Distichiasis is a condition of the eyelashes wherein the lashes or hairs are associated with and arise from the meibomian orifices. It can be congenital or acquired. Chronic inflammatory diseases of the eyelids and/or the conjunctiva are the major etiologic reason for the acquired form. This includes chronic cicatricial pemphigoid, erythema multiform, chemical injury, trachoma, chronic blepharitis, and chronic allergies. The acquired form is more likely to involve the lower eyelids. The congenital form is dominantly inherited with complete penetrance. The congenital form may be an isolated finding or associated with ptosis, strabismus, congenital heart defects, or mandibulofacial dysostosis. Pain, tearing, photophobia, foreign body feeling, and blurry vision are all possible symptoms associated with distichiasis.