Multiple conditions can cause eyelash loss, or madarosis. Some problems are localised to the eyelid while others are caused by systemic issues. A person's age may play a role in eyelash loss as does being male or female. Once eyelash loss is noted, a visit to the eye doctor is in order; the eye doctor can start the evaluation of the madarosis.
Blepharitis can cause eyelash loss and is diagnosed by eye doctors. It is an inflammation of the eyelids and can be caused by bacteria or by problems with the oil glands of the eyelids. Blepharitis is treated with warm compresses, eyelid scrubs and often antibiotic ointment. The condition is chronic and may recur at any time; maintaining lid hygiene is key.
Alopecia areata is an autoimmune disease that causes loss of hair. Sometimes the loss is only on the head, or it can involve all body hair, including the eyelashes. The hair root is attacked by the immune system, causing the hair to fall out. In this condition, the hair may grow back but may fall out again during the course of the disease. There is no cure for alopecia areata; while some hair-growth treatments may stimulate hair growth, these will not prevent further hair loss.
People who suffer from trichotillomania have the urge to pull hair out of the head and from other parts of the body, including the eyelashes. This condition is thought to have a genetic component, but a chemical imbalance in the brain may also play a role. Trichotillomania tends to run in families and can be a lifelong problem. Treatments include psychotherapy and medications such as antidepressants. While the treatments may be successful initially, the condition may recur.
People who use eyelid make-up and mascara can develop eyelash loss. One reason is that the user can develop an allergic reaction to the make-up, mascara or the make-up remover. Switching to a hypoallergenic product may alleviate the problem. Another cause of eyelash loss may be the use of waterproof mascara; it is more difficult to remove this type of make-up, so there may be more mechanical pulling and tugging on the lashes to clean them. Not cleaning the eyelashes of mascara prior to bedtime may also damage the eyelashes and cause them to fall out.
There are also some systemic causes for eyelash loss. Diseases such as hypothyroidism may cause generalised hair loss, which includes the eyelashes. Patients with cancer who have had either chemotherapy or radiation treatments may also experience eyelash loss; often the hair loss is temporary, and the hair (and lashes) will grow back over time when the treatment is discontinued. Ageing and changes in hormones may also cause a loss of lashes.
The eye doctor may start the evaluation for causes of madarosis; however, the full workup may involve other health care professionals such as dermatologists or mental health workers. The final diagnosis may take some time to uncover. In the meantime, there are ways to cope with eyelash loss such as false eyelashes or the use of eyelid liners.