What are the risks and treatments for removing eyelashes?

Risks and Treatments for Removing Eyelashes

Removing eyelashes should be performed only by qualified medical professionals using appropriate techniques, as improper removal can lead to significant complications including infection, scarring, and permanent lash loss.

Risks of Eyelash Removal

Immediate Risks

• Loss of protective function (eyelashes protect eyes from debris and foreign bodies) 1
• Infection (bacterial, viral, or parasitic) 1
• Trauma to eyelid margin 1
• Pain and discomfort 2

Long-term Risks

• Scarring of the eyelid margin 3
• Permanent lash loss (madarosis) 4
• Abnormal regrowth (misdirected lashes/trichiasis) 2
• Eyelid deformity 3
• Corneal irritation or abrasion 2

Medical Indications for Eyelash Removal

Eyelash removal is medically indicated in specific conditions:

1. Trichiasis - misdirected eyelashes that touch the cornea 2, 5
2. Distichiasis - abnormal second row of eyelashes 5
3. Pediculosis palpebrarum (eyelash lice infestation) 1
   • Characterized by adult lice at the base of eyelashes and nits (eggs) adherent to eyelash shafts
   • Often sexually transmitted in adults; consider sexual abuse in children 1

Treatment Methods for Eyelash Removal

For Pediculosis Palpebrarum (Phthirus pubis)

1. Mechanical removal 1

   • Use forceps to remove adult lice and nits from eyelids and eyelashes
   • For adherent nits, epilation (removal) of involved lashes may be necessary
   • Alternative: cutting lashes at their base with microsurgical scissors for heavy infestations

2. Smothering technique 1

   • Apply bland ophthalmic ointment (petrolatum, erythromycin, or bacitracin)
   • Apply 2-3 times daily for 10 days
   • Compliance is crucial for eradication

3. Additional measures 1

   • Advise patients and close contacts to use anti-lice lotion/shampoo for non-ocular areas
   • Wash and dry clothing/bedding thoroughly (highest dryer temperature for 30 minutes)
   • Refer patients and sexual contacts for STI screening

For Trichiasis and Distichiasis

1. Epilation (temporary) 3

   • Simple removal with forceps
   • Regrowth occurs within 2 weeks
   • Not a permanent solution

2. Electrolysis 2, 3

   • Destroys hair follicles with electric current
   • Variable success rate with potential regrowth
   • Can cause focal destruction of follicles

3. Cryotherapy 2, 3

   • Most effective widespread method but has significant complications
   • Double rapid-freeze/slow-thaw technique
   • Potential complications: visual loss, lid notching, corneal ulcers, skin depigmentation, severe soft tissue reaction

4. Argon laser treatment 2, 3

   • More precise placement and control
   • Produces focal necrosis and variable follicle destruction
   • Effective office procedure under local anesthesia
   • Settings: 1W, 50-micron spot size, 0.2-1.0 second duration

5. Eyelash trephination 5

   • Boring of affected lash follicle with microtrephine
   • Removal of the follicle
   • Safe, quick, and effective with low recurrence rate (38%)

Management Approach

For patients requiring eyelash removal:

1. Determine the underlying cause 1

   • Complete history including duration, unilateral/bilateral presentation
   • Examine for signs of infection, inflammation, or abnormal lash growth

2. Select appropriate removal method based on diagnosis:

   • For pediculosis: mechanical removal and smothering technique 1
   • For trichiasis/distichiasis: consider permanent methods (laser, trephination) 2, 5

3. Post-procedure care:

   • Monitor for signs of infection
   • Apply appropriate topical medications if prescribed
   • Schedule follow-up to assess effectiveness and potential regrowth

Important Considerations

• Cosmetic eyelash removal carries all the same risks without medical benefit and should be discouraged 6
• Improper removal techniques can lead to permanent damage and should be avoided 3
• Patients with history of herpes simplex may experience reactivation after certain removal procedures 7
• Patients with advanced glaucoma should avoid aggressive lid manipulation 7

When medically necessary, eyelash removal should be performed by ophthalmologists or oculoplastic surgeons with appropriate training and equipment to minimize complications and ensure optimal outcomes.