or eyelid disease.
Eyelid & Lash Anatomy Involved in Distichiasis
Normal eyelid anatomy maintains proper eyelash growth direction and protects the ocular surface.
Normal Eyelash Row
The primary lash line grows from the anterior eyelid margin and protects the eye from debris.
Accessory Eyelash Row
An additional lash row develops from abnormal locations along the eyelid.
Meibomian Gland Openings
Accessory lashes commonly arise near these posterior eyelid structures.
Eyelid Margin
Contains lashes, gland openings, and structures responsible for tear film health.
Supporting Eyelid Structures
Changes in eyelid anatomy can affect lash growth and ocular surface protection.
Tarsal Plate
Provides structural support and contains meibomian glands.
Hair Follicles
Control eyelash development and growth direction.
Conjunctiva
A sensitive tissue that may become irritated by abnormal lashes.
Cornea
The clear front surface of the eye that may be damaged by lash contact.
Normal Eyelashes vs Distichiasis
The direction and location of eyelash growth determine whether lashes protect or irritate the ocular surface.
Normal Eyelashes
- Grow from the anterior lid margin
- Point away from the eye
- Protect against debris
- Do not touch the cornea
Distichiasis
- Extra row of eyelashes
- May arise from meibomian gland area
- May contact the ocular surface
- Can cause irritation and corneal injury
Types of Distichiasis
Congenital Distichiasis
Present from birth and often related to genetic abnormalities.
Acquired Distichiasis
Develops later due to inflammation, scarring, or eyelid disease.
Complete Accessory Lash Row
An entire secondary row of abnormal eyelashes is present.
Partial Accessory Lash Row
Only a section of the eyelid contains extra lashes.
Symptomatic Distichiasis
Accessory lashes cause irritation or ocular surface damage.
Asymptomatic Distichiasis
Accessory lashes are present but do not affect the eye.
Why Does Distichiasis Occur?
Distichiasis develops when eyelash-producing tissue forms in abnormal locations or when normal eyelid structures are altered.
Abnormal Lash Development
Accessory eyelashes develop from misplaced epithelial tissue.
Meibomian Gland Transformation
Gland structures may develop into lash-producing tissue.
Genetic Mutations
Certain inherited disorders affect eyelid and lymphatic development.
Eyelid Inflammation
Chronic inflammation may contribute to abnormal lash growth.
Common Causes & Risk Factors
FOXC2 Gene Mutation
Associated with inherited lymphedema-distichiasis syndrome.
Lymphedema-Distichiasis Syndrome
A genetic disorder involving abnormal lymphatic and eyelid development.
Chronic Eyelid Inflammation
Inflammatory changes may contribute to acquired accessory lashes.
Ocular Cicatricial Pemphigoid
Scarring disease that may alter eyelid structures.
Stevens-Johnson Syndrome
Severe inflammation may cause eyelid abnormalities.
Trauma or Surgery
Eyelid injury or procedures may contribute to acquired changes.
Conditions Associated With Distichiasis
Lymphedema-Distichiasis Syndrome
A hereditary disorder strongly associated with congenital distichiasis.
Trichiasis
Both conditions may cause lashes to irritate the ocular surface.
Dry Eye Disease
Accessory lashes may worsen ocular surface discomfort.
Blepharitis
Chronic eyelid inflammation may contribute to symptoms.
Corneal Abrasion
Repeated lash contact can damage the corneal epithelium.
Keratitis
Chronic irritation may lead to corneal inflammation.
Symptoms & Clinical Signs
Symptoms of distichiasis depend on the number of accessory eyelashes, their direction, and whether they contact the ocular surface.
Common Symptoms
- Foreign body sensation
- Eye irritation
- Redness
- Excessive tearing
- Burning sensation
- Light sensitivity
- Blurred vision
- Eye discomfort with blinking
- Dryness
- Contact lens intolerance
Clinical Signs
- Second row of eyelashes
- Accessory lashes near meibomian gland openings
- Lashes contacting conjunctiva or cornea
- Conjunctival injection
- Corneal staining
- Ocular surface inflammation
Mechanical Effects of Accessory Eyelashes
Accessory eyelashes may create repetitive mechanical irritation similar to trichiasis when they contact the ocular surface.
Conjunctival Irritation
Repeated lash contact may cause redness and inflammation of the conjunctiva.
Corneal Surface Damage
Constant friction may disrupt the corneal epithelium.
Tear Film Disruption
Mechanical irritation may worsen tear instability and dryness.
Chronic Discomfort
Persistent irritation may affect daily comfort and visual quality.
Clinical Examination of Distichiasis
Diagnosis requires careful evaluation of the eyelid margin, accessory lash location, and ocular surface condition.
Eyelid Margin Evaluation
The clinician examines the eyelid margin for an additional row of lashes.
Lash Direction Assessment
Determines whether accessory lashes point toward the eye.
Slit Lamp Examination
Provides detailed evaluation of lashes, conjunctiva, and cornea.
Eyelid Margin Evaluation
Evaluation of the eyelid margin helps distinguish distichiasis from other eyelash disorders.
Accessory Lash Location
Identifies whether lashes arise from the posterior lid margin near meibomian glands.
Number of Lashes
Determines whether the condition is localized or diffuse.
Eyelid Scarring
Helps identify acquired causes.
Meibomian Gland Assessment
Evaluates gland health and associated eyelid disease.
Slit Lamp Examination
A slit lamp examination provides magnified evaluation of accessory lashes and their effect on the ocular surface.
Accessory Lash Identification
Confirms the presence and location of abnormal eyelashes.
Conjunctival Evaluation
Assesses redness, inflammation, and irritation.
Corneal Evaluation
Identifies epithelial damage caused by lash contact.
Fluorescein Staining
Fluorescein staining helps identify corneal injury caused by accessory eyelashes.
Normal Findings
- No epithelial defects
- Clear corneal surface
- No lash-related staining
Abnormal Findings
- Linear corneal staining
- Superficial epithelial defects
- Areas of mechanical irritation
Corneal Evaluation in Distichiasis
The cornea must be assessed because chronic accessory lash contact may lead to surface damage.
Corneal Abrasion
Surface injury caused by repeated mechanical contact.
Keratitis
Chronic irritation may contribute to corneal inflammation.
Corneal Scarring
Long-term injury may affect corneal clarity.
Tear Film Assessment
Accessory eyelashes may worsen ocular surface symptoms by increasing irritation and inflammation.
Tear Break-Up Time
Evaluates tear stability after blinking.
Ocular Surface Staining
Identifies dryness-related epithelial changes.
Meibomian Gland Evaluation
Assesses associated gland dysfunction.
Assessing Severity of Distichiasis
Severity depends on the number of accessory lashes, ocular surface contact, and symptoms.
Number of Accessory Lashes
More lashes increase the potential for irritation.
Lash Contact Frequency
Constant corneal contact increases risk of injury.
Corneal Involvement
Staining or epithelial defects indicate greater severity.
Patient Symptoms
Discomfort and visual symptoms guide treatment decisions.
Differential Diagnosis
Several eyelid conditions may resemble distichiasis and should be carefully distinguished.
Trichiasis
Normal eyelashes grow in an abnormal direction toward the eye.
Epiblepharon
A skin fold redirects normal lashes toward the ocular surface.
Entropion
Inward rotation of the eyelid causes lash contact.
Blepharitis
Eyelid inflammation may cause irritation and lash abnormalities.
Foreign Body
An external object may mimic lash-related irritation.
Associated Conditions
Lymphedema-Distichiasis Syndrome
Inherited disorder associated with congenital accessory eyelashes.
Ocular Surface Disease
Accessory lashes may worsen dryness and irritation.
Chronic Eyelid Inflammation
Inflammatory conditions may contribute to acquired distichiasis.
Key Clinical Questions
Are There Extra Eyelashes?
Helps identify accessory lash formation.
Do Lashes Touch the Eye?
Determines risk of ocular surface injury.
Is There a Family History?
May suggest inherited lymphedema-distichiasis syndrome.
Treatment Options for Distichiasis
Treatment of distichiasis depends on the number of accessory eyelashes, severity of symptoms, ocular surface involvement, and the underlying cause.
Observation
Patients without symptoms or ocular surface damage may only require monitoring.
Conservative Treatment
Used to improve comfort and protect the ocular surface.
Procedural Treatment
Removes or destroys accessory eyelash follicles to prevent recurrence.
Surgical Treatment
Used for extensive or recurrent distichiasis.
Observation and Monitoring
Not all cases of distichiasis require immediate intervention. Patients with minimal or no symptoms may be monitored regularly.
Asymptomatic Distichiasis
Accessory lashes without corneal contact may only require routine eye examinations.
Regular Follow-Up
Monitoring evaluates lash changes, symptoms, and ocular surface health.
Early Intervention
Treatment is considered if lashes begin contacting the cornea.
Conservative Management
Conservative treatment focuses on reducing irritation and protecting the ocular surface.
Artificial Tears
Lubricating drops reduce friction and improve ocular comfort.
Lubricating Ointments
Provide longer-lasting protection, especially overnight.
Warm Compresses
Improve eyelid comfort and help manage associated inflammation.
Lid Hygiene
Cleaning the eyelid margin helps control associated blepharitis.
Ocular Surface Protection
Because accessory eyelashes may irritate the cornea, maintaining a healthy tear film is an important part of management.
Treatment Goals
- Reduce irritation
- Protect the corneal epithelium
- Improve tear stability
- Prevent corneal complications
Monitoring
- Corneal staining
- Ocular surface symptoms
- Lash contact
- Visual changes
Manual Epilation
Manual epilation involves removing accessory eyelashes with forceps and is commonly used for isolated symptomatic lashes.
Advantages
- Simple office procedure
- Immediate symptom relief
- No surgical incision
- Useful for limited lashes
Limitations
- Lashes may regrow
- Repeated treatments may be needed
- Does not eliminate follicles
Electrolysis
Electrolysis uses electrical energy to destroy individual accessory eyelash follicles.
Best Candidates
Patients with a small number of symptomatic accessory lashes.
Benefits
Provides longer-lasting results compared with repeated epilation.
Limitations
Multiple treatment sessions may be required.
Radiofrequency Ablation
Radiofrequency treatment destroys abnormal lash follicles using controlled energy.
Purpose
Prevents regrowth of problematic accessory eyelashes.
Advantages
Useful for selected recurrent lashes.
Possible Risks
May include scarring, inflammation, or incomplete follicle destruction.
Cryotherapy
Cryotherapy uses freezing temperatures to destroy multiple accessory lash follicles.
Advantages
- Treats multiple lashes simultaneously
- Useful for diffuse disease
- Reduces lash recurrence
Possible Complications
- Eyelid swelling
- Skin changes
- Scarring
- Lash loss
Laser Ablation
Laser therapy may be used to destroy selected abnormal eyelash follicles.
Indication
Localized symptomatic accessory lashes.
Goal
Reduce recurrence by eliminating abnormal follicles.
Surgical Treatment of Distichiasis
Surgery is considered when distichiasis is extensive, recurrent, or associated with eyelid abnormalities.
Accessory Lash Removal
Removes abnormal lash-producing tissue.
Eyelid Margin Reconstruction
Restores normal eyelid anatomy and lash orientation.
Tarsal Plate Procedures
Address abnormalities involving the posterior eyelid.
Follicle Destruction
Eliminates accessory lash follicles to prevent regrowth.
Eyelid Margin Reconstruction
Reconstruction may be necessary when abnormal anatomy contributes to recurrent distichiasis.
Goals
- Restore eyelid structure
- Protect the ocular surface
- Improve eyelid function
- Reduce recurrence
Used For
- Extensive distichiasis
- Cicatricial disease
- Post-traumatic changes
Management of Lymphedema-Distichiasis Syndrome
Patients with congenital distichiasis may have an inherited disorder involving both eyelid development and lymphatic function.
Genetic Counseling
Helps patients understand inheritance patterns and family risk.
Systemic Evaluation
Assessment for lymphedema and associated findings may be recommended.
Lymphedema Management
Systemic symptoms require appropriate medical care.
Postoperative Care
Proper follow-up after procedures helps maintain eyelid health and prevent complications.
Antibiotic Ointment
Helps reduce infection risk during healing.
Lubrication
Protects the ocular surface after treatment.
Wound Care
Supports proper eyelid healing.
Follow-Up Visits
Monitor lash recurrence and ocular surface health.
Complications of Distichiasis Treatment
Recurrence
Accessory lashes may return if follicles remain active.
Scarring
Procedures may occasionally cause eyelid scarring.
Eyelid Notching
Irregular eyelid contour may occur after surgery.
Lash Loss
Treatment may remove normal eyelashes near abnormal follicles.
Preventing Distichiasis Complications
Early Detection
Identifying accessory lashes before corneal damage occurs improves outcomes.
Manage Eyelid Disease
Treating inflammation reduces ocular surface problems.
Routine Eye Care
Regular examinations help monitor recurrence and complications.
Complications of Distichiasis
Although some cases of distichiasis are mild, symptomatic accessory eyelashes can create chronic mechanical irritation and lead to ocular surface damage.
Ocular Surface Complications
- Chronic irritation
- Conjunctival inflammation
- Corneal abrasion
- Keratitis
- Corneal scarring
Vision-Related Complications
- Blurred vision
- Reduced visual quality
- Corneal opacity
- Visual disturbance
- Rare vision loss
Corneal Abrasion
Accessory eyelashes that repeatedly touch the cornea can disrupt the epithelial surface and create a corneal abrasion.
Symptoms
- Foreign body sensation
- Eye pain
- Tearing
- Redness
- Light sensitivity
Clinical Findings
Fluorescein staining may reveal superficial epithelial defects in areas of lash contact.
Management
Treatment includes removing the irritating lash, lubrication, and protecting the ocular surface.
Corneal Ulcer
A corneal ulcer may develop when chronic epithelial injury allows infection and deeper inflammation of the cornea.
Warning Signs
- Increasing eye pain
- Reduced vision
- Corneal opacity
- Severe redness
- Photophobia
Clinical Importance
Corneal ulcers require urgent evaluation because they may result in permanent corneal scarring and vision impairment.
Infectious Keratitis
Persistent irritation from accessory eyelashes may increase susceptibility to corneal infection.
Risk Factors
- Chronic lash contact
- Corneal epithelial defects
- Delayed treatment
- Ocular surface disease
Symptoms
- Eye pain
- Redness
- Light sensitivity
- Vision decrease
Prevention
Early diagnosis and removal of irritating lashes reduce infection risk.
Corneal Scarring
Long-term mechanical irritation may cause inflammation and permanent changes to corneal transparency.
Peripheral Scarring
May have minimal effect depending on location.
Central Corneal Scarring
Scarring involving the visual axis may reduce vision.
Prevention
Early treatment prevents progression to permanent corneal damage.
Chronic Ocular Pain
Repeated irritation from accessory eyelashes may cause persistent discomfort even without severe corneal injury.
Contributing Factors
- Mechanical irritation
- Ocular surface inflammation
- Dry eye disease
- Chronic eyelid inflammation
Management
- Remove offending lashes
- Improve tear film health
- Treat associated eyelid disease
Vision Changes Associated With Distichiasis
Most patients maintain normal vision, but significant ocular surface damage may affect visual quality.
Blurred Vision
May occur from corneal irregularity or tear film disruption.
Reduced Visual Quality
Chronic irritation may cause fluctuating vision.
Severe Vision Loss
Rare and usually associated with advanced corneal complications.
Prognosis
The prognosis of distichiasis is generally good when identified early and managed appropriately.
Asymptomatic Cases
Many patients require only observation and routine monitoring.
Symptomatic Cases
Treatment usually improves comfort and prevents corneal injury.
Genetic Cases
Patients with lymphedema-distichiasis syndrome may require long-term monitoring.
Clinical Pearls
- Distichiasis is an extra row of eyelashes arising from abnormal locations.
- Accessory lashes commonly originate near meibomian gland openings.
- Not all cases require treatment if the lashes do not contact the eye.
- Distichiasis differs from trichiasis because it involves an additional lash row rather than abnormal direction of normal lashes.
- Always evaluate the cornea when accessory lashes touch the ocular surface.
- Congenital distichiasis may be associated with lymphedema-distichiasis syndrome.
- Treatment should focus on both removing problematic lashes and managing the underlying cause.
Common ICD-10 Codes
| Code | Description |
|---|---|
| Q10.3 | Other congenital malformations of eyelid |
| H02.89 | Other disorders of eyelid |
| H02.05 | Trichiasis of eyelid (related lash disorder) |
| H16.8 | Other keratitis |
| H04.12 | Dry eye syndrome |
Patient Education: Living With Distichiasis
Avoid Eye Rubbing
Rubbing may worsen irritation and ocular surface inflammation.
Monitor Symptoms
Pain, redness, or vision changes should be evaluated.
Use Lubrication When Needed
Artificial tears may improve comfort.
Maintain Follow-Up
Regular examinations help prevent corneal complications.
Frequently Asked Questions
What is distichiasis?
Distichiasis is the presence of an extra row of eyelashes that develops from an abnormal location along the eyelid margin.
Is distichiasis the same as trichiasis?
No. Distichiasis involves an extra row of eyelashes, while trichiasis involves normal eyelashes growing in an abnormal direction.
Can distichiasis damage the eye?
Yes. If accessory lashes touch the cornea, they can cause irritation, abrasions, and corneal damage.
Does every patient need treatment?
No. Patients without symptoms or ocular surface damage may only require monitoring.
Can accessory eyelashes come back after treatment?
Yes. Recurrence may occur if lash follicles remain active.
Related Eye Conditions
Trichiasis
Normal lashes growing toward the ocular surface.
Entropion
Inward eyelid turning causing lash contact.
Blepharitis
Chronic eyelid inflammation affecting lash health.
Dry Eye Disease
Ocular surface disorder that may worsen symptoms.
Corneal Abrasion
Superficial corneal injury from mechanical irritation.
Keratitis
Inflammation of the cornea from irritation or infection.
Lymphedema-Distichiasis Syndrome
Inherited condition associated with congenital accessory eyelashes.
Medical Disclaimer
The information provided by Kardia Vision is intended for educational purposes only and should not replace professional medical advice, diagnosis, or treatment.
Eye pain, sudden vision changes, severe redness, or signs of corneal injury require evaluation by a qualified eye care professional.
Kardia Vision is dedicated to providing accurate, evidence-based eye health education for patients, students, and healthcare professionals.