Eyelash Loss (Madarosis): Causes, Diagnosis, and Treatment Options

Madarosis is loss of eyelashes (and/or eyebrows). It can be partial or complete, unilateral or bilateral, temporary or permanent.

Common Causes

• Inflammatory: Blepharitis (staphylococcal, seborrheic, meibomian gland dysfunction), atopic dermatitis, psoriasis
• Autoimmune: Alopecia areata, lupus erythematosus, thyroid disease (hypo/hyper)
• Infections: Herpes simplex, molluscum contagiosum, fungal, Demodex mites
• Mechanical/Trauma: Trichotillomania, eyelash curlers, extensions, rubbing, burns
• Medications: Chemotherapy, prostaglandin analogs (glaucoma drops – can initially increase then cause loss), anticoagulants
• Nutritional: Iron, zinc, biotin, protein deficiency
• Neoplastic: Basal cell carcinoma, sebaceous carcinoma (rare but serious)
• Aging: Gradual thinning, shorter growth cycle

Diagnosis

• History, slit-lamp exam, pull test, dermoscopy
• Labs: CBC, TSH, ferritin, ANA, antibodies if indicated
• Biopsy for scarring alopecia or suspected malignancy

Treatment

• Treat underlying condition
• Topical minoxidil, bimatoprost (Latisse® – FDA-approved for hypotrichosis)
• Corticosteroids (topical/intralesional) for inflammatory/autoimmune
• False lashes, extensions (caution: may worsen loss)
• Address nutritional deficits

Sudden or patchy loss warrants dermatologic or ophthalmologic evaluation.