Eyelash extensions are synthetic fibers (e.g. polyester) applied on the natural lashes for cosmetic reasons. The fibers are typically attached using glue that may contain chemicals such as formaldehyde, lead, and benzoic acid. The procedure is popular due to its improvement in aesthetic appearance and natural look. Repeat application occurs every 2-3 weeks as needed.
There are some safety concerns as eyelash extension treatments have been associated with numerous ocular conditions, including keratoconjunctivitis, allergic blepharitis, conjunctival erosion, subconjunctival hemorrhage, and traction alopecia.
Symptomatology and Pathophysiology
Keratoconjuncitivits usually presents as ocular itchiness, irritation, and conjunctival hyperemia (redness). Eyelash extensions may give rise to keratoconjunctivitis because of the spread of chemicals onto the ocular surface. The glue containing formaldehyde may directly disperse to the ocular surface during the procedure or hours afterwards. The glue may get into the eye if the patient washes their eyelids, or it may be vaporized by body temperature or humidity.
Allergic Blepharitis and Eyelid Edema
Allergic blepharitis typically presents as redness, irritation, itchiness, tearing and swollen eyelids affecting both eyes (although one side may be significantly more affected than the other side). The symptoms may not occur until hours or days after the eyelash extensions are applied. Formaldehyde in the glue and eyelid-fixing tapes are believed to cause the allergic reaction. Lead and benzoic acid, found in varying concentrations in different brands of glue, are also suggested to cause allergy in some patients.
Symptoms of conjunctival erosion include redness, pain, tearing, and foreign body sensation. Conjunctival erosion can be caused by the mechanical irritation of eyelid-fixing tapes.
Patients with subconjunctival hemorrhage often present with an acute red eye. It may be caused by mechanical compression when the lash extensions are removed.
Traction alopecia refers to the condition where natural lashes are lost due to the traction of synthetic lashes. It may induce further damage to the eyelash follicles, resulting in stunted hair growth.
Patients with the symptoms discussed above should seek prompt professional medical advice.
Keratoconjunctivitis can be treated with over-the-counter lubricating eye drops several times per day (3-4 x / day). Dilution of the offending chemicals with these ocular lubricants can speed recovery. Antibiotics are generally not helpful in the treatment of this condition. An eye care professional can also rule out other more serious problems if symptoms do not improve with conservative treatment.
Treatment for allergic blepharitis may include antihistamine eye drops and/or oral tablet, and antibiotics and/or steroid eye drops.
Conjunctival Erosion & Subconjunctival Hemorrhage
Patients with conjunctival injury may require further ophthalmological examination to determine the cause. Tests may include a slit lamp examination and fluorescein examination if the application of eyelash extensions alone cannot explain the injury. A coagulation profile may also be indicated in normotensive patients who experience repeated episodes of subconjunctival hemorrhage. An uncomplicated conjunctival erosion can be managed with topical antibiotics and ocular surface lubrication. Such injuries typically heal within three days. Subconjunctival hemorrhage without an open globe injury may resolve spontaneously over two to three weeks.
Prevention and General Recommendation
To prevent complications arising from eyelash extensions, both the clients and the beauty industry should learn the potential complications of the procedure and consult medical advice promptly if indicated. Clients with existing eye disease or allergy history should avoid eyelash extensions and may consider mascara as a safer alternative if used properly. Questionnaires regarding allergies at the beauty salons or skin patch tests may be considered for screening allergy. Clients should be advised against washing their faces in the first few hours after applying the eyelash extensions, as the glue may take up to six hours to solidify completely. Practitioners in the beauty salons should acquire the correct techniques for applying the eyelash extensions, ensuring hand hygiene and proper placement of the synthetic lashes, glue and tapes. The ingredients of the glue and lash removers should also be strictly regulated and monitored.
- Turbert D, Mendoza O. What Are Eye Allergies? American Academy of Ophthalmology. EyeSmart® Eye health. https://www.aao.org/eye-health/diseases/allergies Accessed May 27, 2022.
- Amano Y., Sugimoto Y., Sugita M. Ocular disorders due to eyelash extensions. Cornea 2012;31:121–125.
- Consumer Council (Hong Kong). Beware of Effects and Risks of Eyelash Extension Before Trying. Consumer Council (Hong Kong). https://www.consumer.org.hk/ws_en/news/press/p46403.html. Accessed November 30, 2015.
- Consumer Reports. Eyelash extensions can pose health risks. Consumer Reports. http://www.consumerreports.org/cro/2013/05/eyelash-extensions-can-pose-health-risks/index.htm. Accessed November 30, 2015.