Chronic eyelid irritation in lash extension users? Think mites

Clinical takeaway: Consider demodectic blepharitis in lash extension users with persistent eyelid complaints. The adhesive sits where diagnostic collarettes form, so infestation may be easy to miss on exam.

Eyelash extensions are a standing appointment for many young women in the age of social media, reapplied every few weeks sometimes for years. When those patients arrive with red, itchy, or watering eyes, the complaint tends to read as possible allergies or dry eye. But the cosmetic procedure sitting at the lash line may never enter the patient's medical history.

Ophthalmologists have linked extensions to irritation, dry-eye symptoms, and gland dysfunction along the lid margin, with most scrutiny falling on adhesives and application technique. How the procedure relates to Demodex infestation is less settled: the mites are common, but whether repeated extensions foster their proliferation had not been measured in the population most exposed. A cross-sectional survey paired with lash microscopy took up that question.

Microscopic examination found Demodex folliculorum on the lashes of 24 of 25 women who regularly get eyelash extensions. Eighteen of the 25 showed clinical signs of demodicosis, including itching and irritation at the eyelid margins, redness, swelling, lashes sticking together, and cylindrical dandruff at the lash base. The gland and symptom findings came from an earlier survey.

Among women who had undergone the lash procedure more than 10 times, meibography showed meibomian gland dysfunction in 85%. Nearly half of extension users, 47.6%, reported discomfort, redness, tearing, or itching after the procedure, and 58% underwent extensions every three to four weeks.

Researchers surveyed 345 young women and adolescents aged 16 to 28, of whom 86, or about a quarter, had experience with eyelash extensions. In the microscopy stage, investigators collected four lashes from each eyelid of 25 regular extension users and examined them under light microscopy. The findings will be presented at the 2026 congress of the European Society of Cataract and Refractive Surgeons.

The researchers suggest frequent extensions may create conditions favorable to the mites by impairing lid hygiene and altering the eyelid skin microenvironment. They say a larger study should include women without extensions, comparing mite counts and testing how extension frequency tracks with eye health and infestation symptoms. In the meantime, the researchers point to eyelid hygiene rather than avoidance: cleansing lashes twice daily with a preservative-free, hypoallergenic gel designed for the eyelids, and a course of anti-parasitic treatment when infestation is confirmed.

"Although these mites are common, we don't typically see a lot of them in younger women. Usually if they are present on the eyelashes, we spot them by the 'collarettes' they leave around the eyelashes. These are waxy rings made up of dead mites, mite feces and mite eggs, mixed with skin and oil," said Sorcha Ni Dhubhghaill, professor and head of ophthalmology at UZ Brussel in Belgium and chair of the ESCRS Cornea Committee, who was not involved in the research. "Since the adhesive used during eyelash extension procedures is applied near the base of the natural lashes, where collarettes are typically located, it could be much harder to spot them in women using eyelash extensions."

"It is important to emphasize that the presence of Demodex folliculorum does not necessarily indicate disease, as these mites may be part of the normal ocular microbiota. But it is important to detect them if they are causing symptoms, signs of inflammation and meibomian gland dysfunction," she concluded.

Source: Zhmud T, et al. (2026 Sep 12) 44th Congress of the European Society of Cataract and Refractive Surgeons. Eyelash extensions and Demodex folliculorum: influence on eyelid microenvironment and ocular surface health