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Eyelash Extensions

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Eyelash extensions are synthetic fibres applied on the natural lashes for cosmetic reasons, using glue that contains formaldehyde, lead and benzoic acid. Also known as ‘semi-permanent eyelash extension’, the cosmetic procedure, usually performed in beauty salons, is gaining popularity worldwide due to its relatively natural look and long lasting effect. Safety concerns are raised, however, as eyelash extensions are found to be associated with numerous ocular conditions, including keratoconjunctivitis, allergic blepharitis, conjunctival erosion, subconjunctival haemorrhage and traction alopecia.


Complications of eyelash extensions include: keratoconjunctiviits, allergic blepharitis, conjunctival erosion, subconjunctival haemorrhage, traction alopecia.

Symptomatology and Pathophysiology


Keratoconjuncitivits usually presents as ocular itchiness and irritation, and conjunctival hyperaemia (redness) affecting predominantly the lower region. Eyelash extensions may give rise to keratoconjunctivitis by three mechanisms. The glue containing formaldehyde may directly invade the eyes during the procedure. It may also arise from an indirect invasion hours after the procedure, when the glue dissolves as the patient washes his or her face, or when the glue is vaporised by body temperature or humidity. Conjunctival hyperaemia in the lower region is attributed to the downward flow of lacrimal fluid from the gland to the lacrimal puncta, and the specific gravity of formaldehyde being greater than that of the lacrimal fluid.

Allergic Blepharitis

Allergic blepharitis typically presents as redness, irritation, tearing and swollen eyelids affecting both eyes. 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 allergic reaction. Lead and benzoic acid, found in varying concentrations in different brands of glue, are also suggested to cause allergy in some patients.

Conjunctival Erosion

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.

Subconjunctival Haemorrhage

Patients with subconjunctival haemorrhage often present with an acute red eye. It may be caused by mechanical compression when the lash extensions are removed.

Traction Alopecia

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 advice from a medical professional immediately.

Management for the diseases may include:


Keratoconjunctivitis can be treated with topical antibiotics ointment or eye drops, such as levofloxacin, and with sodium hyaluronate eye drops.

Allergic Blepharitis

Treatment for allergic blepharitis may include antihistamine eye drops and/or oral tablet, and antibiotics and steroid eye drops.

Conjunctival Erosion & Subconjunctival Haemorrhage

Patients with conjunctival injury may require further ophthalmological examinations to delineate the cause of injury. These tests may include a slit lamp examination and fluorescein examination, if compression during 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 haemorrhage. Uncomplicated conjunctival erosion can be managed with topical antibiotics. Such injuries typically heal within three days. Subconjuncitval haemorrhage without 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 to 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 by government.


[1] [2] [3]

  1. Amano Y., Sugimoto Y., Sugita M. Ocular disorders due to eyelash extensions. Cornea 2012;31:121–125.
  2. 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.
  3. 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.