Acquired Distichiasis in Dermatomyositis: A Possible Delayed Sequela of Chronic Periocular Inflammation

Acquired distichiasis is an uncommon eyelid disorder characterized by an accessory row of eyelashes arising from the meibomian gland orifices, most often in the setting of chronic inflammatory or cicatricial disease. We report a case of a 65-year-old woman with longstanding dermatomyositis, recurrent periocular inflammation, and episodes of blepharitis who developed bilateral upper-eyelid distichiasis. Review of clinical photographs from 2020 and from a severe periocular flare in 2023 showed no clearly visible accessory row. At follow-up in January 2026, clinical and dermoscopic examination demonstrated bilateral accessory rows of long, pigmented eyelashes, findings consistent with acquired distichiasis. The patient had no ocular irritation or visual symptoms, and ophthalmologic evaluation found neither trichiasis nor corneal involvement. There was no history of Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, chemical injury, or eyelid surgery. However, recurrent blepharitis and previous exposure to docetaxel in 2018 were important alternative or contributing factors. Chronic periocular inflammation associated with dermatomyositis may have promoted eyelid margin remodeling and metaplastic changes in the meibomian glands, but a causal relationship cannot be established from a single case. Because the patient was asymptomatic and had no corneal complications, observation with regular ophthalmologic monitoring was selected. This case highlights the need to examine the eyelid margins in patients with chronic periocular inflammation and to consider both inflammatory and treatment-related contributors to acquired distichiasis.