Diseases of the Eyelashes

What is Diseases of the Eyelashes?

Eyelashes play a crucial role in keeping your eyes safe. They act like a barrier, preventing outside particles from getting into the eye, and also guard against wind and water. Moreover, eyelashes are very sensitive, which allows them to detect harmful substances and trigger protective responses from the eyelids and surrounding muscles.

There are many diseases and conditions, both inherited and developed, that can impact eyelashes. Determining the cause and understanding how these conditions alter the normal behavior of the lashes is necessary before any attempts to correct the issue are made.

This article provides a complete summary of all the diseases and conditions that can directly influence eyelashes.

What Causes Diseases of the Eyelashes?

Trichiasis is a condition where the eyelashes grow inwardly, a phenomenon that happens despite the eyelash follicle being normal. In some cases, this misdirection can happen due to inflammation but isn’t due to entropion, a more severe condition where the entire eyelid rolls inward. Trichiasis is sometimes classified into primary, where the lash is misdirected due to the abnormal growth of the hair shaft, and secondary, where there’s a misdirection of the follicle. However, this classification isn’t usually beneficial in clinical practice. Trichiasis mostly occurs on the lower eyelid.

A thorough examination should be done under a microscope to check the lid margin, the posterior lamella, and fornices. Among the numerous causes of Trichiasis include chronic blepharitis, thermal injury, vernal keratoconjunctivitis, chemical burns, eczema, herpes zoster, and atopic diseases.

To manage trichiasis, short-term relief can be received by plucking the lashes or using a bandage contact lens. Surgical treatment should only be offered once active inflammation has been managed. The roots of the offending lashes can be permanently destroyed using various methods such as argon laser, electrolysis, radiofrequency epilation, trephination, eyelash bulb extirpation, resection of the lash follicle, cryotherapy, and surgical repositioning.

A similar condition is Distichiasis, where there’s an extra row of lashes present behind the normal row of lashes. These lashes, although fine and lightly pigmented, can cause corneal irritation. Management includes epilation, cryotherapy, folliculectomy, lid split, and treatment of abnormal follicles. Conditions that cause inflammation and lead to the development of lashes within the Meibomian glands also leads to distichiasis, such as blepharitis, caustic injuries, and Meibomian gland dysfunction.

Another rare condition is Tristichia/Tetrastichiasis, which is the presence of a third or fourth row of lashes. Hypotrichosis is a condition that leads to reduced hair density, including in the eyelashes, which can be treated using a topical bimatoprost ophthalmic solution.

Madarosis is another condition characterized by the loss of lashes or eyebrows. This is often caused by blepharitis, Meibomian gland dysfunction, ocular rosacea, staphylococcal infection, trachoma, chemical burns, and congenital syndromes such as Oliver-McFarlane and Cornelia de Lange.

Risk Factors and Frequency for Diseases of the Eyelashes

Eyelash conditions can happen to anyone, regardless of age, gender, or ethnicity. Certain issues like lash root infections or cysts of Moll are common in kids but often resolve on their own. However, these conditions become more frequent as we get older due to increased eyelid inflammation and issues with the Meibomian gland.

• Demodex infestation, which is the presence of tiny mites on the lashes, is a normal condition that increases with age. By the age of 70, most adults have Demodex mites on their lashes. The increase in mites can lead to more symptoms as we age.
• Trachoma is a disease that can cause blindness and is often found in young people in sub-Saharan Africa. This disease, caused by a bacterium called Chlamydia trachomatis, is preventable. Transmission of trachoma often occurs through direct contact from person to person, typically from a child to a mother and then to another child. However, it can also be spread by flies or through clothing, and unsanitary conditions can increase the risk of contracting the disease.

Signs and Symptoms of Diseases of the Eyelashes

When it comes to diagnosing conditions related to eyelashes, doctors primarily rely on clinical examinations. If trichiasis is suspected, a thorough examination of the eyelid, tarsal (inner lining of the eyelids) conjunctiva, the crease around the eye (fornix), the bulbar (outer surface of the eye) conjunctiva, and the cornea is vital.

If the patient suffers from trichiasis combined with evident loss of eyelashes, doctors examine the eyelid margin under detailed microscopic inspection, looking for blood vessels, ulceration, plaques, and irregularities that could indicate eye cancers like basal cell carcinoma or squamous cell carcinoma.

• Trichiasis with signs of loss of eyelashes
• Detailed microscope inspection required to detect possible cancers

If thickening of the eyelid accompanies trichiasis and lash loss, doctors have to beware sebaceous carcinoma, which can appear as a simple eyelid lump (chalazion), vague eyelid thickness, or accompanied by lash loss and trichiasis. In this case, a full specimen of the eyelid is sent for lab analysis.

• Trichiasis with signs of eyelid thickness and loss of eyelashes
• Specimen sent for lab analysis for possible sebaceous carcinoma

If conjunctival scarring is present alongside trichiasis, the condition could be mucous membrane pemphigoid, a rare autoimmune condition affecting the mucous membranes. The doctor would examine the tarsal conjunctiva and the fornix for signs of scarring and symblepharon.

• Trichiasis with signs of conjunctival scarring
• Possible Mucous Membrane Pemphigoid

Advanced stage trachoma, a bacterial infection of the eye, can be indicated by features including trichiasis, conjunctival scarring, eyelid turning inward (entropion), corneal scarring, reduced vision, and conjunctival inflammation. The earlier stages of the disease showcase inflammatory reactions in the eye with limbal follicles and limbal neovascularization.

• Trichiasis with signs of scarring in the conjunctiva, entropion, and corneal opacification
• Possibly indicating advanced stage trachoma

Lastly, in cases of “madarosis” (loss of eyelashes), doctors always conduct an examination to detect any underlying growth, thickening, ulceration or vascularization, as these features can indicate malignancy.

• Examination of area of loss of eyelashes (“madarosis”) for underlying conditions

Testing for Diseases of the Eyelashes

If your doctor sees inward-growing eyelashes (trichiasis) alongside unusual changes in the delicate membrane (conjunctiva) that covers your eye and inside of your eyelid, they may suspect a condition called mucous membrane pemphigoid (MMP). To verify this, they may take a small sample of your conjunctiva for a test called direct immunofluorescence (DIF). But, even if this test comes back negative, it doesn’t mean you definitely don’t have MMP.

On the other hand, if your doctor suspects that you have an eye infection called trachoma causing the trichiasis, they might perform specific tests on a sample collected from your conjunctiva. However, these tests, called nucleic acid amplification tests (NAATs), are usually not the first action doctors take. They often identify trachoma simply by examining your eyes.

Treatment Options for Diseases of the Eyelashes

Most eyelash conditions are usually managed with local treatment methods.

If a patient is found to have a disease known as mucous membrane pemphigoid, doctors will need to check for involvement in other areas lined with mucous, such as the nasopharynx (which can lead to blocked airflow), as well as the mouth, genitals, anus, and esophagus.

If the loss of eyelashes or abnormal growth is due to a form of cancer, a biopsy will be carried out to diagnose and manage both local and systemic effects.

For patients with an active case of trachoma – an infectious eye disease – oral azithromycin and topical tetracycline are usually prescribed. In addition, if the disease has caused the eyelashes to grow inward (trichiasis) or the eyelid to turn inward (entropion), surgical procedures to remove the lashes or correct the position of the eyelid may be necessary.

What else can Diseases of the Eyelashes be?

If a person has eyelashes that are growing in the wrong direction (a condition known as trichiasis) and scarring on the clear tissue that covers the white part of the eye (conjunctival scarring), but the result from an immunity related test (Direct Immunofluorescence or DIF) is negative, there could be a few other potential causes. These might include:

• Chemical Burns
• Injuries or Trauma
• Stevens-Johnson’s Syndrome (a rare, serious condition affecting the skin and mucous membranes)
• Atopy (a genetic tendency to develop allergic diseases like asthma and eczema)
• Complications from a transplant known as Graft-versus-Host Disease
• Reaction to medication

If these conditions are all ruled out, the person should still be treated as if they have MMP (Mucous Membrane Pemphigoid), an inflammatory disease that affects the mucous membranes. This is because control of the disease is crucial and is normally achieved through a therapy that modulates the immune system.

What to expect with Diseases of the Eyelashes

Most of the conditions affecting the eyelashes can be identified through a careful medical history review and thorough examination by a doctor. If the eye is under threat by these conditions, proper treatment can provide relief.

In particular, trichiasis, a condition caused by a disease called mucous membrane pemphigoid, requires careful management. While treating trichiasis is important, surgery should only be considered after proper immune system-balancing treatments have been started. Due to its unpredictable nature, this disease requires careful monitoring by eye doctors, skin doctors, and immune system specialists. Depending on how extensively other areas of your body are affected, you may need to see other types of doctors as well.

With the case of trachoma, proper diagnosis and treatment can prevent blindness from this condition.

Possible Complications When Diagnosed with Diseases of the Eyelashes

Focal eyelash diseases usually have few complications. But, in the case of a disease called mucous membrane pemphigoid, several issues can occur even if the condition is managed correctly. These challenges might include secondary scarring, inward turning of the eyelid known as entropion, scarring on the clear front surface of the eye, increased pressure in the eye called glaucoma, and even vision loss.

For a condition called trichiasis, it’s important to diagnose and manage it promptly. If not, it can lead to discomfort, ulcers in the eye, and could potentially cause vision loss.

• Complications from mucous membrane pemphigoid:
• Secondary scarring
• Entropion
• Corneal scarring
• Glaucoma
• Vision loss
• Complications from unmanaged trichiasis:
• Pain
• Ulcers
• Vision loss

Preventing Diseases of the Eyelashes

The World Health Organization (WHO) provides comprehensive education about how to prevent, detect, and treat Trachoma, a severe eye infection.

For people suffering from mucous membrane pemphigoid, a condition that affects the body’s mucous membranes, it’s essential they understand that other parts of their body could also be impacted by the disease. So, if they notice any new symptoms, they should report them promptly. This might mean they need more treatment to regulate their immune system’s response.