{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:40:27Z","timestamp":1790354427854,"version":"4.1.0"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>Distichiasis, an extra row of eyelashes emerging from meibomian gland orifices, occurs due to the metaplastic transition of sebaceous glands into the pilosebaceous unit. It can present congenitally, such as in lymphedema distichiasis syndrome, or secondary to acquired conditions, such as cicatrizing conjunctivitis, trachoma. This review summarizes the etiology of distichiasis, its presentation, the evolution of various surgical techniques, and their outcomes in human and animal eyes. The published literature has focused on the different treatment modalities and their outcomes; the etiopathogenesis of this condition remains elusive. Truncating mutations (missense, frameshift, and nonsense) in the Forkhead family gene FOXC2 are involved in the distichiasis\u2013lymphedema syndrome. The treatment options are no different for congenital versus acquired distichiasis, with no specific available algorithms. Acquired distichiasis in cicatrizing ocular surface diseases is difficult to manage, and existing treatment options offer success rates of 50%\u201360%. The outcomes of electroepilation or direct cryotherapy are not as good as surgical excision of distichiatic lashes after splitting the anterior and posterior lamella under direct visualization. The marginal tarsectomy with or without free tarsoconjunctival graft has shown good results in eyes with congenital and acquired distichiasis. The details of differences between normal and distichiatic lash, depth, or course of distichiatic eyelashes remain largely unknown. Studies exploring the distichiatic eyelash depth might improve the outcomes of blind procedures such as cryotherapy or radiofrequency-assisted epilation.<\/jats:p>","DOI":"10.4103\/ijo.ijo_1141_21","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T07:53:23Z","timestamp":1648454003000},"page":"1100-1106","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":18,"title":["Distichiasis: An update on etiology, treatment and outcomes"],"prefix":"10.4103","volume":"70","author":[{"given":"Swati","family":"Singh","sequence":"first","affiliation":[{"name":"Ocular Surface and Adnexa Services, Hyderabad, Telangana, India"},{"name":"Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,3,22]]},"reference":[{"key":"B1-20240828","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/0002-9394(62)90387-2","article-title":"Distichiasis","volume":"53","author":"Fox","year":"1962","journal-title":"Am J Ophthalmol"},{"key":"B2-20240828","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/0002-9394(66)91209-8","article-title":"Distichiasis and trichiasis: Origin and management","volume":"61","author":"Scheie","year":"1966","journal-title":"Am J Ophthalmol"},{"key":"B4-20240828","first-page":"100","article-title":"Treatment of distichiasis with cryotherapy","volume":"12","author":"Freuh","year":"1981","journal-title":"Ophthalmic Surg"},{"key":"B5-20240828","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1001\/archopht.1981.03930010631008","article-title":"Lid splitting and posterior lamellar cryosurgery for congenital and acquired distichiasis","volume":"99","author":"Anderson","year":"1981","journal-title":"Arch Ophthalmol"},{"key":"B6-20240828","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1001\/archopht.1997.01100150284028","article-title":"Eyelid splitting with excision or microhyfrecation for distichiasis","volume":"115","author":"Vaughn","year":"1997","journal-title":"Arch Ophthalmol"},{"key":"B7-20240828","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1136\/bjo.77.5.289","article-title":"Distichiasis: Management with cryotherapy to the posterior lamella","volume":"77","author":"O'Donnell","year":"1993","journal-title":"Br J Ophthalmol"},{"key":"B8-20240828","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3928\/0191-3913-19870101-06","article-title":"Excision of individual follicles for the management of congenital distichiasis and localised trichiasis","volume":"24","author":"Wolfley","year":"1987","journal-title":"J Paed Ophthalmol Strabismus"},{"key":"B9-20240828","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1001\/archopht.1978.03910050067016","article-title":"Excision of distichiasis eyelashes through a tarso-conjunctival trapdoor","volume":"96","author":"Dortzbach","year":"1978","journal-title":"Arch Ophthalmol"},{"key":"B10-20240828","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1080\/01676830.2017.1423356","article-title":"Modified treatment of distichiasis with direct tarsal strip excision without mucosal graft","volume":"37","author":"Rozenberg","year":"2018","journal-title":"Orbit"},{"key":"B11-20240828","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00417-005-0176-3","article-title":"Eyelid splitting with follicular extirpation using a monopolar cautery for the treatment of trichiasis and distichiasis","volume":"245","author":"Chi","year":"2007","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"B12-20240828","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/j.1463-5224.2011.00946.x","article-title":"Histopathologic features of canine distichiasis","volume":"15","author":"Raymond-Letron","year":"2012","journal-title":"Vet Ophthalmol"},{"key":"B13-20240828","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1111\/j.1748-5827.1973.tb06486.x","article-title":"Canine distichiasis","volume":"14","author":"Lawson","year":"1973","journal-title":"J Small Anim Pract"},{"key":"B14-20240828","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s40575-015-0024-7","article-title":"Prevalence and heritability of distichiasis in the english Cocker spaniel","volume":"2","author":"Petersen","year":"2015","journal-title":"Canine Genet Epidemiol"},{"key":"B15-20240828","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1111\/evj.12157","article-title":"Treatment and long-term follow-up of distichiasis, with special reference to the Friesian horse: A case series","volume":"46","author":"Hermans","year":"2014","journal-title":"Equine Vet J"},{"issue":"Suppl 1","key":"B16-20240828","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/j.1463-5224.2011.00932.x","article-title":"Successful treatment of distichiasis in a cat using transconjunctival electrocautery","volume":"14","author":"Reinstein","year":"2011","journal-title":"Vet Ophthalmol"},{"key":"B17-20240828","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1136\/vr.105816","article-title":"A description of blend electrolysis for treatment of canine distichiasis: 78 cases (2012-2017)","volume":"187","author":"Ioannides","year":"2020","journal-title":"Vet Rec"},{"key":"B18-20240828","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/vop.12565","article-title":"Evaluation of transconjunctival thermal electrocautery for treatment of canine distichiasis: 88 eyelids (2013-2016)","volume":"22","author":"Zimmerman","year":"2019","journal-title":"Vet Ophthalmol"},{"key":"B19-20240828","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1111\/vop.12748","article-title":"Evaluation of partial tarsal plate excision using a transconjunctival approach for the treatment of distichiasis in dogs","volume":"23","author":"Palella G\u00f3mez","year":"2020","journal-title":"Vet Ophthalmol"},{"key":"B20-20240828","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1136\/vr.144.15.413","article-title":"Reconstruction of the eyelids of a dog using grafts of oral mucosa","volume":"144","author":"Pe\u00f1a","year":"1999","journal-title":"Vet Rec"},{"key":"B21-20240828","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1136\/jmg.39.7.478","article-title":"Analysis of the phenotypic abnormalities in lymphedema distichiasis syndrome in 74 patients with FOXC2 mutations or linkage to 16q24","volume":"39","author":"Brice","year":"2002","journal-title":"J Med Genet"},{"key":"B22-20240828","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1136\/jmg.38.11.761","article-title":"Clinical heterogeneity in lymphoedema-distichiasis with FOXC2 truncating mutations","volume":"38","author":"Erickson","year":"2001","journal-title":"J Med Genet"},{"key":"B23-20240828","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1097\/00019605-200110000-00003","article-title":"Absent lacrimal ducts, distichiasis, dysmorphic features, and brachydactyly: A case report","volume":"10","author":"Holder-Espinasse","year":"2001","journal-title":"Clin Dysmorphol"},{"key":"B24-20240828","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.7150\/ijbs.13774","article-title":"Novel FOXC2 mutation in hereditary distichiasis impairs DNA-binding activity and transcriptional activation","volume":"12","author":"Zhang","year":"2016","journal-title":"Int J Biol Sci"},{"key":"B25-20240828","first-page":"98","article-title":"Novel FOXC2 missense mutation identified in patient with lymphedema-distichiasis syndrome and review","volume":"41","author":"Dellinger","year":"2008","journal-title":"Lymphology"},{"key":"B26-20240828","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1086\/316915","article-title":"Mutations in FOXC2 (MFH-1), a forkhead family transcription factor, are responsible for the hereditary lymphedema-distichiasis syndrome","volume":"67","author":"Fang","year":"2000","journal-title":"Am J Hum Genet"},{"key":"B27-20240828","first-page":"152","article-title":"Lymphedema-distichiasis syndrome without FOXC2 mutation: Evidence for chromosome 16 duplication upstream of FOXC2","volume":"42","author":"Witte","year":"2009","journal-title":"Lymphology"},{"key":"B28-20240828","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/ajmg.a.61935","article-title":"Lymphedema distichiasis syndrome may be caused by FOXC2 promoter-enhancer dissociation and disruption of a topological associated domain","volume":"185","author":"Wallis","year":"2021","journal-title":"Am J Med Genet A"},{"key":"B29-20240828","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1136\/bjo.70.2.132","article-title":"Corneal hypoaesthesia in asymptomatic familial distichiasis","volume":"70","author":"Kremer","year":"1986","journal-title":"Br J Ophthalmol"},{"key":"B31-20240828","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1001\/archpedi.1970.02100050345013","article-title":"Distichiasis lymphedema: A hereditary syndrome of multiple congenital defects","volume":"119","author":"Robinow","year":"1970","journal-title":"Am Dis Child"},{"key":"B32-20240828","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/S1091-8531(03)00144-7","article-title":"Mutation of the FOXC2 gene in familial distichiasis","volume":"7","author":"Brooks","year":"2003","journal-title":"J AAPOS"},{"key":"B33-20240828","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1097\/IOP.0b013e31819a44a1","article-title":"Conjunctival edema and distichiasis in association with congenital lymphedema of the lower legs","volume":"25","author":"Ramasubramanian","year":"2009","journal-title":"Ophthal Plast Reconstr Surg"},{"key":"B34-20240828","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1002\/(SICI)1096-8628(19961218)66:3<273::AID-AJMG7>3.0.CO;2-Q","article-title":"Distichiasis-Lymphedema syndrome: Tetralogy of Fallot, chylothorax, and neonatal death","volume":"66","author":"Chen","year":"1996","journal-title":"Am J Med Genet"},{"key":"B35-20240828","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1002\/pd.1832","article-title":"Perinatal diagnosis of a lymphedema-distichiasis syndrome (LD)","volume":"27","author":"B\u00fcchner","year":"2007","journal-title":"Prenat Diagn"},{"key":"B36-20240828","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1002\/pd.1901","article-title":"Perinatal diagnosis of a lymphoedema-distichiasis syndrome","volume":"28","author":"Brice","year":"2008","journal-title":"Prenat Diagn"},{"key":"B37-20240828","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.sjopt.2017.05.003","article-title":"Congenital distichiasis: Histopathological report of 3 cases","volume":"31","author":"Alkatan","year":"2017","journal-title":"Saudi J Ophthalmol"},{"key":"B38-20240828","doi-asserted-by":"crossref","first-page":"192","DOI":"10.26719\/2004.10.1-2.192","article-title":"Distichiasis and dysplastic eyelashes in trachomatous trichiasis cases in Oman: A case series","volume":"10","author":"Khandekar","year":"2004","journal-title":"East Mediterr Health J"},{"key":"B39-20240828","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/S0002-9394(14)77425-2","article-title":"Localized distichiasis after tarsorrhaphy","volume":"114","author":"Perusse","year":"1992","journal-title":"Am J Ophthalmol"},{"key":"B40-20240828","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1111\/tbj.13697","article-title":"Distichiasis in association with entropion in metastatic HER2-positive breast cancer treated by pertuzumab, trastuzumab, and docetaxel combination chemotherapy","volume":"26","author":"Tas","year":"2020","journal-title":"Breast J"},{"key":"B41-20240828","first-page":"491","article-title":"Distichiasis complicating allergic rhinoconjunctivitis","volume":"132","author":"Friday","year":"1978","journal-title":"Am J Dis Child"},{"key":"B42-20240828","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1016\/S0161-6420(87)80013-1","article-title":"An experimental study to compare methods of eyelash ablation","volume":"94","author":"Bartley","year":"1987","journal-title":"Ophthalmology"},{"key":"B43-20240828","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/01.iop.0000229872.81219.9e","article-title":"Treatment of trichiasis and distichiasis by eyelash trephination","volume":"22","author":"McCracken","year":"2006","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"B44-20240828","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1080\/01676830.2017.1383454","article-title":"A new surgical technique for congenital distichiasis","volume":"37","author":"Galindo-Ferreiro","year":"2018","journal-title":"Orbit"},{"key":"B45-20240828","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1097\/IOP.0000000000001037","article-title":"Lymphedema-distichiasis syndrome in a male patient followed for 16 years","volume":"34","author":"Grisolia","year":"2018","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"B46-20240828","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/00002341-199703000-00004","article-title":"Anatomy and physiology of eyelash follicles: Relevance to lash ablation procedures","volume":"13","author":"Elder","year":"1997","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"B47-20240828","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1097\/00002341-199203000-00009","article-title":"Argon laser treatment for trichiasis","volume":"8","author":"Huneke","year":"1992","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"B48-20240828","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/j.1442-9071.1984.tb01146.x","article-title":"A simplified cryotherapy technique for trichiasis and distichiasis","volume":"12","author":"Delaney","year":"1984","journal-title":"Aust J Ophthalmol"},{"key":"B49-20240828","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1001\/archopht.1981.03930010462014","article-title":"Complications of cryosurgery","volume":"99","author":"Wood","year":"1981","journal-title":"Arch Ophthalmol"},{"key":"B50-20240828","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1080\/01676830.2018.1546749","article-title":"A new perspective in oculoplastic surgical management of symptomatic distichiasis in lymphedema-distichiasis syndrome","volume":"38","author":"Sheth","year":"2019","journal-title":"Orbit"},{"key":"B51-20240828","first-page":"182","article-title":"Distichiasis vrai des quatre paupieres du au development de poils a Porofice de glands e Meibomius","volume":"1","author":"Nicati","year":"1880","journal-title":"Arch Ophtalmol"},{"key":"B52-20240828","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/0002-9394(75)90216-0","article-title":"Correction of distichiasis by tarsal resection and mucous membrane grafting","volume":"80","author":"White","year":"1975","journal-title":"Am J Ophthalmol"},{"key":"B53-20240828","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1001\/archopht.1976.03910030403010","article-title":"Surgical repair for distichiasis, trichiasis, and entropion","volume":"94","author":"Fein","year":"1976","journal-title":"Arch Ophthalmol"},{"key":"B54-20240828","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1080\/01676830.2020.1782439","article-title":"Labial mucosa grafting for lid margin, anterior- and posterior lamellar correction in recurrent cicatricial entropion","volume":"40","author":"Singh","year":"2021","journal-title":"Orbit"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijo.IJO_1141_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:09:58Z","timestamp":1787166598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijo.IJO_1141_21"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,22]]},"references-count":52,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_1141_21","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,22]]},"assertion":[{"value":"2021-05-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-27","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}