Cosmetic eyelash extensions are widely used to lengthen and thicken natural eyelashes; however, this procedure may pose risks to ocular health. A recent case report described postoperative exposure keratopathy associated with eyelash extensions, highlighting the potential complications that clinicians should consider.

Eyelash extensions are achieved by attaching synthetic or natural hair fibers to existing eyelashes using waterproof adhesives. Because the natural eyelash growth cycle lasts approximately 3 months and extensions can only be applied once the lashes reach a sufficient length after approximately 4 weeks, the typical lifespan of the extensions is 6-8 weeks. Touch-ups are usually recommended every 2-3 weeks.

Ocular Complications

Several ocular complications have been reported following eyelid extension procedures. Allergic reactions to eyelash extension adhesives are common, often presenting as contact dermatitis along the eyelid margin, and infections of the conjunctiva and eyelid margin may also occur. Damage to hair follicles can lead to the loss of natural eyelashes.

Chronic blepharitis is often seen in individuals who extensively use eyelash extensions. This eyelid margin inflammation is commonly associated with meibomian gland dysfunction. These small sebaceous glands open along the inner eyelid margin and produce an oily substance that lubricates the lipid layer of the tear film.

Damage to these glands can disrupt the tear film and contribute to dry eye. Patients may experience symptoms such as burning and foreign body sensations in the eye. Ocular surface vulnerability may increase, raising the risk for more serious corneal complications, including epithelial defects, corneal ulcers, keratitis, and corneal scarring.

Incomplete eyelid closure owing to artificial eyelashes may further increase the risk for complications.

Case Report: Postoperative Exposure Keratopathy

A recent case report from Australia described a 38-year-old woman who underwent general anesthesia with endotracheal intubation during elective cesarean delivery.

The patient reported a history of bilateral blepharitis and dry eye symptoms that had developed after eyelash extensions were applied 5 years prior. Examination revealed an untreated chalazion on the right upper eyelid.

The patient was managed with general anesthesia and intubated for the procedure because of inadequate sensory block from neuraxial anesthesia. In the setting of eyelash extensions, the Eyepro cover could not completely close the patient’s eyes. Instead, saline-soaked gauze secured with tape was used to cover the eyes. Care was taken during surgery to prevent foreign objects from coming into contact with the covered eyes.

After surgery, the patient reported pain in the right eye.

A thorough ophthalmologic examination revealed signs consistent with blepharitis and dry eye.

• Normal visual acuity
• Lid margin hyperemia with telangiectasia
• Meibomian gland capping
• Corneal punctate epithelial erosions
• A tear film break-up time < 5 s
• A superficial epithelial corneal defect 0.5 cm × 0.5 cm at the 6 o’clock position adjacent to the limbus

Clinical Outcome

The epithelial defect resolved within 7 days of treatment with antibiotic eye drops, lubricating eye drops, and systemic analgesics.

The patient reported that the first 48-hour post-delivery was extremely uncomfortable and that the discomfort from her eye exceeded that from the cesarean section wound.

This case illustrates that enhanced protective measures may reduce the risk for exposure to keratopathy and related complications in patients with eyelash extensions who undergo anesthesia.

This story was translated from Coliquio, part of the Medscape Professional Network.