Distichiasis has been seen in all ethnic backgrounds. Abnormal lashes from the meibomian gland orifices are noted on slit lamp examination. The cornea epithelia should be evaluated at the slit lamp after instillation of fluorescein for any defects or abnormalities. The metaplasia of meibomian glands and abnormal growth of lashes from these glands, secondary to severe chemical burn, Stevens-Johnson syndrome, OCP, or chronic blepharoconjunctivitis, can cause acquired distichiasis. Lubricants and bandage contact lenses can be used temporarily to relieve symptoms.
Definitive treatment is removal of the abnormal eyelashes.
Mechanical epilation of lashes has been used, but the eyelashes regrow within 4-6 weeks. Complications of surgical interventions are hemorrhage, infection, wound dehiscence, lid margin deformities, entropion or ectropion, and regrowth. Adequate electrocautery, especially for marginal arcade vessel, can reduce the chance of hemorrhage. Performing the procedure in a sterile environment should reduce the chance of infection, and the ability to close the defect can be reduced with a lateral superior or inferior cantholysis with or without Tenzel semicircular flap. This method is ideal for cases with few aberrant eyelashes.