A patient told me today that her mother noted her eyelashes grew when she used Restasis. I had not heard this complaint so had to look it up.
It turns out there is 1 case report published on this phenomenon and a couple of online blog posts noting Restasis may be associated with longer eyelashes. The blog post below notes the eyelashes that grew were irregular and an annoyance. I could not find any randomized, controlled studies to prove this.
There are a couple of blog posts noting a patient who LOST eyelashes using Restasis. Again, I could not find any randomized, controlled studies to prove this either (Ref 4).
Meibomian gland dysfunction can absolutely cause eyelash drop–out and trichiasis (the growth of abnormal eyelashes), so it is hard to say which of the above patients had this as a cause of eyelash issues.
SLC
REFERENCES:
1.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268523/pdf/cop0002-0398.pdf
- Journal List
- Case Rep Ophthalmol
- v.2(3); Sep-Dec 2011
- PMC3268523
Case Rep Ophthalmol. 2011 Sep-Dec; 2(3): 398–400.
Published online 2011 Dec 17. doi: 10.1159/000335281
PMCID: PMC3268523
PMID: 22291642
Cyclosporine A Eye Drop-Induced Elongated Eyelashes: A Case Report
aDepartment of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
bDepartment of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
cInstitute of Biochemical and Biomedical Engineering, Taoyuan, Taiwan, ROC
dDepartment of Chinese Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
*Chi-Chin Sun, MD, PhD Department of Ophthalmology Chang Gung Memorial Hospital 222 Mai-Chin Road, Keelung 204, Taiwan (ROC) Tel. +886 2 2431 3131 2553, E-Mail ten.tenih.asm@nus.nivra
Abstract
Purpose
The most common ocular adverse event following the use of cyclosporine A (CsA) 0.05% ophthalmic emulsion is ocular burning (17%). Other adverse effects that have been reported include conjunctival hyperemia (1-5%), discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging and blurred vision. Here, we report a specific side effect of CsA, namely eye drop-induced eyelash elongation in a patient with refractory giant papillary conjunctivitis.
Design
Observational case report.
Methods
Case report and review of the literature.
Results
A 32-year-old female with giant papillary conjunctivitis on the left eye, who had undergone papillectomy 3 years previously and was refractory to topical steroid therapy, was treated with CsA 0.05% ophthalmic emulsion (Restasis) 4 times a day, preservative-frees artificial tears and gentamicin ophthalmic solution in the left eye. After 5 months of topical CsA treatment, elongated eyelashes of her left eye were observed without other adverse effects.
Conclusion
Although hypertrichosis and trichomegaly have been documented in the literature as side effects of systemic CsA, topical CsA 0.05% eye drop-induced elongated eyelashes have not been reported, and we believe ophthalmologists should be mindful and inform patients about this specific side effect.
Key words: Cyclosporine A, Eyelash elongation, Giant papillary conjunctivitis, Side effect
Case Report
A-32-year-old Asian female patient, who had received conjunctival papillectomy on the left eye in 2002, visited our ophthalmic outpatient department in 2007 complaining of a swollen eyelid and discharge from her left eye. The ocular examination revealed notable injected conjunctiva, especially over the superior part, and multiple papillae with injected and engorged vessels on the left eye (fig. fig.11).
External photographs showing multiple papillae with conjunctival injection (a) and engorged vessels (b) over tarsal conjunctiva on the left eye.
Due to the suspicion of giant papillary conjunctivitis, she was started on topical steroid medications including fluorometholone 0.1% and prednisolone acetate 1% ophthalmic solutions for 2 months. However, steroid treatment was discontinued due to poor response and an elevated intraocular pressure. Therefore, her treatment was switched to topical cyclosporine A (CsA) 0.05% ophthalmic emulsion (Restasis) 4 times a day, preservative-free artificial tears and gentamicin ophthalmic solution. After 5 months of topical CsA treatment, she came back to our clinic complaining of elongated and darkened eyelashes on her left eye without other adverse effects (fig. fig.22). According to the patient, no systemic medications such as calcium channel blockers, erythropoietin or minoxidil were used during the treatment period.
Discussion
CsA is a hydrophobic, cyclic polypeptide produced as a metabolite by the fungus Tolypocladium inflatum. CsA functions as an immunomodulating agent that binds to cyclophilin, a cytoplasmic protein, thus interrupting the signaling for interleukin (IL]-2 production, in addition to inhibiting the proliferation of CD4 T lymphocytes [1]. It also has direct inhibitory effects on both eosinophil and mast cell activation [2], which has established its role in the treatment of allergic inflammation [2, 3]. In the early 1980s, topically applied CsA was first used to inhibit experimental corneal allograft reaction [4]. Meanwhile, CsA eye drops were also prescribed for patients with inflammatory ocular surface disorders, particularly dry eye syndrome and severe allergic keratoconjunctivitis [5]. The current literature supports the safety of topical CsA [6].
The major side effect of systemic CsA is nephrotoxicity that is reversible with dosage reduction. Other documented adverse reactions to systemic CsA include mild hepatotoxicity, hypertension, dose-dependent hypertrichosis and trichomegaly, tremor, infection, gum hyperplasia, gastric irritation symptoms and neuropathies [7]. On the other hand, adverse events following the use of CsA 0.05% ophthalmic emulsion include ocular burning (17%], conjunctival hyperemia (1-5%], discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging and blurred vision [6]. However, to our knowledge, no CsA ophthalmic emulsion-induced hypertrichosis has been reported in the literature to date. The factors that regulate the growth cycle of the eyelash hair follicles remain unclear. Paus et al. [8] suggested that CsA induces telogen follicles to enter an anagen growth phase, implying a role of CsA in regulating the hair follicle immune system and its cellular components through the release of inhibitory/stimulatory cytokines [8, 9]. The experiments also indicated that the rate of anagen induction is dependent on the dose, time course, and method of administration [8].
In summary, although rarely encountered, CsA 0.05% ophthalmic emulsion may induce the growth of eyelashes, and we believe ophthalmologist should be mindful and inform patients treated with topical CsA about this side effect.
References
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I’ve been on Restasis for five months, after I suffered permanent damage courtesy of a 3-month bout of chronic follicular conjunctivitis. It burns a little bit when you first start using it, though it wasn’t near as bad as some of the other drops I was on for a while. My opthamologist had me on Pataday shortly before I started the Restasis to ‘work me up’ to it. It’s not that bad though. Think the Pataday was probably unnecessary.
It has seemed to help the dry eye issue, but hasn’t resolved it 100%. But any improvement is welcome. And like Kayjay said, as long as you don’t touch the tip you can use it a couple of times before throwing the little vial out. Be careful though, Restasis doesn’t have any preservatives so if you keep using it after you’ve opened it bacteria might have a chance to grow in it and cause an eye infection.
On a side note, it makes your eyelashes grow! I have not been able to find any legitimate research to back this up, but on me the change is definitely noticeable. A nice fringe benefit to have when you’re dealing with eye crap.
It has seemed to help the dry eye issue, but hasn’t resolved it 100%. But any improvement is welcome. And like Kayjay said, as long as you don’t touch the tip you can use it a couple of times before throwing the little vial out. Be careful though, Restasis doesn’t have any preservatives so if you keep using it after you’ve opened it bacteria might have a chance to grow in it and cause an eye infection.
On a side note, it makes your eyelashes grow! I have not been able to find any legitimate research to back this up, but on me the change is definitely noticeable. A nice fringe benefit to have when you’re dealing with eye crap.