Cosmetic Eyelash Extensions Independently Associated With Dry Eye in Observational Study

 Cosmetic procedures to lift or extend eyelashes are linked to dry eye, new research shows.

Nearly 90% of patients in the observational study reported experiencing symptoms of dry eye and other ocular conditions after receiving the cosmetic procedures, researchers reported at the American Society of Cataract and Refractive Surgery (ASCRS) 2026 Annual Meeting.

“Although these procedures are generally perceived as safe and are associated with high user satisfaction, case reports and small observational studies have described a range of potential ocular surface effects,” such as allergic blepharoconjunctivitis, keratitis and epithelial defects, and dry eye symptoms, said Pamela Capellan, MD, MBA, an ophthalmology resident physician at Baylor College of Medicine in Houston, who helped conduct the research.

Lash procedures are becoming increasingly popular, said Masako Chen, MD, an ophthalmologist at New York Eye and Ear Infirmary of Mount Sinai in New York City, who was not involved in the study.

“It’s a huge trend right now,” said Chen, who suggested clinicians should start asking about lash procedures when patients come in with dry eye or irritation. “We think about eye makeup use, but other procedures may not be totally obvious,” she told Medscape Medical News.

However, both she and the researchers stopped short of recommending people steer clear of lash procedures based on the risk. “It’s a personal choice,” Chen said. “But I think with patients with dry eye, I would say use your caution.”

“I think as someone myself who also gets some of these lash modifications and have friends who do, it is very difficult to tell patients not to do something,” Capellan said. “If they are having symptoms or becoming symptomatic, then how can we help them with aggressive lubrication and treatments and looking at the frequency or even the location and the kind of chemicals that they’re using as well?”

Among 49 women surveyed, 24 had recently undergone lash extensions or lifts. That group had an average score of 29.9 on the 100-point Symptom Assessment in Dry Eye scale compared with 4.4 among women who had never or not recently undergone the procedures (P = .0003). The association retained statistical significance after controlling for age, race, ethnicity, and use of contact lenses, Capellan and her colleagues reported (P = .0010).

The same pattern was seen in the 22-point Dry Eye Questionnaire-5, with averages of 7.1 among recent users vs 3.4 among the control individuals (P = .0023; P = .0497 after adjustment for age, race, ethnicity, and use of contact lenses).

Notably, 88.5% of lash extension users reported at least one ocular symptom, and 37% reported prior complications from the cosmetic procedure, Capellan’s group reported.

The most common ocular symptoms were itching and tearing (50% of participants each), followed by redness, dryness, and burning (38.5% each). None of the women in the study reported blurred or disturbed vision.

Despite the prevalence of eye adverse effects, all the women who had used lash services said they were satisfied with the procedures and intended to repeat them. About 58% said they would tolerate ongoing eye symptoms rather than stop getting lash extensions. Indeed, 63% said they got them monthly.

Notably, none reported being advised by an eye care professional to stop doing so.

“The disconnect between symptom burden and care-seeking behavior underscores a substantial gap in patient education and proactive clinical counseling regarding ocular surface health risks associated with cosmetic lash procedures,” the researchers concluded.

The single-center study included 24 recent users of lash procedure (in the prior 1-2 months), five nonrecent users (over 3 years since the last procedure), and 20 age-matched women who never used the products, recruited from specialty clinics including ophthalmology and dermatology. Telephone-based questionnaires captured demographics, lash practices, and ocular symptoms.

Never users tended to be older (mean age, 49.2 years) than nonrecent or recent users (34.8 and 41 years, respectively). A history of ocular comorbidity was uncommon across the groups.

The mean duration of use was about 41 months, with about 45 lifetime lash procedures on average. All the women who used lash procedures received extensions, and 27.6% also reported receiving lifts.

More frequent, longer duration, and higher cumulative use of lash procedures was not significantly associated with eye symptoms.

“Symptom severity appears related to recent exposure rather than cumulative duration or frequency of use, suggesting an acute rather than chronic dose-dependent mechanism,” Capellan and her colleagues reported.

The retrospective study leaves open questions of whether certain approaches to lash lifts or extensions are riskier than others and what might be their long-term impacts, such as repeated chemical conjunctivitis altering homeostasis of the tear film or worsening meibomian gland dysfunction, Chen said.

“It’s definitely helpful from my standpoint to have a study to go to when I counsel patients about this,” Chen said, but “long-term studies would be helpful so that we can properly counsel our patients.”

The researchers and Chen disclosed having no relevant financial conflicts of interest. 

https://www.medscape.com/viewarticle/cosmetic-eyelash-extensions-independently-associated-dry-eye-2026a1000bku