Distichiasis is the congenital condition of partial or complete accessory rows of eyelashes which exit from the posterior lid margin at or near the meibomian gland orifices. A series of 24 patients with distichiasis is presented with clinical features and results of treatment. The treatment modes of epilation, lid margin cryotherapy, or eyelid splitting cryotherapy to the posterior lamella are evaluated. The latter was found to effectively relieve symptoms without retreatment in 87% patients. Keratinisation of the lid margin was found at long term follow up in a few cases and retinoic acid has been used successfully in the treatment of this. Two previously unreported associations of distichiasis are Pierre Robin syndrome and idiopathic eyelid oedema. A family history of distichiasis was found in 50% patients, and of distichiasis with lymphoedema in 30%.