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Eyelash Poliosis

FIXME

Causes

  • Idiopathic- diagnosis of exclusion
  • Vitiligo
    • acquired pigmentary disorder of skin and hair with depigmented skin patches
    • frequently associated with other autoimmune conditions.
  • Chronic blepharitis
  • Post-inflammatory change from atopic or contact dermatitis especially if there is a history of eczema or dermatitis involving the periocular region.
  • Drug-induced
    • topical prostaglandin F(2α) analogues used for glaucoma, usually reversible poliosis
  • Halo nevus or other benign nevus-associated poliosis
    • localized whitening of lashes adjacent to a melanocytic nevus.
  • Phthisis bulbi or chronic uveitis–related poliosis with longstanding ocular inflammation.
  • 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