Eyelash and eyebrow loss in adults: what it can mean

Lashes that are getting sparse, or an eyebrow tail that has gone, are easy to put down to age. Sometimes that is right. Often it is not, and the difference is worth an examination, because the eyelid margin, the strip where the lashes grow, is where several unrelated diseases first show themselves.

The medical name for loss of lashes or eyebrows is madarosis. Loss of the lashes alone has its own word, milphosis, which you will rarely hear in a clinic. This piece is the eyelid surgeon's half of the subject: what the lash line can tell me, which causes are harmless, and the one cause I never leave to watching. Tired, older-looking eyes have a longer list of explanations than people expect, which I set out in what actually makes eyes look tired.

Why are my eyelashes or eyebrows thinning?

Because something is either damaging the hair follicle or interrupting its cycle, and the first job is to work out which. Clinicians divide madarosis into two kinds. In non-scarring loss the follicle survives, so the hair can grow back once the cause is dealt with. In scarring loss the follicle has been destroyed, and the hair will not return. That single distinction decides how urgent the visit is.

DermNet, the dermatology reference, lists the common causes as staphylococcal infection, herpes simplex, rosacea, alopecia areata, an underactive or overactive thyroid, eczema, psoriasis, trauma and the effects of treatment such as chemotherapy or radiotherapy. It also says madarosis can usually be diagnosed from a careful history and examination. At the examination, I look at whether the loss is even or patchy, whether one eyelid or both are involved, whether the lid margin itself looks normal, and whether any hairs are broken rather than absent.

Can blepharitis make my lashes fall out?

Yes, particularly the staphylococcal kind. Blepharitis, the medical name for chronic inflammation of the lid margin, damages the follicles at the base of each lash when it is left inflamed for long enough. EyeWiki, the American Academy of Ophthalmology's clinical wiki, describes eyelash loss or misdirection as signs rarely seen with other types of blepharitis, and lists long-standing disease as a cause of permanent change to the lid margin.

The pattern I expect is scale and crusting at the roots of the lashes, a red and slightly thickened margin, and lashes that are sparse or growing in odd directions rather than missing in a clean patch. The full routine for controlling it, the warm compress, the massage and the cleaning, is in my guide to blepharitis and lid margin disease, and I will not repeat it here. When lashes are growing back into the eye rather than out of it, that is a separate problem, trichiasis, where one or two lashes grow the wrong way, and it needs its own treatment.

When is lash loss a sign of an eyelid tumour?

When it happens in one patch, over a lump or a change on the lid margin, and does not come back. Ordinary ageing thins lashes fairly evenly. A tumour destroys the follicles beneath it, so the lashes vanish exactly where the growth is. EyeWiki lists malignant tumours, basal cell and squamous cell carcinoma among them, as causes of scarring madarosis, and DermNet includes skin cancers among the less common causes.

This is the cause I never guess at. Sebaceous carcinoma, a rare cancer arising from the oil glands of the lid, can look like a stubborn chalazion or a one-sided blepharitis for months. EyeWiki advises biopsy, a small piece of tissue sent to a laboratory, where there is marked asymmetry, resistance to treatment, or a chalazion that keeps recurring in the same place. I explain the full list of features in the warning signs of eyelid skin cancer.

Most lash loss is not cancer, and I say so plainly. But a single bald patch on the margin, a notched lash line, or a lump that has been treated once and returned is not a reason to wait and see. It is a reason to have the lid looked at by an eye doctor, who can decide whether a biopsy is needed.

Can thyroid disease thin my eyebrows?

It can. DermNet lists both an underactive and an overactive thyroid as causes of madarosis, and notes that hypothyroidism typically affects the outer third of both eyebrows. EyeWiki also names thyroid hormone disturbance under non-scarring causes. So brow tails that thin on both sides, without any skin change, are a reason to ask your doctor for a thyroid blood test, and that test is done by a family doctor or endocrinologist, the doctor who manages glands and hormones, rather than by me.

There is a distinction I make carefully. Thyroid hormone imbalance and thyroid eye disease are related but not the same thing. Thyroid eye disease is an immune inflammation behind the eye that causes bulging, a retracted lid or double vision, and I cover it in thyroid eye disease: signs and treatment. If you have thinning brows together with a stare, puffy lids or eyes that look pushed forward, both belong in the same conversation, and the eye signs need an eye doctor promptly.

Could lash extensions, pulling or a habit be the cause?

Yes, and these are causes people often do not connect to the loss. Traction alopecia, hair loss from prolonged tension on the follicle, is well described on the scalp. DermNet says it is reversible early, but that prolonged and excessive tension destroys follicles and leaves permanent loss. Direct evidence for eyelash follicles specifically is thinner, so I treat this as a sound mechanism by analogy, not a proven eyelash figure. Every extension adds weight to one natural lash. If the lash line looks sparse or notched after months of continuous extensions, stop and be examined. The reactions to the glue itself are covered in allergic and irritant eyelid reactions to lash extensions and cosmetics.

The other habit is pulling. Trichotillomania, an irresistible urge to pull out one's own hair, is usually thought of as a childhood problem, but DermNet notes it becomes more common in females with age and that eyelashes and eyebrows may be broken or absent. The clue I look for is broken hairs of uneven length rather than clean bare skin. It is a recognised condition, managed mainly with behavioural therapy, and it deserves kindness, not a lecture. For children, Dr Chan Li Yen has written a gentle guide to why a child pulls out their own eyelashes.

What about alopecia areata, skin disease and medicines?

All three can take lashes and brows. Alopecia areata, an autoimmune condition where the body attacks its own follicles, can affect the lashes and brows, and DermNet observes that other autoimmune conditions, including thyroid disease, may be more common in people who have it. Eczema, psoriasis and rosacea affect the lid margin and can thin the lashes as a side effect of the inflammation. Chemotherapy and radiotherapy can cause madarosis, and DermNet also lists laser and botulinum toxin among treatments that can do so. If you are on a medicine and have noticed the change, tell the doctor who prescribed it, and do not stop it yourself.

Once the cause is found and controlled, DermNet lists cosmetic camouflage, tattooing, minoxidil solution, prostaglandin-class lash treatment and eyelash grafting among the options for restoring density. Those are decisions to make after a diagnosis, not before one. The scalp is a separate territory, and Dr Ong Jin Khang explains why hair loss is several different diseases, not one. His article covers scalp hair, not lashes or brows, and the same principle applies: name the cause first.

Who should I see first, and what will they check?

An eye doctor if the loss is in one patch, involves a lump, a crust, a red margin or lashes turning inward. A family doctor or endocrinologist if brow tails are thinning on both sides and you feel unusually tired, hot, cold or unwell. A dermatologist, the skin doctor, if you see round bald patches or scaly, itchy skin. When the cause is unclear, start with the eye doctor, because they can examine the margin under magnification and refer on. In practice this is a short conversation and a careful look at the lids, and often a blood test or a small biopsy follows.

Bring a photograph of how your lashes and brows looked a year ago, a list of your medicines, and an honest account of extensions, pulling or new products. Being blamed is not part of the visit. Whatever the cause, the loss is worth an explanation, and the eyelid margin is the right place to begin looking for it. You can read more about the eyelid conditions I see in clinic.