A study of young women with eyelash extensions showed that almost all had some degree of infestation with Demodex folliculorum, spider-like parasites that feed on dead skin cells.
Microscopic examination of samples from 25 women who regularly used the extensions identified D. folliculorum in samples from all but one patient. Additionally, 18 of the women had demodicosis, a type of skin irritation typical of exposure to the mites.
The 25 women were among 345 teenagers and young women surveyed about use of eyelash extensions. A fourth of the participants had experience with eyelash extensions, almost half of whom reported discomfort, redness, tearing, or itching after an extension procedure. Almost all of the extension users had evidence of meibomian gland dysfunction, irritation of oil-secreting glands in the eyelids.
The study does not make a case for avoiding eyelash extensions altogether, but rather the need for regular eyelid care, said Tetiana Zhmud, MD, of the National Pirogov Memorial Medical University in Vinnytsia, Ukraine, at the European Society of Cataract and Refractive Surgeons (ESCRS) meeting in London.
The findings "highlight the importance of proper eyelid hygiene, awareness of symptoms, and timely assessment when symptoms arise," Zhmud said in an ESCRS press release. "For optimal care of eyelash extensions, the use of a preservative-free, hypoallergenic gel designed for therapeutic eyelid hygiene may be recommended twice daily, using an eyelash cleansing brush. In individuals with confirmed Demodex infestation, a course of antiparasitic treatment may be considered."
The findings have implications for eye care specialists and cosmetology practitioners.
"For clinicians, these findings emphasize the importance of considering demodectic blepharitis in patients presenting with chronic eyelid irritation, particularly those who regularly use eyelash extensions," said Zhmud. "For beauty professionals, our results may support the development of recommendations regarding eyelid hygiene and the need to inform clients about potential ocular health risks associated with repeated eyelash extension procedures."
False eyelashes are not new, but their popularity has increased dramatically in recent years. The global market is expected to exceed $2 billion in 2026, with the U.S. accounting for as much as 40% of the total. The market is expected to continue growing at a rate of almost 7% annually into the next decade.
As opposed to ready-made false eyelashes that fit over existing lashes, eyelash extensions are natural or synthetic fibers that are attached one by one to existing lashes, resulting in longer lashes that look more realistic. The extensions are attached by means of a glue or other type of adhesive.
Concern about the health and hygienic implications of eyelash extensions also is not new. Almost a decade ago, the American Academy of Ophthalmology published a fact sheet on eyelash extensions, addressing safety, hygiene, and factors that can increase or decrease potential risks.
A search for "eyelash extensions" on PubMed generated about a dozen reports published in the past 10-15 years, addressing extension use and safety. Investigators in one older study found that 60% of patients who had extension procedures developed keratoconjunctivitis and 40% had reactions to the glue. The publications included a case report of eyelash extensions that were set on fire during minor eyelid surgery.
The current study had its genesis in the growing popularity of eyelash extensions and parallel growth in evidence "suggesting this procedure may create problems on the surface of the eye," said Zhmud. "However, the relationship between eyelash extensions and demodicosis remains poorly understood."
Responses to the survey showed that 86 of the 345 participants (24.9%) had experience with eyelash extensions, 58% of whom had extension procedures every 3 to 4 weeks. Among all patients who had used eyelash extensions, 47.6% reported discomfort, redness, tearing, or itching after a procedure. In a subgroup of participants who had undergone more than 10 extension procedures, 85% had evidence of changes in the meibomian glands.
Investigators collected four eyelashes from each eyelid of the 25 participants who had undergone more than 10 procedures. Microscopic analysis revealed D. folliculorum in samples from 24 of the patients. The 18 patients with demodicosis had symptoms that included itching and irritation of the eyelid margins, hyperemia, edema, eyelash sticking, scales, and cylindrical dandruff at the base of the lashes.
Disclosures
Zhmud and colleagues reported no relevant financial disclosures.
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