Distichiasis: Real Double Eyelashes — Causes, Symptoms, and Treatments

Distichiasis, or double eyelashes, is a rare condition where you have two rows of eyelashes. The second row might include a single lash, a few hairs, or a complete set. Compared to normal lashes, the extra lashes are usually thinner, shorter, and lighter. Typically, distichiasis affects all four eyelids, but it can show up on just one lid or the lower lids. The extra lashes come out of the meibomian glands on the edge of the eyelid. These glands normally produce an oil that coats tears, which stops them from drying up too quickly.

You might not have any symptoms, but if you do you might experience: sensitivity to light (photophobia), conjunctivitis, irritation of the cornea, styes, and in some cases droopy eyelids (ptosis). In most cases, distichiasis is congenital, which means it’s present at birth. It can be caused by a genetic mutation that’s linked to heart problems. You can also get distichiasis later in life if your eyelids are inflamed or injured. In this article, we’ll explore the causes, risk factors, and treatment of double eyelashes.

Present at birth (congenital distichiasis) and LDS linkage

The most common cause of congenital distichiasis is a rare genetic mutation of the FOXC2 gene on chromosome 16. This gene helps lymphatic and blood vascular development during embryonic growth. Scientists aren’t sure how this genetic mutation causes double eyelashes. However, congenital distichiasis is usually part of a rare condition called lymphedema-distichiasis syndrome (LDS). LDS involves double eyelashes and lymphedema, or fluid accumulation in the body’s tissues. The fluid, or lymph, leaks from the blood vessels and into tissues. The lymphatic system normally drains and filters this fluid through tubes called lymphatic vessels. But if the lymphatic vessels aren’t working properly, the fluid accumulates in the tissue and causes swelling. People with LDS usually experience swelling in both legs.

In LDS, the lymphatic vessels might be: underdeveloped, obstructed, malformatted, functioning incorrectly. LDS is also associated with other conditions, including: early onset varicose veins, scoliosis, cleft palate, structural heart abnormalities, abnormal heart rhythm. It’s also possible to inherit distichiasis without lymphedema, but this is extremely rare.

Developing later in life (acquired distichiasis)

Acquired distichiasis, or developing double eyelashes after birth, is less common than the congenital form. It’s caused by inflammation or injury of the eyelid. Common causes include: chronic blepharitis, ocular cicatricial pemphigoid (OCP), meibomian gland dysfunction (MGD), Stevens-Johnson syndrome (SJS), chemical injury. Genetics is the biggest risk factor for congenital distichiasis. You’re more likely to inherit the condition if one of your parents has it. In fact, about 75 percent of people who have LDS have a parent with the disorder. Acquired distichiasis, on the other hand, is caused by certain conditions such as eyelid inflammation, allergic reactions, rosacea, bacterial infections, clogged oil glands on your eyelids, and eyelash mites or lice. Being female, older age, wearing contacts, certain medications, and a weakened immune system also increase risk for conditions that can lead to distichiasis.

Signs, symptoms, and diagnosis

Signs and symptoms of distichiasis include an extra row of eyelashes growing from the upper or lower eyelids. The extra lashes can grow inward (trichiasis), irritating the cornea or conjunctiva, resulting in redness, swelling, and tearing. Individuals may report an itchy or gritty sensation in the eyes and may experience dry eyes due to inadequate lubrication. Clinicians may also notice an inward rotation of the eyelid margin (entropion). In severe cases, the extra eyelashes may irritate the cornea with each blink leading to corneal abrasions and corneal ulcers, which may lead to photosensitivity, pain, and blurry vision. Other complications include corneal scarring, secondary infections, and permanent vision loss if left untreated.

Diagnosis begins with a thorough review of symptoms and medical history. An initial physical exam revealing two rows of eyelashes may prompt a referral to an ophthalmologist for comprehensive assessment. The eyelids may be evaluated to assess the eyelid margins and the positioning of eyelashes. A close-up examination can help differentiate between distichiasis and trichiasis. A slit-lamp examination provides detailed information about the eye structures and helps identify corneal abrasions or ulcers. Genetic testing for FOXC2 mutations can be considered if there is high suspicion for LDS.

Treatment options

Management of distichiasis consists of supportive care measures and interventions aimed at alleviating symptoms and preventing secondary complications. In mild cases, where the individual is asymptomatic, supportive care measures include ocular lubricants (artificial tears) and soft contact lenses, which serve as a barrier between the eyelashes and the cornea. If symptoms persist despite conservative measures, procedures include electrolysis (destroying the hair follicle) and cryotherapy (freezing the hair follicle) to prevent regrowth. In severe, refractory cases, surgical treatments, such as surgical removal of the affected glands or lid splitting, may be necessary to alleviate symptoms.

Secondary complications, including corneal abrasions and corneal ulcers, are managed with a combination of topical antibiotics (e.g., ciprofloxacin, ofloxacin), lubricants, and cycloplegic agents (e.g., atropine, cyclopentolate) to promote healing and prevent further complications. A note from clinicians emphasizes early detection and early treatment to provide relief and prevent progression.

Specific treatments include:
Argon laser thermoablation to destroy lash follicles. Cryotherapy to destroy lash follicles by extreme cold. Electrolysis to destroy lash follicles with electricity and short-wave frequency. Epilation to pluck lashes (temporary, as regrowth occurs in weeks). Lid splitting surgery to expose follicles and remove abnormal lashes, often combined with other procedures. In some cases, cryotherapy or electrolysis may be used after lid splitting. In LDS-related distichiasis, genetic counseling and monitoring for associated features are important components of care.

Facts and practical considerations

Distichiasis is a rare condition characterized by two rows of eyelashes that may be congenital or acquired. Signs include an extra row of lashes and potential entropion, irritation, or corneal involvement. Diagnosis involves physical examination, slit-lamp assessment, and sometimes genetic testing. Treatment aims to relieve symptoms and prevent complications, with options ranging from lubricants and contact lenses to ablative and surgical procedures. Distichiasis can occur as part of LDS, a genetic syndrome linked to FOXC2 mutations that may also include lymphedema and a spectrum of other anomalies.

Be mindful of potential sources of irritation or inflammation that can contribute to acquired distichiasis, such as blepharitis, ocular cicatricial pemphigoid, and meibomian gland dysfunction. If you have a family history of double eyelashes or notice new or persistent symptoms, consult an eye care professional for an evaluation and individualized treatment plan.

Overview of related considerations

In addition to human patients, distichiasis can occur in animals, including dogs, where it presents with similar signs of irritation and potential corneal issues. This emphasizes the importance of veterinary as well as human ophthalmic awareness for this condition.

Images can help readers visualize how extra lashes arise from meibomian glands and how they may interact with the ocular surface. Visuals should clearly depict the posterior margin location of the lashes relative to the globe to avoid confusion with normal lashes.

A short video illustrating the pathophysiology of distichiasis and a demonstration of common treatments can enhance understanding for readers new to the topic. The video should explain the difference between congenital and acquired forms and show example procedures such as lid splitting, cryotherapy, and electrolysis.

Practical data summary

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