Eyelash Loss: Causes, Diagnosis, and Management

Eyelashes serve a crucial protective function for the eyes, acting as filters against dust and debris and triggering the blink reflex. While the occasional eyelash falling out is normal, excessive eyelash loss, known medically as madarosis, can be a cause for concern. This article explores the various causes of eyelash loss, diagnostic approaches, and potential management strategies.

What is Madarosis?

Madarosis refers to the loss of eyelashes or eyebrows. It is important to distinguish madarosis from the normal shedding of a few eyelashes daily, which is a natural part of the eyelash growth cycle. Madarosis is diagnosed when hair loss is faster than usual, including losing large amounts or chunks of hair.

Madarosis can affect either the eyebrows (superciliary madarosis) or the eyelashes (ciliary madarosis). In non-scarring madarosis, the hair follicles are retained, making the condition potentially reversible. However, some conditions may lead to scarring madarosis, where the hair follicles are destroyed.

The Natural Eyelash Growth Cycle

Similar to hair on the head, eyelashes have a natural growth cycle consisting of three phases:

• Anagen Phase: This is the active growth period, lasting approximately two weeks. If an eyelash falls out during this phase, it will not immediately regrow.
• Catagen Phase: A short transition phase where the hair follicle shrinks.
• Telogen Phase: This is the resting phase, lasting four to nine months, before the eyelash falls out and a new one grows in its place.

The complete eyelash cycle can last from five to 11 months. At any given time, eyelashes are in different phases of this cycle, which explains why it's normal to lose a few lashes each day. The average adult has 100 to 150 upper eyelashes and 50 to 75 lower eyelashes on each lid.

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Causes of Eyelash Loss

Eyelash loss can result from various factors, including local issues, systemic diseases, medications, and behavioral habits.

Local Factors

• Blepharitis: This common condition involves inflammation of the eyelids, often caused by bacterial overgrowth or clogged oil glands at the base of the eyelashes. Symptoms include itchy, burning, red, or swollen eyelids, and crusting on the lashes.
• Irritation from Cosmetics: Improper use or sensitivity to eye makeup can damage eyelashes. This includes leaving eye makeup on for extended periods, using eyelash extensions, improper removal of lash extensions, frequent use of eyelash curlers, and aggressive removal of waterproof mascara. Allergic reactions to mascara can also contribute to eyelash loss.
• Trauma: Physical trauma to the eyelids, including rubbing or tugging at the lashes (especially when coated with mascara), can cause them to fall out. Additionally, the use of eyelash curlers can lead to lash breakage and loss. Careless removal of false eyelashes and extensions can also pull out natural lashes due to the strong adhesive used.
• Infections: Chronic or recurrent infections of the eyelids or surrounding skin can lead to madarosis.

Systemic Diseases

Eyelash loss can be a symptom of underlying systemic conditions, including:

• Thyroid Disorders: Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can disrupt the hair growth cycle, leading to eyelash loss.
• Alopecia Areata: This autoimmune condition causes patchy hair loss, which can affect the scalp, eyebrows, and eyelashes. Eyelash loss may sometimes be the initial manifestation of alopecia areata.
• Lupus: This autoimmune disease can cause inflammation and hair loss, including eyelash loss.
• Scleroderma: This connective tissue disorder can affect the skin and internal organs, sometimes leading to hair loss.

Medications

Certain medications can cause hair loss as a side effect, potentially affecting the eyelashes. It is important to review potential side effects of all medications a patient is taking.

Behavioral Factors

• Trichotillomania: This psychological disorder involves the compulsive urge to pull out one's own hair, including eyelashes. Patients with trichotillomania may deny pulling their eyelashes, making diagnosis challenging.

Diagnosis of Eyelash Loss

Diagnosing the cause of eyelash loss involves a thorough medical history, physical examination, and potentially laboratory testing.

Medical History

A detailed history should include:

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• Onset and progression of eyelash loss: When did the eyelash loss begin, and how has it progressed?
• Associated symptoms: Are there any other symptoms, such as itching, burning, redness, or swelling of the eyelids?
• Past and present skin conditions: History of skin diseases, such as eczema or psoriasis, can provide clues.
• Systemic diseases: A history of thyroid disorders, autoimmune diseases, or other systemic conditions is important.
• Medications: A complete list of current and past medications should be reviewed.
• Family history: A family history of hair loss or thyroid disorders may be relevant.
• Psychological factors: Assess for stress, anxiety, or other emotional factors that could contribute to trichotillomania.

Physical Examination

A thorough examination should include:

• Eyelid examination: Assess the eyelids for signs of inflammation (blepharitis), infection, trauma, or scarring. Look for collarettes (crusts) and telangiectasia (small blood vessels) associated with blepharitis.
• Eyelash examination: Note the pattern and extent of eyelash loss. Look for broken eyelashes, which may suggest trichotillomania or trauma.
• Examination of other hair-bearing areas: Assess for hair loss on the scalp, eyebrows, or other areas of the body.
• Dermatological consultation: A dermatologist can assess for other signs of skin disorders that may be associated with hair loss.

Laboratory Tests

Depending on the clinical findings, laboratory tests may be helpful to identify underlying systemic conditions. These may include:

• Thyroid-stimulating hormone (TSH): To evaluate for thyroid dysfunction.
• Serum calcium: To assess for hypoparathyroidism.

Additional Diagnostic Procedures

• Microscopic Examination of Hairs: Collecting hairs and examining the roots may help differentiate alopecia areata from other diseases causing hair loss such as trichotillomania. Scalp hairs that have been epilated usually show 80 to 90% in anagen (growing) and 10 to 20% in telogen (resting) phase.
• Skin Biopsy: A skin biopsy may help differentiate alopecia areata from trichotillomania.

Management of Eyelash Loss

The treatment of eyelash loss depends on the underlying cause.

Addressing Underlying Medical Conditions

If eyelash loss is caused by an underlying medical condition, such as thyroid disease or blepharitis, treating the condition may restore eyelash growth.

• 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.
• Hyperthyroidism: Within 3 months of initiating the propylthiouracil, the eyelashes started to grow back and the area of hair loss over the occiput had begun to fill in. Nineteen months later the eyelashes showed continued growth and the patient remained euthyroid.
• Blepharitis: 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.

Lifestyle Modifications

Small changes to daily habits can prevent excessive eyelash loss:

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• Gentle Makeup Removal: Rubbing or tugging at lashes, particularly when coated with mascara, can make them fall out. Use a gentle makeup remover and a soft touch.
• Avoid Harsh Products: If you wear mascara and your eyelashes fall out excessively, you may be allergic to the product. If you use waterproof mascara, try switching to a non-waterproof formula.
• Take off makeup before bed: Eyelashes coated with mascara are more brittle and prone to breakage. Rubbing against your pillow all night may also cause them to fall out.
• Limit Eyelash Curling: These devices can cause eyelashes to come out, especially if you tug or use them while wearing mascara.
• Careful Removal of False Eyelashes and Extensions: Be sure to use a gentle, oil-based cleanser. Or let extensions fall off naturally.
• Healthy Diet: Good nutrition supports eyelash growth, as well as overall health. A diet rich in protein, biotin, vitamins A and C, niacin, and iron can help promote healthy eyelash growth.

Medical Treatments

If there isn’t a root cause for your eyelash loss and you wish to speed up lash growth, there are several medically sound ways to do this.

• Latisse (bimatoprost): Latisse is a topical treatment approved by the Food and Drug Administration (FDA) to enhance eyelash growth. It increases the number of hair follicles produced during the active growth (anagen) phase and can lengthen and darken lashes. Since any medication can carry risks, speak to your Atlantic Eye physician to help you weigh the pros and cons of this product.
• Over-the-Counter Lash Serums: 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.

Nutritional Support

Good nutrition supports eyelash growth, as well as overall health. Here are some nutrients that may help eyelash production.

• Protein: Your hair is comprised largely of protein, so a diet high in this building block is vital. Protein provides the body with amino acids, which are needed to produce keratin. Keratin can help eyelashes remain healthy and strong.
• Biotin: Biotin also supports keratin production. It’s found in many foods, including: nutscauliflowerbroccolikaleonionswhole grains
• Fruits and vegetables containing vitamins A and C: Thesefruits and vegetables help encourage eyelash growth by supporting cell and collagen production. Options include: dark orange and yellow fruits and vegetablesberriesavocados
• Niacin: Niacin (vitamin B-3) helps improve blood flow to hair follicles, stimulating growth. Niacin is found in: chicken fishbeefturkeypeanutsgreen peasavocados
• Iron: A diet lacking in iron can cause many eyelashes to go into their resting phase at one time. Eating foods rich in iron may help prevent this. These include: dark, leafy greens such as spinach dried fruit poultryseafoodbeansiron-fortified cereals
• Multivitamins: You can supplement your diet with a multivitamin to ensure you’re getting essential nutrients. Although a number of brands are specifically geared towards hair, nail, and skin health, any high-quality multivitamin should do the trick. Make sure the one you choose provides 100 percent of the recommended daily intake.

tags: #eyelash #loss #causes

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