Ingrowing eyelashes: why electrolysis often isn't the answer

A retired schoolteacher came to my clinic last year having had electrolysis to her eyelashes every few months for nearly four years. Each time, two or three lashes were removed. Each time, within a few months, two or three more had taken their place. Her eyes were chronically red, watery, and sore. Each session of treatment had been competent and well intentioned. Each session had also added a small amount of scar tissue to her eyelid margin, and the scar tissue was now part of the problem.

This is one of the more common patterns I see in patients with ingrowing eyelashes. They have been told electrolysis is the answer. For most of them, it is not.

What is happening

Eyelashes normally grow outward, away from the eye. When they grow inward, they brush against the surface of the eye with every blink, causing irritation, redness, watering, and over time damage to the cornea itself. There are two related causes that are often confused with one another.

Trichiasis is individual lashes growing in the wrong direction from a normally positioned eyelid margin. The platform is in the right place; one or two lashes have decided to point the wrong way.

Marginal entropion is the lid margin itself rolling slightly inward, taking otherwise well-behaved lashes with it. The lashes are oriented correctly from their follicles, but the platform they sit on is tilted.

Both are usually the result of long-standing chronic eyelid margin disease, most commonly chronic blepharitis. Inflammation of the lash follicles and the lid margin slowly causes scarring and distortion, and over years the lid margin loses its normal architecture. Less commonly there are specific underlying conditions such as ocular cicatricial pemphigoid or previous chemical injury, which need to be recognised and treated separately.

Why electrolysis is offered, and why it so often disappoints

Electrolysis works by passing a small electrical current down the lash follicle, destroying it. In principle, the offending lash never grows back. In practice, three things make it less attractive than it sounds.

First, the success rate per lash per attempt is around 50 percent. A single lash needs an average of two attempts to be permanently removed, and there is no guarantee even then. For a patient with chronic lid margin disease, the typical pattern is three or four affected lashes in each of all four eyelids (the upper and lower of each eye). At fifty percent per lash per attempt, fully clearing twelve to sixteen lashes typically takes five or six rounds of treatment, spaced over months. The maths quickly becomes punishing.

Second, electrolysis is not benign. The current that destroys the lash follicle also causes a small amount of inflammation and scarring at the lid margin. In a patient whose underlying problem is exactly that, scarring and distortion of the lid margin, repeated electrolysis can be counterproductive. Each session can tip the lid margin slightly further inward, recruiting previously well-behaved lashes into the problem. The treatment becomes part of the disease.

Third, electrolysis only addresses the lashes you can see misdirected on the day. It does nothing to address the underlying lid margin disease or the lid position itself. For a genuinely isolated single lash with a stable, healthy lid margin, electrolysis can be entirely reasonable. For most patients the ingrowing lash is the symptom rather than the cause, and treating only the symptom means more lashes follow.

I should be clear: electrolysis has a place. The problem is that it is often offered as a default first-line treatment by clinicians who do not see the longer-term consequences. By the time these patients reach an oculoplastic clinic, they have often had years of repeated treatment and the lid margin is in worse shape than when they started.

What works better in most cases

The right operation depends on which combination of trichiasis and marginal entropion is present, and which part of the eyelid is affected.

For genuinely focal disease, where one short segment of lid margin is the problem and the rest is normal, a small wedge resection removes the affected segment cleanly in a single procedure.

For more extensive marginal entropion, particularly in the lower lid and to a degree in the upper, the standard surgical approach is a grey line split. This separates the front and back of the eyelid along the natural seam at the lid margin, allowing the front layer (the skin and underlying muscle) to be slid upward and rotated outward. The lashes follow.

The standard version of this operation tacks the front layer to the tarsal plate higher up. My version goes a little further: I reinsert the eyelid retractors (in the lower lid) or the levator aponeurosis (in the upper lid) into the front layer at its new position, and add a row of everting sutures. This anchors the new lid position to the dynamic structures that move with every blink, rather than just to the rigid plate of the eyelid. The result is more durable and the lashes evert more reliably.

For more severe upper lid entropion, where the lid margin is significantly rotated inward, a procedure called posterior lamellar tarsal rotation is often the best answer. This works on the eyelid from inside.

For a defined cluster of lashes that are persistently the problem, surgically removing the lash follicles directly gives the most certain result. In the lower lid this is often best done by excising a small block of the front layer of the eyelid that contains the affected follicles.

Three questions worth asking before agreeing to electrolysis

1. How many lashes are affected? If the answer is more than one or two, the maths starts to work against you.
2. Is there underlying lid margin disease? If your eyelids are chronically red, crusted, or inflamed, electrolysis treats the wrong problem.
3. What is the long-term plan? If the answer involves repeated sessions over years, it is worth at least exploring whether a single definitive operation might be a better use of your time and your eyelid tissue.

When to seek a specialist opinion

If you have been having electrolysis or epilation repeatedly for the same lashes, if the same lashes keep coming back, if more lashes have appeared over time, or if the eye remains uncomfortable despite treatment, it is worth a specialist assessment. A careful examination of the lid margin will usually clarify within a single visit whether you have isolated trichiasis, marginal entropion, or underlying chronic lid disease, and which approach is most likely to deliver lasting relief.