Eyelashes are important anatomical structures that protect the eye by preventing particulate matter from reaching it and by diverting wind and water. Eyelashes also have strong tactile sensitivity, allowing them to detect foreign particles and trigger appropriate responses from the eyelids. Many congenital and acquired diseases and conditions can affect your delicate lashes. It is important to identify the cause and recognise how the lashes behave differently from normal before treating them appropriately.
- Trichiasis
Trichiasis is a condition in which a normal lash grows inward. During this condition, the lash follicle is normal, but the direction of lash growth is abnormal. Because of the inflammation, there may be a misdirection of the follicle, with the lash growing inwards toward the cornea. In most cases, trichiasis affects the lower eyelid. Causes of Trichiasis include chemical burns, thermal injury, chronic blepharitis, atopic diseases, eyelid trauma, eyelid surgery, herpes zoster, leprosy, eyelid tumours, vernal keratoconjunctivitis, and chalazia.
In most cases, trichiasis affects the lower eyelid; in chemical burns, both eyelids are affected; and in trachoma, the upper eyelid is more severely affected. Chlamydia trachomatis gives rise to trachoma. Trachoma, eyelid margin, and conjunctival inflammation can cause a combination of trichiasis and entropion. Scarring of the cornea and corneal opacification can occur.
Management of Trichiasis
Epilating the eyelashes or inserting a bandage contact lens may provide short-term relief. Surgical treatment is recommended only after active inflammation is under control. Numerous techniques can permanently destroy the roots of the offending eyelashes. These techniques include electrolysis, argon laser, epilation, radiofrequency, eyelash bulb extirpation, cryotherapy, surgical repositioning, trephination, and resection of the lash follicle.
- Distichiasis
Distichiasis is a condition in which a separate row of eyelashes forms behind the normal row. These eyelashes are fine, with little pigmentation, but may contribute to corneal irritation. Different forms of distichiasis are seen, from a complete row to an irregular row. Distichiasis may be congenital. Other congenital causes of distichiasis include focal facial dermal dysplasia, in which upper eyelid lashes are present in multiple rows, which may be completely absent.
Secondary distichiasis is seen in conditions that cause inflammation, leading to metaplasia of the meibomian glands and the formation of eyelashes within them. These conditions are like those causing trichiasis, including caustic injuries, meibomian gland dysfunction, blepharitis, and Stevens-Johnson syndrome.
Management of Distichiasis
The treatment includes epilation, trephination, cryotherapy, folliculectomy, lid split, treatment of abnormal follicles, and radiofrequency treatment.
- Tristichia/Tetrastichiasis
This condition is defined as the presence of a third row of eyelashes. Tetrastichiasis is the presence of a fourth row of eyelashes.
Management of Tristichia
Consult your dermatologist to find the appropriate solution for this condition.
- Hypotrichosis
Hypotrichosis is defined as reduced hair density anywhere in the body and may also affect delicate lashes. The only effective treatment for this condition is topical bimatoprost ophthalmic solution 0.03%. It is applied to the base of the lash line, resulting in thicker, darker, and longer eyelashes. Results are seen in sixteen weeks. Side effects of careprost bimatoprost include increased skin pigmentation, iris pigmentation, and skin irritation. However, these effects will reverse with the discontinuation of the medicine.
- Alopecia Adnata
This term describes underdeveloped eyelashes. Alopecia areata is thought to be an autoimmune process and can also affect eyelashes.
Management of Alopecia adnata
Alopecia Areata is an autoimmune disorder and is not curable. Discuss the appropriate management of this condition with your dermatologist.
- Madarosis
Madarosis is the loss of eyelashes. In most cases, psychiatric evaluation and treatment are required. Causes may include blepharitis, ocular rosacea, trachoma, certain congenital syndromes, psoriasis, chemotherapy, seborrheic blepharitis, staphylococcal infection, etc.
Management of Madarosis
Given this list of causes of eyelash madarosis, the underlying condition must be diagnosed and treated. Eyelash transplants have not gained widespread acceptance due to the risk of trichiasis and the lack of hair on the lid margin.
Zinc nutritional deficiency has been reported to cause eyelash alopecia. Acrodermatitis enteropathic, an inherited disorder of abnormal zinc absorption, has also been shown to cause diffuse eyelash loss.
The bottom line!
To maintain eyelash health, it is also important to recognise any changes you notice. In most eyelash conditions, early treatment leads to better outcomes. Having a few stray lashes may seem unimportant, but it is best to check with your healthcare specialist. Even if there’s a mild issue, your healthcare provider can help you find a solution. If it’s a serious condition like trichiasis, ensure you receive the treatment before your eyes are damaged.
