Extensions make for long and lush lashes — and the glue used to hold them can cause eye problems, doctors say

Lash extensions are glued onto individual eyelashes and can stay in place for up to six weeks. Credit: iStock

New varieties of long and lush false eyelashes offer Hollywood glamour — just in time for a post-holiday pick-me-up — yet ophthalmologists increasingly see problems with them.

Lash extensions, often made from light synthetic or natural materials, are glued onto individual eyelashes — and can stay in place for four to six weeks. Yet lash extensions can cause minor ailments, such as allergies or inflammations, and severe, though rare, sight-ruining afflictions such as infected corneas.

"I've see a lot of problems; the most common thing I see is kind of an allergic reaction to the glue," said Dr. Mitesh Kapadia, of Ophthalmologist and Oculoplastics Specialist at Tufts Medical Center in Boston. "The first thing we do is get the last extension taken off, and that often solves the problem."

Lash extensions are prized for their somewhat more natural and feathery look. They can be as short as just under a ¼-of-an-inch or as long as almost ½-an-inch. Prices start around $100 and run as much as three times that in the metropolitan area.

Traditional false eyelashes, in contrast, are strips of lashes that also are glued in place or held with tiny magnets. They are applied daily and cost just a fraction of what extensions do.

Patients typically suffer from swollen, reddened and irritated eyes and even severe blepharitis, an inflammation that often causes dry eyes — and is almost impossible to cure. Their own eyelashes also may wither.

Applied with proper safeguards, doctors say, and kept scrupulously clean are the safest ways to use these beauty enhancers.

A number of lash artists appear well-versed in possible ailments — and how best to avoid them.

The Scottsdale, Arizona based "The Lash Professional," for example, stresses strict hygiene and monitoring for any "excessive tearing, itchy eyes, red or pink eyes, crusting of the lash line, burning, swelling of the eyelids and sensitivity to light."

Traditional mascara is another option. "For many of my patients, I recommend that they get a tubing mascara," said Dr. Laura Palazzolo, an ophthalmologist with expertise in cornea external diseases and refractive surgery at NYU Langone Huntington Medical Group.

Tubing mascaras lengthen lashes with tiny fibers that rinse off easily.

Alternatively, Dr. Milap Mehta, an ophthalmologist and eyelid plastic surgeon at NorthShore University HealthSystem, said eyelash transplants were becoming more popular, using "a strip of hair-bearing skin" from the head that is transplanted and "trimmed down so it's more appropriate in size."

Eyelash growth serum Latisse, however, also can prove troublesome for some, not only darkening the eyelid and the iris, the colored part of the eye, but over-reducing the fat around it.

"In those patients where they use an eyedrop," explained Dr. Kapadia, "the fat around the eye shrinks … and their eye can look very hollowed out."

The extraordinary power wielded by social media influencers in fashion and wellness partly explains the rosy growth forecasts for the lash extension niche.

In the United States alone, the lash extension business is expected to grow 7.6% a year, more than doubling to $2.4 billion in 2031 from 2020, according to the Albany-based Transparent Market Research.

"You look on TV, everyone has beautiful eyelashes and no wrinkles — I think it's something people are sort of striving for, their idea of what ideal beauty is," said Dr. Sarah Weissbart, a Stony Brook University Hospital ophthalmologist with expertise in diseases of the corneas and the ocular surface.

"Most people probably don't realize there are any risks."

Problems may take time to develop, the doctors said, so patients, mostly ages 20 to 40, may not realize lash extensions are the culprit. Eyedrops, antibiotics, and steroids — plus removing the lash extensions — should clear most minor ailments, including the droopy eyes caused by their weight.

Most ailments stem from the formaldehyde-containing glue, which releases toxic compounds that clients may not be told are hazardous.

Cleansing is an imperative: both before the lash extensions are glued on and afterward.

"You really need to be careful about not sleeping in makeup, not allowing any kind of buildup in that area," said Dr. Laura Palazzolo, an NYU Langone Huntington Medical Group ophthalmologist and clinical assistant professor of ophthalmology at NYU Grossman School of Medicine. Daily cleansing the base of the eyelashes where infections might sprout is a must.

"Recent studies have reported that 73.3% of patients experienced ocular side effects after the application of eyelash extensions, including itching [45.8%], redness [45.5%], pain [43.9%] and heavy eyelids [41.6%]," according to a 2019 study that reviewed 18 research papers.

"Failure to treat those reactions most often leads to other serious ocular disorders, including contact dermatitis, toxic conjunctivitis, conjunctival erosion and allergic blepharitis," said the study, entitled "Eyelid Cosmetic Enhancements and Their Associated Ocular Adverse Effects."

As Mehta noted, "A lot of patients with lash extensions do have styes," he said, referring to unsightly red bumps that reveal infected oil glands.

One Long Island bride last summer erupted in styes just two weeks before her wedding, a Manhattan ophthalmologist said.

Contact dermatitis is an itchy rash caused by an allergy; conjunctivitis, called redeye, is an inflammation, bacterial or viral, of layers of the inner eyelid and outer eye globe.

Untreated, these problems can jeopardize sight.

Blepharitis, an inflammation of eyelid oil glands, can cause burning, soreness, redness and a flaky discharge.

That's not all. "When the [eyelid] glands are not working well," explained Weissbart, patients can develop "very severe dry eyes." As a result, "You can even end up getting infections of the cornea. That would be the most severe case involving lash extensions," said the specialist in cornea and refractive care.

"Depending on the size and location, you can be left with permanent scarring that can be disabling for the rest of your life," Weissbart said.

Patients may need corneal transplants if they cannot even make out the big E on an eye chart.

"And then, one of the things we always forget, is a lot of employees working in these industries, they are getting exposed" to that toxic-releasing glue, Mehta said.

"So make sure you’re going to a reputable place, with single-use items," Mehta said.

Correction: Tufts Medical Center is in Boston. An earlier version of this story had the wrong city in Massachusetts.

New varieties of long and lush false eyelashes offer Hollywood glamour — just in time for a post-holiday pick-me-up — yet ophthalmologists increasingly see problems with them.

Lash extensions, often made from light synthetic or natural materials, are glued onto individual eyelashes — and can stay in place for four to six weeks. Yet lash extensions can cause minor ailments, such as allergies or inflammations, and severe, though rare, sight-ruining afflictions such as infected corneas.

"I've see a lot of problems; the most common thing I see is kind of an allergic reaction to the glue," said Dr. Mitesh Kapadia, of Ophthalmologist and Oculoplastics Specialist at Tufts Medical Center in Boston. "The first thing we do is get the last extension taken off, and that often solves the problem."

Lash extensions are prized for their somewhat more natural and feathery look. They can be as short as just under a ¼-of-an-inch or as long as almost ½-an-inch. Prices start around $100 and run as much as three times that in the metropolitan area.

Traditional false eyelashes, in contrast, are strips of lashes that also are glued in place or held with tiny magnets. They are applied daily and cost just a fraction of what extensions do.

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Patients typically suffer from swollen, reddened and irritated eyes and even severe blepharitis, an inflammation that often causes dry eyes — and is almost impossible to cure. Their own eyelashes also may wither.

Applied with proper safeguards, doctors say, and kept scrupulously clean are the safest ways to use these beauty enhancers.

A number of lash artists appear well-versed in possible ailments — and how best to avoid them.

The Scottsdale, Arizona based "The Lash Professional," for example, stresses strict hygiene and monitoring for any "excessive tearing, itchy eyes, red or pink eyes, crusting of the lash line, burning, swelling of the eyelids and sensitivity to light."

Traditional mascara is another option. "For many of my patients, I recommend that they get a tubing mascara," said Dr. Laura Palazzolo, an ophthalmologist with expertise in cornea external diseases and refractive surgery at NYU Langone Huntington Medical Group.

Tubing mascaras lengthen lashes with tiny fibers that rinse off easily.

Alternatively, Dr. Milap Mehta, an ophthalmologist and eyelid plastic surgeon at NorthShore University HealthSystem, said eyelash transplants were becoming more popular, using "a strip of hair-bearing skin" from the head that is transplanted and "trimmed down so it's more appropriate in size."

Eyelash growth serum Latisse, however, also can prove troublesome for some, not only darkening the eyelid and the iris, the colored part of the eye, but over-reducing the fat around it.

"In those patients where they use an eyedrop," explained Dr. Kapadia, "the fat around the eye shrinks … and their eye can look very hollowed out."

The extraordinary power wielded by social media influencers in fashion and wellness partly explains the rosy growth forecasts for the lash extension niche.

In the United States alone, the lash extension business is expected to grow 7.6% a year, more than doubling to $2.4 billion in 2031 from 2020, according to the Albany-based Transparent Market Research.

"You look on TV, everyone has beautiful eyelashes and no wrinkles — I think it's something people are sort of striving for, their idea of what ideal beauty is," said Dr. Sarah Weissbart, a Stony Brook University Hospital ophthalmologist with expertise in diseases of the corneas and the ocular surface.

"Most people probably don't realize there are any risks."

Problems may take time to develop, the doctors said, so patients, mostly ages 20 to 40, may not realize lash extensions are the culprit. Eyedrops, antibiotics, and steroids — plus removing the lash extensions — should clear most minor ailments, including the droopy eyes caused by their weight.

Most ailments stem from the formaldehyde-containing glue, which releases toxic compounds that clients may not be told are hazardous.

Cleansing is an imperative: both before the lash extensions are glued on and afterward.

"You really need to be careful about not sleeping in makeup, not allowing any kind of buildup in that area," said Dr. Laura Palazzolo, an NYU Langone Huntington Medical Group ophthalmologist and clinical assistant professor of ophthalmology at NYU Grossman School of Medicine. Daily cleansing the base of the eyelashes where infections might sprout is a must.

"Recent studies have reported that 73.3% of patients experienced ocular side effects after the application of eyelash extensions, including itching [45.8%], redness [45.5%], pain [43.9%] and heavy eyelids [41.6%]," according to a 2019 study that reviewed 18 research papers.

"Failure to treat those reactions most often leads to other serious ocular disorders, including contact dermatitis, toxic conjunctivitis, conjunctival erosion and allergic blepharitis," said the study, entitled "Eyelid Cosmetic Enhancements and Their Associated Ocular Adverse Effects."

As Mehta noted, "A lot of patients with lash extensions do have styes," he said, referring to unsightly red bumps that reveal infected oil glands.

One Long Island bride last summer erupted in styes just two weeks before her wedding, a Manhattan ophthalmologist said.

Contact dermatitis is an itchy rash caused by an allergy; conjunctivitis, called redeye, is an inflammation, bacterial or viral, of layers of the inner eyelid and outer eye globe.

Untreated, these problems can jeopardize sight.

Blepharitis, an inflammation of eyelid oil glands, can cause burning, soreness, redness and a flaky discharge.

That's not all. "When the [eyelid] glands are not working well," explained Weissbart, patients can develop "very severe dry eyes." As a result, "You can even end up getting infections of the cornea. That would be the most severe case involving lash extensions," said the specialist in cornea and refractive care.

"Depending on the size and location, you can be left with permanent scarring that can be disabling for the rest of your life," Weissbart said.

Patients may need corneal transplants if they cannot even make out the big E on an eye chart.

"And then, one of the things we always forget, is a lot of employees working in these industries, they are getting exposed" to that toxic-releasing glue, Mehta said.

"So make sure you’re going to a reputable place, with single-use items," Mehta said.

Correction: Tufts Medical Center is in Boston. An earlier version of this story had the wrong city in Massachusetts.