Madarosis is defined as the loss or absence of eyelashes (ciliary madarosis) or eyebrows (superciliary madarosis) or both. The term madarosis was originally coined to denote loss of eyelashes due to destruction of hair follicles. But now, this term encompasses loss of cilia either of eyelashes or eyebrows or both. Loss of eyelashes is also known as milphosis. Madarosis as a clinical sign has varied aetiology. This may be a manifestation of local or systemic diseases. Chronic blepharitis is one of the common causes of madarosis. It may be scarring or non-scarring type, depending upon the aetiology.
The word madarosis is of Greek origin, in which ‘’ madao’’ means to fall off.
Eyelashes protect the eyeball from small foreign bodies due to inherent reflex closure of the eyes. Eyebrows protect bony ridges above the eyes. Eyelashes and eyebrows have important cosmetic function as well.
Symptoms
Symptoms of madarosis are mainly cosmetic.
Patients present with loss of eyelashes over some part of or complete eyelid margin.
Patient may be asymptomatic or may have associated redness or itching.
Causes
Causes of madarosis are varied and include
Local
Chronic blepharitis.
Trauma.
Burns.
Eyelid infections such as herpes, syphilis, or leprosy.
Eyelid neoplasm.
Psychiatric condition like trichotillomania.
Systemic
Endocrine disorders like hypothyroidism.
Skin conditions such as acne vulgaris, psoriasis or seborrhoeic dermatitis.
Use of medications like topical epinephrine.
Connective tissue disease such as systemic lupus erythematosus.
Nutritional deficit.
Diagnosis
Diagnosis depends upon clinical history and examination of eyes (both eyebrows and eyelids) including facial skin and scalp.
Clinically, patients present with loss of eyelashes over some or whole of eyelid margin. Stumps of cilia may be visible broken off at or a few millimetres from the surface of skin.
Patients with focal areas of madarosis or telangiectasia should be evaluated for neoplasm.
Based on suspicion of aetiology, patient may be investigated for any nutritional or hormonal deficit.
Management
Management should be carried out under medical supervision.No adequate treatment is available in most of the cases.
Medical therapy
Management includes treatment of underlying aetiology.
Cessation of the use of long term topical epinephrine therapy has shown re-growth of previously lost lashes. Similarly, treatment of blepharitis may prevent further loss of eyelashes.
Therapy of malignant neoplasms causing madarosis is a priority and is more important than treating madarosis alone.
Surgical therapy
Surgical procedures include
Pentagonal eyelid resection: Full-thickness pentagonal eyelid resection of the abnormal area may be contemplated in patients with localised madarosis.
Pentagonal eyelid resection with Lateral Canthoplasty: This procedure is adopted when the affected area is little larger which cannot be treated with pentagonal eyelid resection alone.
Hair transplantation: Hair may be taken from eyebrow, temporal eyelid or scalp for transplantation in areas of madarosis.
Prognosis
Prognosis depends upon underlying aetiology.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358936/
http://www.ijdvl.com/article.asp?issn=0378-6323;year=2008;volume=74;issue=1;spage=74;epage=76;aulast=Sachdeva
http://www.canadianjournalofophthalmology.ca/article/S0008-4182(16)30005-9/pdf