Noticing thinning eyelashes can be alarming. Lashes protect our eyes from debris, so losing them raises concerns about both aesthetics and eye health. While shedding a few lashes daily is normal, excessive loss warrants investigation. This article delves into the potential causes of eyelash loss, when to seek medical advice, and what steps you can take to address the issue.
Like all hair, eyelashes have a natural growth cycle. Losing one to five lashes a day is considered normal. However, when lash loss exceeds this amount consistently, leading to visible thinning, it's time to investigate the underlying cause.
Several factors can contribute to increased eyelash shedding. Here's a breakdown of the most frequent culprits:
The most common reason for lash loss is friction and pulling, often related to makeup application and removal, especially mascara. Research indicates a correlation between frequent mascara use and lash loss. Removing waterproof mascara and lash extensions, and using eyelash curlers can also harm lashes and speed up shedding.
Aside from makeup, any form of friction or pressure on the lashes can cause them to fall out prematurely. This includes:
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Blepharitis, or eyelid inflammation, is a common condition that can lead to lash loss. Symptoms include:
Blepharitis can be chronic or triggered by external irritants or pathogens, such as bacterial infections, mites, or allergens. The inflammation caused by blepharitis can disrupt the hair follicles and lead to lash loss. To help keep your lashes healthy, wash your face and eyelids daily with gentle soap and water. Glands in the eyelid naturally lubricate lashes, so lotions and conditioners are not necessary unless lashes feel excessively dry.
Various skin and autoimmune conditions can affect the eyes and eyelids, leading to eyelash loss. These include:
If inflammation impacts the eye area, it can disrupt lash growth.
Alopecia areata is an autoimmune condition that can cause hair loss anywhere on the body, including the eyelashes. Hair loss may recur on and off for the rest of a person's life. 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.
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Hormones, particularly sex and thyroid hormones, play a crucial role in regulating the hair growth cycle. Hormonal imbalances can trigger lash loss, often observed:
Lashes usually resume normal growth once hormonal balance is restored. A 25-year-old woman was seen in consultation for loss of lashes involving all four eyelids. 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. The patient was felt to have a compensated hypothyroidism consistent with Hoshimoto's thyroiditis. Follow up was recommended as she was at risk of becoming more hypothyroid.
Chemotherapy, in particular, commonly causes eyelash loss, along with hair loss on the head and brows. Chemotherapy targets rapidly growing cells, including those in hair follicles.
Lash loss can be a symptom of eyelid cancer, usually accompanied by other visible changes to the lash line, such as discolored growths or lesions that don’t heal.
When the body lacks essential nutrients, it cannot repair and renew itself effectively, potentially leading to hair and lash thinning.
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Trichotillomania is a mental health condition characterized by the compulsive urge to pull out hair, including eyelashes. This condition is often accompanied by stress, anxiety, or obsessive-compulsive disorder, making it difficult to resist the urge, often leading to bald patches or total eyelash loss.
Improper application or removal of lash extensions can damage natural lashes, leading to premature shedding. 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.
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.
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.
The medical term for the loss of eyelashes or eyebrows is madarosis. In non-scarring madarosis, the hair follicles are retained, making the condition potentially reversible. Madarosis can be diagnosed through a thorough medical history and examination.
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.
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.
Collecting hairs and examining the roots may have been helpful in differentiating alopecia areata from other diseases causing hair loss such as trichotillomania. The anagen or growing hair root found in trichotillomania is easy to distinguish from the normal telogen or resting hair root. Skin biopsy may also help differentiate alopecia areata from trichotillomania. The characteristic features of trichotillomania on skin biopsy include plugging of the empty follicles with heavily pigmented, soft keratinous material and a varying degree of atrophy.
Given that some causes of lash loss can be linked to underlying health issues, consulting a doctor is advisable if you experience:
The specific treatment for eyelash loss depends on the underlying cause. Some common approaches include:
Addressing underlying medical conditions: Treating conditions like thyroid disorders or autoimmune diseases can help restore normal lash growth. For madarosis caused by bacterial infection, antibiotics are recommended.
Improving hygiene: Keeping the eyelids and lashes clean can help prevent blepharitis and other infections.
Changing makeup habits: Using gentle makeup removers, avoiding excessive mascara use, and being careful with lash extensions can minimize friction and damage.
Managing stress: Finding healthy ways to manage stress can help reduce lash shedding associated with high cortisol levels.
Medications: Several products are marketed to promote lash growth, among them Latisse®, which is FDA-approved and shown to have consistent eyelash growth results. 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.
