Eyelash Poliosis

Idiopathic poliosis is a diagnosis of exclusion when no underlying cause is found. Vitiligo is a common acquired pigmentary disorder that can present with poliosis of the eyelashes, often accompanied by depigmented skin patches; it is frequently associated with other autoimmune conditions. Chronic blepharitis may rarely cause poliosis due to chronic inflammation of the eyelid margin. Post-inflammatory change from atopic or contact dermatitis can result in localized poliosis, especially if there is a history of eczema or dermatitis involving the periocular region. Drug-induced poliosis is most commonly seen with topical prostaglandin F(2α) analogues used for glaucoma, which can cause reversible poliosis of the eyelashes. Halo nevus or other benign nevus-associated poliosis may present as localized whitening of lashes adjacent to a melanocytic nevus. Phthisis bulbi or chronic uveitis–related poliosis can occur in the context of longstanding ocular inflammation.[1-5] Most Important Not to Miss Diagnoses: Vogt–Koyanagi–Harada (VKH) disease is a multisystem autoimmune disorder that can present with eyelash poliosis, often accompanied by bilateral granulomatous uveitis, auditory symptoms, and meningeal signs. Diagnosis relies on clinical findings and multimodal imaging, with indocyanine green angiography and enhanced depth imaging OCT being key tools. Sympathetic ophthalmia is a bilateral granulomatous uveitis following ocular trauma or surgery, and may present with poliosis; early recognition and prompt systemic immunosuppression are critical.

Cutaneous/ocular malignant melanoma may rarely present with poliosis due to destruction of melanocytes adjacent to a melanoma; biopsy is required for diagnosis, as recommended by the American Academy of Dermatology.[6-8]

Key Additional History and Follow-up Tests: • History of autoimmune disease, ocular trauma, surgery, or topical medication use. • Associated skin depigmentation, hearing changes, or neurologic symptoms. • Slit-lamp examination for uveitis. • Skin and eyelid examination for vitiligo, nevi, or dermatitis. • Consider biopsy of suspicious lesions. • Imaging (OCT, ICGA) if VKH or sympathetic ophthalmia is suspected. • Thyroid and autoimmune panel if systemic disease is suspected.

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Leading Journal

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Practice Guideline