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.
Basak Samar K. Atlas of Clinical Ophthalmology Second edition. Jaypee Brothers Medical Publishers (P) Ltd. 2013. P 9.
Mukherjee PK. Clinical Examination In Ophthalmology Second Edition. Elsevier, RELX India Pvt. Ltd. 2016. P 64- 65.
Dutton Jonathan J, Gayre Gregg S, Proia Alan D. Diagnostic Atlas of Common Eyelid Diseases. Informa Healthcare, Taylor & Francis Group, LLC 2007. P 87- 87.
Roy Frederick Hampton, Tindall Renee. Master Techniques in Ophthalmic Surgery Second Edition. Jaypee Brothers Medical Publishers (P) Ltd. 2015. P 377- 379.
Gold Daniel H, Lewis Richard Alan. Clinical Eye Atlas Second Edition. Oxford University Press 2011. P 62- 69.
Kaiser Peter K, Friedman Neil J, Pineda Roberto. The Massachusetts Eye and Ear Infirmary- Illustrated Manual of Ophthalmology Fourth Edition. Elsevier Saunders 2014. P 80- 81.
Kanski Jack J, Bowling Brad. Synopsis of Clinical Ophthalmology Third Edition. Elsevier Saunders 2013. P 14.
Fay Aaron, Dolman Peter J. Diseases and Disorders of the Orbit and Ocular Adnexa. Elsevier 2017. P 247- 248.
Sundaram Venki, Barsam Allon, Barker Lucy, Khaw Peng Tee. Training in Ophthalmology- the essential clinical curriculum Second Edition. Oxford University Press 2016.
Bowling Brad. Kanski’s Clinical Ophthalmology- A Systematic Approach Eighth Edition. Elsevier 2016. P 27- 30.
Denniston Alastair KO, Murray Philip I. Oxford Handbook of Ophthalmology Third Edition. Oxford University Press 2014. P 139.
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 of madarosis are varied and include
Eyelid infections such as herpes, syphilis, or leprosy.
Psychiatric condition like trichotillomania.
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.
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 should be carried out under medical supervision.
No adequate treatment is available in most of the cases.
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 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 depends upon underlying aetiology.