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Wednesday / June 19.
HomemicontactSmall Things Cause Significant Symptoms

Small Things Cause Significant Symptoms

Once you’ve been on the receiving end of a misdirected eyelash, you can appreciate why patients experiencing the same seek your urgent attention.

Surprisingly for some, significant issues can arise from misdirected or aberrant eyelashes. There are varying, confusing terms used to describe eyelashes that either grow in the wrong direction (causing contact with the conjunctiva) or at times, originate from abnormal positions on the lid margins. For simplicity I call any lashes that grow inward toward the eye ‘retro lashes’. Some are much finer than typical, normal lashes.

I’m amazed at how such a seemingly innocuous lash can cause such irritation

There is a broad spectrum of patients who regularly pay unscheduled visits requiring urgent epilation of lashes that are literally driving them nuts. They are often middleaged females with fair complexions. There are also a number of Asian patients who, through their unique lid anatomy, have a multitude of lashes pretty much bunched up against their conjunctiva from a relative entropion. Some of these patients are surprisingly symptom free while others are quite symptomatic. It would be impractical to regularly epilate a large number of lashes in this cohort. At times – where symptoms are present or where resultant conjunctival inflammation, corneal abrasions, and staining arise – a bandage contact lens is necessary. For others the best long term solution is blepharoplasty. Routine blepharoplasty for such problems is quite common in Korea, where this condition seems more prevalent.


By and large, for the patient with misdirected ‘retro lashes’ causing significant irritation, one would simply fit them in and very carefully epilate them. Often the lashes are only a millimetre or three long and sit in and around the inner or outer canthus. However they can be found anywhere along the lid margins and at times are rather well hidden.

Over the years I saw patients who reported having seen a number of optometrists and ophthalmologists, who told them there’s nothing they could see that matched their symptomology. I recall one who had travelled over 200km to see me. She complained about a highly irritated, scratchy eye over some weeks. Careful slit lamp exam – while rotating and lifting the lid margins – revealed a tiny lash that had rolled behind the lid at the superior aspect of the nasal inner canthus. I carefully epilated the errant lash and she reported that it felt a bit better. She called about an hour after she left to report that after settling down her eye felt normal for the first time in weeks. She was absolutely ecstatic and asked why her local practitioners had flippantly implied she was imagining things. Needless to say, she became a regular patient and spent considerable amounts of money on highend eyewear, while referring many loyal patients from her hometown.


In recent years, I developed an irritating misdirected lash that caused me to rub my eyes. It ultimately led to concretions and a highly symptomatic follicular conjunctivitis. With a long history of allergies, I initially thought I was suffering from an acute seasonal allergic conjunctivitis, but the uniocular symptoms told me the differential diagnosis was likely something else. At times I’d try Patanol eye drops which did not help. The only thing that provided some relief was a dexamethasone drop, which is obviously not to be used on a regular basis. I eventually learnt to ask a colleague to have a look whenever the irritation built up. They’d invariably find the culprit lash and pluck it out. Now that I’m retired from clinical practice, I have to call on colleagues, wherever I happen to be, and ask them to sort it, as I have done in recent months in Western Australia, Sydney, Newcastle, and Pretoria, South Africa.

I’m amazed at how such a seemingly innocuous lash can cause such irritation. It’s something to consider in your differential workup when dealing with patients suffering from significant symptoms which do not seem to match the signs.

Take a careful, thorough look.

In many cases you’ll obtain another ‘patient for life’.