INTRODUCTION Madarosis refers to the loss of eyelashes. It may result from trauma, rubbing the eyelids, or it can follow eyelid surgery with injury to the lash follicles. Madarosis is also associated with systemic diseases such as alopecia areata, but here hair loss is usually seen in other parts of the body as well. Discoid lupus erythematosis involving the eyelids presents with erythema, scarring, and madarosis, but the latter can be the only presenting finding before any other
manifestations. Lash loss is also associated with infiltrative lesions such as sarcoidosis, lymphoma, and cutaneous neoplasms. Inflammatory processes including severe blepharitis can cause lashes to fall out, and chronic infections with the mite Demodex folliculorum, found in 10% to 15% of normal individuals, can also be associated with madarosis. Loss of lashes and facial hair has been reported as a complication of botulinum toxin for oromandibular dystonia, but this is exceedingly uncommon. Iodine plaque brachytherapy and external beam irradiation for choroidal tumors is a known cause of madarosis. Loss of lashes is a common finding in leprosy and ichthyosis. In some cases the loss of lashes can be factitious or idiopathic.
CLINICAL PRESENTATION Patients present with absent lashes over some or all of the eyelid margin. In some cases stumps may be seen broken off at or a few millimeters from the skin surface. The lid margin may show evidence of chronic inflammation including erythema, meibomianitis, blepharitis, chalazion, crusting, or ulceration. When the madarosis is localized and associated with lid thickening and telangiectasias, malignancy should be suspected. When associated with excoriations of the facial skin in a young female, a factitious self-inflicted etiology should be considered.
TREATMENT There is no adequate treatment for madarosis in most cases. Surgical grafting of eyebrow hairs has been used with some success, but often the hairs grow at uncontrolled angles, so that they are cosmetically unattractive or else result in trichiasis. When a specific etiology can be found, such as blepharitis, lid hygiene and topical antibiotics may halt the process. Demodex infections are difficult to eradicate, but can be treated with 3% isoptocarbachol or mercury oxide.
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