The isolated absence or loss of eyelashes (madarosis) is associated with many processes including systemic and local diseases. Madarosis of dental origin has not been reported. This paper is a report of the successful treatment of unilateral eyelash loss following root canal therapy of an upper posterior tooth.
Loss of eyelashes, known as madarosis, may be the presenting feature of a number of vision and life threatening conditions, including endocrinopathy (hypothyroidism), bacterial infections (leprosy), viral infections (HIV/herpes zoster), autoimmune disease (scleroderma, discoid lupus) and malignant tumors . It is divided into scaring and non-scaring types, which indicate the potential for lash re-growth . Loss of eyelashes following dental treatment has never been reported in the English medical literature. This article presents a case of unilateral eyelash loss following endodontic treatment of a posterior maxillary tooth.
A 25-year-old man was referred with the chief complaint of eyelash loss in the right lower eyelid. The patient’s progressive loss of eyelashes began 1 month before arriving at the hospital ( Fig. 1 ). Previous medications, including antibiotics and anti-inflammatory drugs, had not alleviated the problem. There was no record in the medical history of endocrinopathy, viral infections, autoimmune diseases or local inflammatory disease. His social and family history was normal. Reviewing his dental history, the patient had root canal therapy of the right maxillary second molar 2 months previously with persisting dull pain during mastication on the same tooth.
Physical examination showed complete loss of eyelashes on the right lower lid without scaring. There was also mild swelling and erythema over the right infra-orbital area as well as mild tenderness. The eyes had normal function (confirmed by ophthalmologic consultation). The right upper vestibule was tender on intra-oral examination but there was no sinus tract .The patient had posterior nasal discharge which had started recently.
The laboratory profile, including thyroid hormones, showed normal values with a mild elevation in white blood cell count (11,500/mm 3 ; compared with the normal range of 6000–10,000/mm 3 ). Blood serology for HIV was negative.
An orthopantomograph was taken to rule out odontogenic pathology and showed a severely decayed upper right third molar and radiopaque foreign bodies in the right maxillary sinus related to the second molar root ( Fig. 2 A ). A computed tomography (CT) scan revealed right maxillary sinusitis in the coronal and axial views ( Fig. 2 B). These findings, the history and physical examination suggested a possible inflammatory origin for the eyelash loss.
The patient was scheduled for surgery under general anaesthesia to remove the foreign bodies from the maxillary sinus. The right maxillary sinus was approached via a classic Caldwell–Luc incision and anterior sinus wall window. The foreign bodies were surrounded by granulation tissue and small amounts of pus, which were removed completely. All pathologic sinus epithelium were also removed preserving the healthy mucosa and osteome. The periapical pathology was approached via the same incision and curetted without manipulation of the root. The patient’s right upper third molar was extracted at the same time. The incision was sutured with 4.0 vycril and the patient was sent to the recovery room. The removed tissues were sent for histopathologic examination, which revealed hypertrophic sinus lining with infiltration of inflammatory cells around the foreign bodies. Analysis of the foreign body showed a zinc-based material that is used routinely in root canal therapy. The postoperative period was uneventful and the patient was discharged 5 days after surgery with oral wide spectrum antibiotics, analgesics and topical and systemic nasal decongestants. The patient was requested to come for regular follow up every week. The patient did not return until 6 weeks later, in which time there had been complete re-growth of the eyelashes in the involved eye ( Fig. 3 ). The patient did not return for further follow up.