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Why might lashes be lost unilaterally?

Q -- A seven-year-old female patient has lost the eyelashes from one eye only. There doesn't seem to be any persistent trauma and they have not grown back after three months. What could cause this?

A -- The technical name for loss of the eyelashes is madarosis. One of the commonest reasons for lash loss is blepharitis, but this is uncommon in children, is usually bilateral and there are usually other signs such as itch and red, scaly lid margins. It is worth, however, examining the other eye. A pen torch or direct ophthalmoscope will be adequate, looking for obvious lid margin disease or patchy lash loss. If there are any signs of blepharitis an ophthalmic referral should be made.

In cases of unilateral eyelash loss, trauma from rubbing or plucking is a strong possibility. Gentle inquiries about habitual rubbing should be made and attention given to the likelihood of behavioural disturbance or problems in the social setting. Lashes can also be lost with long-term applications of make-up and make-up removers although this is unlikely to be relevant.

Lash loss due to alopecia areata can occur in isolation but is commonly found with hair loss elsewhere on the body. This is an autoimmune disorder with a genetic link and associated with other diseases such as vitiligo and atopy. Discoid lupus may rarely present as scarring madarosis.

As ever, many cases are designated as idiopathic and hopefully spontaneous re-growth will occur. Treatments are available but are usually initiated by an ophthalmologist or dermatologist.

Mr Scott Fraser is a consultant ophthalmologist,

Sunderland Eye Infirmary

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