Eyelash Trichomegaly: A Closer Look at Eyelash Hypertrichosis

A Review of Eyelash Trichomegaly.

Trichomegaly is defined as an increase in the length (above 12 mm), thickness, stiffness, curling, and pigmentation of existing eyelashes. The term “trichomegaly” was first used by Gray in 1944.

Trichomegaly (longer eyelashes) and hypertrichosis in a patient receiving The EGFR inhibitor chemotherapy medication Erlotinib. Inamadar S and Kumar NSP. Lady with Long Eyelashes… Int J Trichology. Mar-Apr 2022;14(2):71-72. Image shown with creative commons license.

It is important to understand some of the common conditions associated with trichomegaly as this will guide history taking, physical examination and work up. A patient with trichomegaly associated with glaucoma eyedrops may not need any workup. A patient with trichomegaly associated with fatigue, muscle weakness, weight loss, or rashes may require a detailed work up by various specialist.

GENETIC SYNDROMES

Oliver-McFarlane syndrome

Oculocutaneous albinism type I

Familial hypertrichosis

Cornelia de Lange Syndrome

Cone—rod dystrophy

Tetralogy of Fallot

Hermansky Pudlak syndrome

Familial Trichomegaly

Goldstein Hutt Syndrome

Costello Syndrome

Phylloid hypomelanosis

Smith-Magenis Syndrome

Cantú syndrome

CHOPS syndrome

Coffin-Siris syndrome

Cornelia de Lange syndrome

Floating Harbor syndrome

Kabuki-Makeup syndrome

KBG syndrome

Rubinstein-Taybi syndrome

TOPICAL MEDICATIONS

topical latanoprost, bimatoprost and travoprost (**most commonly reported causes)

topical cyclosporine

topical tacrolimus

ORAL MEDICATIONS

oral zidovudine (HIV medication)

oral topiramate

oral cyclosporine

oral tacrolimus

Interferon-α2b

Corticosteroids

Penicillamine

EGFR inhibitors (cetuximab, erlotinib, gefitinib, panitumumab)

FGFR inhibitors Pemigatinib

Streptomycin

Acetazolamide

Diazoxide

Minoxidil

Psoralens

Vismodegib

SYSTEMIC CONDITIONS

HIV type 1 (often late stage)

Uveitis

Vernal keratoconjunctivitis

Dermatomyositis

Systemic lupus erythematosus

Paraneoplastic acquired hypertrichosis lanuginosa (renal cell cancer, lung cancer etc)

Anorexia

Atopic dermatitis

Allergic rhinitis

Hypothyroidism

Pregnancy

Alopecia areata

Malnutrition

Porphyrias

Work up and Management

The work up and evaluation of patients with trichomegaly will depend on the information obtained from the history and the physical examination. History taking must involve inquiry into medication use, medical conditions, family history, syndrome features, past surgeries and complete review of system systems (a head to toe review of organ associated features including fatigue, headaches, seizures, rashes, eye symptoms, difficulty swallowing, shortness of breath, chest pain, diarrhea, vomiting, muscle weakness, joint pains, back pain, menstrual cycles in women, skin rashes, sneezing, rhinorrea). HIV history should be obtained as appropriate. Hair growth or loss in other areas of the body must be ascertained. Pregnancy in women must be considered.

Examination should include careful evaluation of the eyelashes for symmetry and length and distribution (even growth or patchy growth). The eye should be examined for immediate evidence of redness, conjunctivitis or trichiasis. Generally speaking, all patients with trichomegaly and eye symptoms or cursory eye signs need immediate referral to the eye doctor to rule out corneal irritation or scarring.

Examination should proceed with evaluation for hypertrichosis in other areas of the body including face, arms, legs and adbomen. The skin should be examined for rashes as well as other dermatologic manifestations. A physical examination should be conducted by a general practitioner or interest if there are any concerns for a systemic cause. Concerns for a systemic cause will depend on the answer to questions posed during history taking.

Trichomegaly often occurs within a few months of starting treatment. It is reversible once the drugs are stopped. Trichomegaly can be associated with an increased risk of eye infection and secondary corneal ulcerations from trichiasis. For this reasons, patients with trichomegaly who have eye symptoms should be referred to an eye doctor for full review. Trimming the eyelashes is a satisfactory treatment for most patients although surgery and other means to control eyelash growth may be needed.

REFERENCE

Kaur S et al. Eyelash Trichomegaly. Indian J Dermatol. 2015 Jul-Aug; 60(4): 378–380.

Koksal UI et al. Trichomegaly Induced by Cetuximab: Case Series and Review the Literature. Am J Ther. 2016 Sep-Oct;23(5):e1226-9. doi:

Hutchison DM et al. Eyelash trichomegaly: a systematic review of acquired and congenital aetiologies of lengthened lashes. .J Eur Acad Dermatol Venereol. 2022 Apr;36(4):536-546.

Paul LJ et al. Eyelash trichomegaly: review of congenital, acquired, and drug-associated etiologies for elongation of the eyelashes. Int J Dermatol. 2012 Jun;51(6):631-46; quiz 643-4, 64

Freites-Martinez A et al. Hair disorders in patients with cancer. J Am Acad Dermatol. 2019 May;80(5):1179-1196.