What is Cilia Incarnata (Eyelashes Growing in the Wrong Direction)?
Eyelashes develop from a type of skin cell between 22 and 26 weeks of pregnancy. The length of eyelashes varies from person to person. They grow until a certain point, then fall out naturally, and don’t need to be shortened unless the growth of the lashes is exceptionally long. If an eyelash is pulled out, it can take around 8 weeks to grow back. It’s interesting to note that eyelash growth isn’t affected by puberty.
Eyelash roots penetrate about 2.4 millimeters deep in the upper eyelid, and 1.4 millimeters in the lower lid. The upper lid has more active eyelash roots compared to the lower lid. The purpose of eyelashes is to shield the eyes from dust and other small particles. They are also very sensitive to touch, which helps protect the eyes further. The lower eyelid of a human has 75 to 80 lashes arranged in 3-4 rows, while the upper eyelid has 90 to 160 lashes spread over 5-6 rows. Each eyelash has a hair shaft that extends outside the skin, a root beneath the skin, and a bulb at the end. The lower portion of the bulb connects with a tissue layer that plays a crucial role in hair growth.
Eyelid skin is thinner than scalp skin, having only two layers rather than three. Unlike scalp hair, lashes don’t have tiny muscles that make them stand on end when you are cold or very emotional.
This piece also introduces a condition called Cilia incarnata, where eyelashes grow waywardly, either under the skin or back towards the eye, rather than normally from the eyelid edge. Two kinds are identified:
1. Cilium incarnatum internum
2. Cilium incarnatum externum
The terms originate from Latin. ‘Cilium’ meaning ‘lash’ and ‘incarnata’ meaning ‘made to become flesh.’ The terms can mislead to think there is inflammation or redness, which is not the case in Cilia incarnatum. Instead, these conditions can be called ‘Cilium crescere internum’ (lash growing inward) and ‘Cilium crescere externum’ (lash growing outward).
What Causes Cilia Incarnata (Eyelashes Growing in the Wrong Direction)?
In the conditions known as cilium incarnatum internum and cilium incarnatum externum, the origin of the eyelashes is normal. It was suggested by Bloch that the lashes in these cases grow beneath a thin membrane covering the eye, known as the conjunctiva, and then pierce through a part of the eyelid called the tarsus. The lashes can then irritate the eye and cornea or grow underneath the skin if they run into an obstacle while growing, taking the path of least resistance.
If an eyelash grows in the wrong direction into an area under the skin, it might either continue growing underneath the skin (in the case of externum) or curve and grow more inward (in case of internum). Interestingly, there doesn’t seem to be a physical reason preventing such misdirected growth of lashes, as no irregularities or local inflammation are usually seen in either condition.
Risk Factors and Frequency for Cilia Incarnata (Eyelashes Growing in the Wrong Direction)
There are two conditions being discussed here, and they’re both quite rare. Only a handful of cases have been documented. This could be because these conditions might get overlooked if they only cause mild symptoms or they might not get reported even when they are diagnosed and treated.
One condition is called cilia incarnata internum, which makes people feel like they’ve something stuck in their body. The other condition, cilia incarnata externum, usually doesn’t cause any symptoms at all. Some women might notice an unattractive bump but usually don’t have any other issues. As a result, doctors only discover these external buried lashes when they examine a person closely under a biomicroscope.
No evidence has been found to suggest that rubbing of eyelids (as seen in conditions like floppy eyelid syndrome) or any form of trauma makes a person more likely to develop either of these conditions.
Signs and Symptoms of Cilia Incarnata (Eyelashes Growing in the Wrong Direction)
Cilium Incarnatum Internum is a condition where eyelashes grow inwards. It can cause a feeling like something is stuck in your eye and can come on very suddenly, usually within a few days. Depending on where the eyelash is pushing through the inner eyelid skin, the discomfort can feel worse when looking in certain directions. Symptoms can include small dots of damage on the cornea (the clear, outer layer of the eye) and inflammation of the tissue lining the whites of the eyes. This could be mistakenly diagnosed as episcleritis, an inflammatory condition of the eye. You may also experience light sensitive due to inflammation of the cornea.
Unless the doctor checks the eyelid edges and the inside of the eyelid very closely using a special microscope called a biomicroscope, these in-turned lashes could be overlooked. In some cases, only a tiny dark spot representing the tip of the in-turned eyelash pushing through the inner eyelid skin may be seen.
Any patient experiencing symptoms like inflammation of the cornea, one-sided conjunctivitis (inflammation of the eye), inflammation of the tissue lining the whites of the eyes, light sensitivity or episcleritis should have their eyes examined on the slit lamp to rule out conditions like cilium incarnatum internum, trichiasis (a condition where eyelashes grow inwards), and foreign bodies in the eye.
Cilium Incarnatum Externum refers to eyelashes that grow outwards but then push back into the eyelid skin. It usually doesn’t cause any symptoms, although some people may feel a bump around the buried eyelash. Occasionally, a person might experience a sharp discomfort when they rub their eye, especially if the tip of the hair pierces the skin – this is usually not the case, though. Signs include the absence of inflammation, sores or bleeding. The in-turned eyelash can often be spotted moving under the eyelid skin.
Testing for Cilia Incarnata (Eyelashes Growing in the Wrong Direction)
To evaluate cilia incarnata, or ingrown eyelashes, a detailed health history and in-depth microscopic examination is necessary. This examination has to be done with a magnification of at least 15 times to clearly see the problem lashes and to notice any changes on the inside part of the eyelids, the junction between the cornea and the white part of the eye, and the clear front part of the eye. Often, a special dye called fluorescein is used to better visualize any changes. However, no special tests beyond this are typically needed.
Treatment Options for Cilia Incarnata (Eyelashes Growing in the Wrong Direction)
In both instances mentioned, removing the troublesome eyelash typically solves the problem. We’ve removed lashes for 12 patients over the last 20 years and none have come back with the same issue. Some doctors suggest that using cryotherapy or radiofrequency cautery – therapies that basically destroy tissue using extreme cold or heat – could be needed if the lash grows back. However, these treatments are usually not necessary because the problem isn’t the lash itself, but rather its growth in a faulty direction. From our experience, the likelihood of it growing back in the same faulty way is quite low.
In the case of ‘cilium incarnatum externum’, which is an eyelash buried under the skin, it might require a small cut on the eyelid skin to reach and remove the lash. For ‘cilium incarnatum internum’, which refers to an inward-growing eyelash, the removal can be tricky if only a tiny bit of the lash is showing. Usually, by injecting some local anesthesia, both the lash and the root can be located and removed. Sometimes a small cut on the tarsal conjunctiva or tarsus (parts of the eye) may be needed to reach the buried lash. The use of cryotherapy or radiofrequency therapy is rarely required.
What else can Cilia Incarnata (Eyelashes Growing in the Wrong Direction) be?
Cilia incarnata is a condition that involves abnormal eyelash growth. This might mean that the eyelashes grow in the wrong direction, from the wrong place or have abnormal features. There are several conditions that should be considered when examining a patient with abnormal eyelashes.
Trichiasis, for instance, is a condition where the eyelashes grow inwards. It is usually due to inflammation or scarring that changes the direction of lash growth. It typically affects the lower eyelid and it’s common for patients to experience a feeling similar to having a foreign object in their eye. The irritation causes can also lead to infections and further scarring of the cornea. Treatment often involves the temporary removal of the lashes and appropriate surgery once the inflammation has been controlled.
Distichiasis results in two rows of eyelashes instead of one, with the second row often being lighter and finer. This condition is usually inherited and the lashes grow out of the oil-producing glands in the eye known as the meibomian glands. Those with distichiasis often require surgical treatment for the second row of lashes.
Other conditions such as Tristichi and Tetrastichiasis can cause three or four rows of lashes respectively. The condition pseudocilium manifests as a loose lash growing out of the meibomian gland or the tear drainage hole, and only needs a simple removal of the loose lash for treatment.
Additional conditions affecting eyelashes include hypertrichosis where there’s an increase in hair or eyelash number. This increase could be due to a variety of conditions, including genetic conditions, infections, inflammation, and certain medications. Eyelash ptosis is another condition where eyelashes slope or bend downward which can be a result of inflammation, trauma, certain medical conditions, or use of some medications. Treatment can range from weight loss for cases related to obesity to stopping medication use for drug-induced ptosis.
Lastly, cilium inversum, similar to cilium incarnatum, is a condition that causes inward-growing eyelashes. This term, however, is often used when the condition is congenital. Simple removal of the in-growing lashes is often a curative treatment.
It’s important to note that full assessment and diagnosis are needed before a proper treatment could be suggested. Always consult with a healthcare provider for a personalized treatment plan.
What to expect with Cilia Incarnata (Eyelashes Growing in the Wrong Direction)
Cilia incarnata, also known as ingrown eyelash, can be easily cured with a simple lash removal provided an accurate diagnosis has been confirmed. Patients have reported a continuous feeling of a foreign body in their eyes. This could be due to the diagnosis not being made, possibly because the eyelid margin wasn’t thoroughly examined both externally and in the flipped-out position with a special microscope called a biomicroscope.
Possible Complications When Diagnosed with Cilia Incarnata (Eyelashes Growing in the Wrong Direction)
Cilia incarnata is a condition that can often cause long-term issues like redness of the eyes, discomfort in the eye region, sensitivity to light, and excessive tearing. If not treated properly, cilia incarnata can result in more serious problems, such as:
- Mechanical conjunctivitis – inflammation of the outer eye layer
- Corneal abrasions – scratches on the surface of the eye
- Corneal ulcers – open sores on the cornea
- Corneal thinning – weakening and thinning of the cornea
- Keratinization – the formation of a protein that toughens the cornea
- Rarely, a corneal perforation – a hole in the eye’s cornea