Ethical approval

Not required.
Acknowledgement. The authors would like
to thank Ms. Marie-Paule Friocourt for her
assistance.
References
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Address:
Reza Arbab-Chirani
UFR dOdontologie de Brest
22 rue Camille Desmoulins
29238 Brest Cedex 3
France
Tel.: +33 298223330
fax: +33 298016932
E-mail: arbab@univ-brest.fr
doi:10.1016/j.ijom.2010.04.049
Case Report
Oral Medicine
Temporary eyelash loss
following dental treatment
S. Nezafati, S. Rahimi, H. Mohseni: Temporary eyelash loss following dental
treatment. Int. J. Oral Maxillofac. Surg. 2010; 39: 11421144. #2010 International
Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights
reserved.
S. Nezafati
1
, S. Rahimi
2
,
H. Mohseni
1
1
Oral and Maxillofacial Surgery, Emam Reza
Hospital, Tabriz University of Medical
Sciences, Tabriz, Iran;
2
Dental Faculty, Tabriz
University of Medical Sciences, Tabriz, Iran
Abstract. 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.
Keywords: eyelash loss; dental treatment; ma-
darosis.
Accepted for publication 27 April 2010
Available online 3 July 2010
Loss of eyelashes, known as madarosis,
may be the presenting feature of a number
of vision and life threatening conditions,
including endocrinopathy (hypothyroid-
ism), bacterial infections (leprosy), viral
infections (HIV/herpes zoster), autoim-
mune disease (scleroderma, discoid lupus)
and malignant tumors
4,9
. It is divided into
scaring and non-scaring types, which indi-
cate the potential for lash re-growth
4
. 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 max-
illary tooth.
Case report
A 25-year-old man was referred with the
chief complaint of eyelash loss in the right
1142 Chevalier et al.
lower eyelid. The patients progressive
loss of eyelashes began 1 month before
arriving at the hospital (Fig. 1). Previous
medications, including antibiotics and
anti-inammatory drugs, had not alle-
viated the problem. There was no record
in the medical history of endocrinopathy,
viral infections, autoimmune diseases or
local inammatory 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 swel-
ling and erythema over the right infra-
orbital area as well as mild tenderness.
The eyes had normal function (conrmed
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 prole, including thyr-
oid hormones, showed normal values with
a mild elevation in white blood cell count
(11,500/mm
3
; compared with the normal
range of 600010,000/mm
3
). Blood serol-
ogy 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. 2A). A computed
tomography (CT) scan revealed right max-
illary sinusitis in the coronal and axial
views (Fig. 2B). These ndings, the his-
tory and physical examination suggested a
possible inammatory origin for the eye-
lash 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 CaldwellLuc 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 pre-
serving the healthy mucosa and osteome.
The periapical pathology was approached
via the same incision and curetted without
manipulation of the root. The patients
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 inltration of inammatory 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 spec-
trum 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.
Discussion
Madarosis is derived from the ancient
Greek word madao meaning to fall off
and is dened as hair loss of the eyebrows
(superciliary madarosis) or loss of eye-
lashes (ciliary madarosis)
5
. Loss of eye-
lashes is also known as milphosis
4
. In
addition to the obvious cosmetic blemish
for which the patient usually presents to
dermatologists or ophthalmologists,
madarosis may be the presenting sign of
many systemic diseases and warrants
detailed systemic examination and in
some cases, consultation with an internist
or endocrinologist for further treatment
4,9
.

Fig. 1. Loss of eyelashes in the right lower lid.

Fig. 2. Images for detecting foreign body: (A) orthopantomograph, (B) CT scan.
Temporary eyelash loss following dental treatment 1143
Madarosis may be linked to skin dis-
ease, infectious disease, endocrinopathies,
drugs, trauma, neoplasms and congenital
disease
4,5,7,9
. The results of previous
investigations, by different specialists,
did not suggest any of these conditions
in the present case.
Trichotillomania, the habit of hair pull-
ing in patients with underlying psycho-
pathology, can be considered in cases with
isolated eyelash alopecia
8
. In factitious
disease, the morphologic characteristics
of the eyelashes are different, the hairs
are broken at different levels and may be
coarse and sometimes tortuous as a result
of repeated trauma
8
. This patient was an
active and healthy male with no sign or
symptoms of psychopathology and the
hairs were absent completely and uniquely
in one eye.
Focal infection can cause localized hair
loss
4,6,7
. The importance of dental pathol-
ogy in the therapy of alopecia areata (AA)
has been pointed out
2,6,10
. Alopecia areata
of dental origin is generally located on the
scalp but occasionally affects the beard
and more exceptionally the eyebrows
2,6,7
.
The lesions are usually ipsilateral and
posterior to the related tooth
6
. The lesions
of maxillary origin are located above the
commissure line
6
. The main mechanism
of AA of dental origin is usually based on
an immunologic hypothesis including the
presence of a perifollicular lymphocytic
inltrate as a result of local T cell-
mediated cytotoxic inammatory
response. A trigemino-sympathetic reex
has also been proposed, induced by a
peripheral infectious or mechanical stimu-
lus and causing angiospasm of the pilose-
baceous follicle
6
.
There have been reports of the migra-
tion of root canal lling material into the
paranasal sinuses
1,3
. Some ingredients in
these materials, such as zinc and calcium,
have the potential to stimulate the growth
of fungi, but in the previous cases of
maxillary sinusitis resulting from dis-
placed endodontic sealer materials, loss
of eyelashes has not been reported
1
.
Although maxillary sinusitis resulting
from intra-sinus foreign bodies is not
uncommon, there are different, interre-
lated etiopathogenic factors for AA of
dental origin, so elimination of one factor
as the main cause of hair loss is not always
sufcient
6
.
This is possibly the rst case of tem-
porary eyelash loss following root canal
therapy of a maxillary tooth. The presence
of common immune mediators in the
pathogenesis of both AA and dental infec-
tion could account for the dental origin of
the hair loss.
In conclusion, dental pathosis should be
included in the differential diagnosis for
eyelash loss.
Funding
No funding.
Competing interests
None declared.
Ethical approval
Not required.
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Address:
Saeed Nezafati
Oral and Maxillofacial Surgery
Emam Reza Hospital
Tabriz University of Medical Sciences
Tabriz
Iran
Tel.: +98 9141150952
fax: +98 4113346977
E-mail: nezaf2000@yahoo.com
doi:10.1016/j.ijom.2010.04.052

Fig. 3. Eyelash growth following treatment.
1144 Nezafati et al.