Noticing that your eyelashes are starting to disappear can be upsetting, to say the least. Maybe you’ve noticed that lashes come off when you take off your makeup, or perhaps there are visible gaps in your lash line. Experiencing any of this should prompt you to ask: Why are my eyelashes falling out? Our lashes frame our eyes and keep them safe from debris and dust. If you suddenly lose more eyelashes than normal, you’re absolutely right to be concerned. It could be a sign of a major underlying health condition, or it could just be a signal that you’re a little too rough with your lashes.
It’s natural for things to fall in the Fall, like leaves and temperatures, and it’s also natural that eyelashes fall out all year long. Like hair, eyelashes grow, fall out and replace themselves every six to 10 weeks. On average, we lose between one and five lashes every day. Losing a few lashes per day is totally normal. The hair all over our bodies, including our lashes, has a life cycle. Lash loss stops normal when you consistently lose more than five lashes a day and start seeing visible thinning along your lash line. Madarosis is a condition in which people may lose more lashes than average.
Madarosis is the medical term for any condition or issue that makes your eyebrows or eyelashes fall out. Your eyebrows protect the bones above your eyes. They also act like built-in sweatbands and prevent sweat from running down your forehead into your eyes. Your eyelashes act like filters that protect your eyes from dust and other small pieces of debris. They also trigger your eye’s natural reflex to blink or close if they’re disturbed. Madarosis is different than the usual amount of hair or eyelashes you lose every day. It’s perfectly normal to find a few eyelashes on your pillow in the morning or see some hair on your washcloth after washing your face. If you’re experiencing madarosis, you’ll lose hair faster than usual, including in larger amounts or chunks than you typically do. All of your hair is part of a growth cycle - new strands grow and take the place of older ones. Madarosis and other types of hair loss happen when you’re losing more than your hair follicles can naturally replace. Depending on what’s causing madarosis, you’ll probably notice other symptoms in the skin on or near your eyes. A healthcare provider or eye care specialist will diagnose and treat the condition that’s causing your eyebrows or eyelashes to fall out. How madarosis is treated depends on what’s causing your eyebrows or eyelashes to fall out. Visit a healthcare provider or eye care specialist as soon as you notice any hair loss - especially if you’re experiencing other symptoms like pain or skin discoloration.
Madarosis can cause two types of hair loss - your eyebrows and eyelashes. Madarosis that makes your eyebrows fall out is called superciliary madarosis. Madarosis that affects your eyelashes is called ciliary madarosis. Some conditions that cause madarosis lead to scarring on or under your skin.
There are numerous terms used to describe the isolated loss of eyelashes. Milphosis refers to the falling out of eyelashes. Although a synonymous term often used to describe eyelash loss from any cause, madarosis was originally used to describe eyelash loss resulting from a destructive process. Madarosis may also be used to describe loss of brow hairs. Alopecia is a more general term used to describe the absence or loss of hair from any skin area where it is normally present. Alopecia areata is a relatively common condition of undetermined etiology that involves a circumscribed patchy loss of hair in several areas including the scalp, brows, eyelashes, and bearded portion of the face. Alopecia adnata has been used to describe eyelash loss but more appropriately refers to an underdevelopment of the eyelashes rather than a falling out or loss of the eyelashes as in milphosis or madarosis. The term trichotillomania refers to a rare form of hair/eyelash loss resulting from avulsion of hairs by the patient.
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There are so many potential reasons you might be losing eyelashes at an increased rate. Loss of eyelashes may occur with several conditions, including a variety of skin diseases, drug side effects, endocrine disorders, metabolic abnormalities, traumatic insults, inflammations, toxins, psychiatric disorders, and systemic disease. If the history and results of clinical, laboratory, and consultative assessments are negative, one must consider the possibility the patient is pulling them out (trichotillomania).
The most common reason for lash loss is friction and pulling from makeup, especially during the mascara removal process. Research shows that the more often one wears mascara, the greater the likelihood of lash loss. Irritation from cosmetics. Leaving eye makeup on for too long, application of lash extensions, removal of lash extensions, use of eyelash curlers, and removal of waterproof mascara can all harm lashes and speed up shedding.
Aside from makeup, other forms of friction can lead to lash loss. Anything that exerts pressure on your lashes may cause them to fall out prematurely. This includes sleeping on your stomach with your face pressed against the pillow, rubbing your eyes when tired, and more. Breaking such habits can be difficult, but it’s worth the effort.
If you’re a fan of lash extensions, paying attention to signs that the application or removal is causing your lash loss is important. Removing your lash extensions incorrectly can also result in pulling out your natural lashes.
Blepharitis is the medical term for eyelid inflammation. Are your eyelids itchy, burning, red or swollen? Do you experience crusting on your lashes in the morning? You may have a common condition known as blepharitis, a chronic inflammation caused by overpopulation of human bacteria on the lids and lashes or clogged oil glands near the base of the eyelashes. Its main symptoms are eyelid pain, itchiness, and crusting, often with some redness and swelling. This condition is usually chronic, but it can also crop up temporarily as a reaction to external irritants or pathogens, including bacterial infections, mites, allergens, and more. Infections from other pathogens, including bacteria and viruses, may be the cause of madarosis, particularly infections of the eyelid. Furthermore, bacterial infections in the eyelid and eyelash follicles can cause inflammation of the eyelid, known as blepharitis. In cases like this, the eyelid will be swollen, reddish, warm feeling, and sore.
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Demodex mites: One strong possibility is infestation by demodex mites, also known as “eyelash mites.” These are microscopic bugs that live on the skin around your eyes, spend most of their time living in hair follicles or sebaceous (oil) glands, and eat oils and dead skin cells. Demodex infestations are very common, though most people who maintain proper ocular hygiene do not present any symptoms. Around 69% of adults between the ages of 31-50 have been found to have demodex mites, and the percentage of affected individuals increases with age to 80% in people over 60 and virtually 100% in people over the age of 80. Therefore, demodex mites should be the first suspects in a new case of madarosis. An optometrist can easily help you find out if you are suffering from a demodex infestation.
Many other health conditions impact the skin or eyes and may lead to losing eyelashes. Dermatological conditions affecting the area of the eyes can also be a cause of madarosis, as can any condition that causes irritation at the eyelids. This includes inflammatory skin conditions such as rosacea and styes that can impact the eyes or eyelids. Certain auto-immune conditions cause skin inflammation, such as psoriasis and lupus. They may cause lash loss if the inflammation impacts the eye area. Discoid lupus erythematosus presenting as madarosis.
Alopecia areata is an auto-immune condition that may cause lashes to fall out. This condition can show up at any point in life. While the hair will often grow back within a year, hair loss can recur on and off for the rest of a person's life.
Hormones, especially our sex and thyroid hormones, play a big role in regulating the hair growth cycle. This is most common after pregnancy, during menopause, or after stopping medications that impact hormones. The hair and lashes normally resume normal function once the body finds its hormonal equilibrium. Serum TSH was slightly high at 5.8 mU/L (normal = 0.3 to 4.7 mU/L) indicating possible hypothyroidism. Serum calcium was normal; however, serum TSH was slightly high at 5.8 mU/L (normal = 0.3 to 4.7 mU/L) indicating possible hypothyroidism. The patient was seen by an endocrinologist, who confirmed the slightly high TSH, a low T4 (13 pmol/L [normal = 9.1 to 23.8 pmol/L]), and the presence of antithyroid antibodies.
Thyroid problems, including hyperthyroidism, hypothyroidism, and hypoparathyroidism, as well as low levels of pituitary hormones, can also cause hair loss in extreme cases. Eyelash loss as the presenting sign of thyroid dysfunction is uncommon. The diagnosis, however, can be facilitated by confirming symptoms and signs of thyroid disease as well as abnormal thyroid function tests (case 3).
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Those undergoing cancer treatments, and especially chemotherapy, commonly experience eyelash loss, along with loss of hair from the head and brows. Chemotherapy treatment works by attacking any growing cells, including the cells making hair in your lash and hair follicle.
Lash loss can be a symptom of eyelid cancer, usually along with other visible changes to the lash line, such as discolored growths or lesions that won’t heal. Treatment is complex and requires doctors with multiple specialities.
When your body is missing out on key nutrients, it can’t properly repair and renew itself, which can result in hair and lash thinning. Certain dietary insufficiencies, such as inadequate intake of protein, biotin, zinc, or iron can all cause hair loss, as well as severe overall malnutrition.
Trichotillomania (or trich for short) is a mental health condition that leads to hair or lash pulling. Emotional or psychological distress can cause a person to pull out their own eyelashes habitually. It’s often accompanied by stress, anxiety, or obsessive-compulsive disorder. This condition makes it nearly impossible to resist the urge to pull out hair, often leading to bald patches or total eyelash loss. Trichotillomania is more common in women, and the most common site for hair pulling is the central region of the scalp followed by the eyebrows and eyelashes. The patients generally present with a history of eyelashes falling out, as in our patient, with no clear explanation.
Failing to keep your lashes clean can result in lash loss. Dust, mites, and bacteria can irritate the lash line, leading to inflammation or clogged glands (i.e., styes). This is why washing your lashes and removing makeup completely at the end of the day is important. To help keep your lashes healthy, wash your face and eyelids daily with gentle soap and water.
It's normal to experience lash shedding during periods of extreme stress (as well as regular hair loss). Stress spikes the cortisol levels in the body, pushing hair and lashes into the telogen phase.
When faced with a patient having eyelash loss, a thorough medical history is essential as it may offer clues to the diagnosis. Current or past skin problems, endocrinologic disorders (hypo- or hyperthyroidism), previous lid infections (herpes zoster), previous lid surgery, other systemic conditions (e.g., lupus), as well as a variety of other conditions all may have eyelash loss associated with them. There is a lengthy list of medications that may potentially cause drug-induced hair loss. It is important to determine the potential side effects of any medication the patient is using. One must examine the eyelids and eyelash roots, searching for clues to the diagnosis (e.g., the collarettes and telangiectasia of blepharitis). Other areas of hair loss are also important to document as in the patients described herein. If no clues are seen clinically, a few laboratory tests such as TSH and calcium level may be helpful to detect an underlying systemic condition (e.g., thyroid dysfunction, hypoparathyroidism) that may potentially have hair loss associated with it. A dermatologic consultation is also beneficial to determine if there are other areas of hair loss or any signs of a skin disorder that may be associated with hair loss.
Some of the health conditions that lead to lash loss are quite severe. If your lashes are falling out, you may need to consult your doctor on an appropriate treatment plan.
How madarosis is treated depends on what’s causing your eyebrows or eyelashes to fall out. Be sure to consult with your eye care provider before trying over-the-counter lash serums, as these can cause adverse reactions such as inflammation, redness on site of application and changes in eye pressure.
Your eyelashes can be a very visible indicator of your overall eye health. Sleek, sturdy lashes show that the hair follicles in your eyelids are doing well, and are not being negatively impacted by any health conditions in the area of the eyes. On the other hand, eyelashes that are loose, brittle, or flaky suggest that something problematic is going on.
Glands in the eyelid naturally lubricate lashes, so lotions and conditioners are not necessary unless lashes feel excessively dry. Several products are marketed to promote lash growth, among them Latisse®, which is FDA-approved and shown to have consistent eyelash growth results. Since any medication can carry risks, speak to your Atlantic Eye physician to help you weigh the pros and cons of this product.
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