What is trichiasis and distichiasis?

Having a pair of eyes that function well is indeed everyone’s dream. It is often a blessing in disguise and many do take it for granted. While having a good eye vision with no need for glasses or contact lenses can be the biggest gift to have, being able to see things with ease and comfort is another thing to be grateful for. In this DoctorOnCall’s article, we will be learning about eye problems that cause great discomfort or even vision problems known as trichiasis and distichiasis.

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Trichiasis is defined as eyelashes that grow inwards towards the eyes. It is one of the common eyelid problems. The lashes often irritate the eyes as it rubs against the cornea, the conjunctiva and the inner surface of the eyelids.

The exact causes for people to have trichiasis is not well understood as sometimes people do get this condition for no reasons. Some of the causes include eye infection (Herpes zoster, trachoma and chronic blepharitis), inflammation of the eyelid, trauma to the eyes and autoimmune conditions. Those with certain eye conditions such as epiblepharon (extra lower eyelid skinfolds that directs lashes into vertical position) which is mostly found in Asian people and rare disorders of skin with mucous membrane such as Stevens-Johnson syndrome and cicatricial pemphigoid can increase risk for developing trichiasis.

Symptoms include irritated eye and inflammation of eye characterised by redness, tearing and sensitivity to bright light (photophobia). Patients often feel gritty (foreign body sensation) to the eyes. Due to the fact that eyelashes can keep rubbing against the cornea in the long run, it can cause corneal abrasion and can be serious such as corneal ulcer.

Treatment involves removing the eyelashes, follicle or both. Sometimes, even redirecting eyelash growth. Eyelash removal with forceps is used as initial treatment. Surgery to reposition the eyelashes is recommended for those with epiblepharon. Removal of the extra lashes and hair follicles can be done by ablation, electrolysis or cryosurgery. These surgeries can help permanently remove it. To know which surgery is the best, only an ophthalmologist can help guide through the process and the pros and cons of each procedure.


Distichiasis is defined as an extra row of eyelashes or known as double eyelashes. The rows may be complete rows, a few extra lashes or single lash growing next to another.

This condition can be presented at birth (congenital) or acquired due to other health problems. It is more common for distichiasis to occur later in life. For congenital distichiasis, it may be caused by genetic issues during pregnancy causing the cells of the eyes to develop abnormally and hair follicles to locate differently than normal. In some of these cases, it involves the rare genetic multisystem disorder known as lymphedema-distichiasis syndrome resulting from mutations of the gene FOXC2. For acquired distichiasis, it can be caused by many reasons such as late-stage cicatrizing conjunctivitis associated with chemical injury, Steven-Johnson syndrome and ocular cicatricial pemphigoid.

What can be seen on patients with congenital distichiasis are partial or complete second rows of lashes. The lashes are often directed towards the eyes. Lashes are typically soft and do not cause symptoms until the child reaches the age of 5. Patients with acquired distichiasis have less uniform row of lashes. The lashes tend to be less coloured or non-pigmented than normal lashes. Patients often have corneal irritation due to the eyelashes and this causes symptoms such as tearing, foreign body sensation and photophobia. In case of lymphedema-distichiasis syndrome, apart from the distichiasis, symptoms outside of the eyes such as swelling to the lower limbs typically presented in late childhood or puberty. Other abnormalities include congenital heart defects, cleft palate, scoliosis, renal abnormalities and early onset varicose vein.

Treatment is given for patients with symptoms or when damage to the cornea is presented. Common treatment includes eye lubricants and soft contact lenses to provide a barrier between the cornea and eyelashes. The extra eyelashes can be removed through surgery. Most patients will need multiple treatments. Manual epilation (plucking) is helpful for those with few extra lashes but this only acts as a temporary measure since the eyelashes normally grow back in 2-3 weeks. Cryosurgery may be effective for those with a large number of lashes by freezing the lash follicles and destroying it. Radiofrequency destroys the lash follicles using very small tools. Lid splitting surgery is used for extreme cases and often combined with cryotherapy. Patients without symptoms typically do not need treatment. It is important to treat distichiasis when it causes symptoms as this is a sign that the cornea is injured. When this is left untreated, the cornea could be at risk for scarring, thinning and ulceration.

In essence, no matter what kind of eyelash problems you are facing or when you realise your eyelashes look differently than others, it is best to get checked by doctors. This is especially true when there are symptoms. Getting treatment can help provide relief and preserve eye function,

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