Scleritis Associated With Cosmetic Eyelash Extensions
Thomas O'Donnell, Safa Ibrahim, Dina Abdelsalam, Andrew G. Lee, Rahul T. PanditPurpose:
The purpose of this study was to describe a case of anterior scleritis temporally associated with cosmetic eyelash extensions presenting with atypical visual disturbances.
Methods:
A 21-year-old woman presented with acute left eye pain, redness, and progressive visual loss shortly after placement and removal of eyelash extensions. Examination demonstrated decreased visual acuity, marked scleral injection with nonblanching vessels after phenylephrine, constricted visual fields, dyschromatopsia, intermittent large angle esotropia with pupillary constriction, and pain with eye movement. Neuroimaging and laboratory evaluation were unremarkable, and there was no relative afferent pupillary defect. Humphrey visual field testing showed severe global depression, while confrontation testing demonstrated nonphysiologic tubular fields. A diagnosis of anterior scleritis was made, and the patient was treated with corticosteroids and intraocular pressure-lowering therapy. At 1-week follow-up, symptoms resolved with normalization of visual acuity, color vision, ocular alignment, and visual fields.
Results:
This case highlights a rare presentation of anterior scleritis associated with cosmetic eyelash extensions and demonstrates how inflammation and ocular pain may produce functional visual disturbances that mimic optic neuropathy. Discordant visual field testing, normal neuroimaging, and rapid resolution with treatment support a nonstructural etiology. The intermittent esotropia with pupillary constriction is most consistent with dysregulation of the near triad, potentially triggered by inflammation-mediated nociceptive input.
Conclusions:
Cosmetic eyelash extensions may represent an underrecognized trigger for anterior scleritis. Associated functional visual findings can mimic optic neuropathy and contribute to diagnostic uncertainty. Recognition of this presentation is important to avoid misdiagnosis and to prompt consideration of cosmetic exposures in patients presenting with acute painful vision loss.