Chemical conjunctivitis and diffuse lamellar keratitis after removal of eyelash extensions

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Title: Chemical conjunctivitis and diffuse lamellar keratitis after removal of eyelash extensions.
Abstract: The authors: present a unique case of a 46-year-old female with a prior history of laser assisted in-situ keratomileusis (LASIK) who presented with bilateral chemical conjunctivitis and diffuse lamellar keratitis (DLK) secondary to epithelial defects following the misapplication of eyelash extension removal gel.
Industry Significance Rating: High - Industry alert, report has major implications related to health and safety.
Publication: American Journal of Ophthalmology Case Reports. 2018 Aug 4;12:21-23. doi: 10.1016/j.ajoc.2018.07.007. eCollection 2018 Dec.
Authors: Moshirfar M, Masud M, Shah TJ, Avila MR, Hoopes PC Sr.
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The authors present a case with serious outcome for their patient following the chemical removal of eyelash extensions followed by the immediate application of eyeliner tattooing, a few hours after the procedures the patient developed "bilateral chemical conjunctivitis and diffuse lamellar keratitis (DLK) secondary to epithelial defects", one month later the patient developed and was treated for dry eye symptoms and approximately 3 years after the initial incident the patient still "had moderate but stable dry eye symptoms".

Some noteworthy comments within the report include that high strength topical anaesthetics were applied prior to the cosmetic tattooing "
40% lidocaine and 60% tetracaine" and an anaesthetic from China containing epinephrine "SSJ 48 Anesthetic Gel, China; Lidocaine HCl 60 mg, Epinephrine HCl 0.4 mg".

Given the range of chemicals applied to the patients eyelids it is understandable that the treating doctors faced a challenge in determining the causative agent i.e. was the cause of the chemical injury one of the chemicals applied or due to a combination of the chemicals used during the eyelash removal and eyeliner tattooing service. The authors also mention that "patients with prior history of LASIK can sometimes be more susceptible to significant damage and slower healing time following a chemical insult". This may be due to a degree of interruption to tear film quality/quantity after Lasik surgery.

Even if a trace amount of high concentration topical anaesthetic enters the eye after application to the eyelid it is likely to completely anaesthetise the eye surface which would mask the discomfort of a chemical injury from the anaesthetic itself or from other chemical agents that are being used at the time.

No mention is made in the report about the pH of the topical anaesthetics that were used however it should be noted that many topical anaesthetics on the market are alkaline and can be extremely corrosive to the eye, due to the challenges associated with the production process the higher the concentration of anaesthetic active ingredients the more challenging it is for a chemist to produce a product that would be pH safe for use near the eye. For this reason topical anaesthetics should always be assumed to be corrosive unless proven otherwise via written disclosure from the manufacturer.

The authors emphasise that their patient "
suffered many years of significant dry eyes, poor visual acuity, visual fluctuation, intermittent headaches, and significant functional impairment".

  • Any chemical agent used near the eye should be thoroughly checked for safety, if in doubt consult with an ophthalmologist prior to use.

  • Due to the range of chemical agents that may be used during the removal of eyelash extensions by third parties it is advisable not to perform eyeliner tattooing for at least 2 weeks after the removal of eyelash extensions.

  • High strength topical anaesthetics, topical anaesthetics containing epinephrine, and anaesthetics that may be corrosive should not be used near the eye.

  • Caution should be exercised with any client with a past history of Lasik surgery as they may be more susceptible to chemical injury to the eye.


Medical Report, chemical conjunctivitis, lamellar keratitis, eyelash removal, eyelash extensions, eyeliner tattoo, lasik, dry eye


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