Ophthalmologist Miss Jennifer Doyle explores the efficacy of eyelash enhancer serums, investigating how they work, their methods of action and the risks.
Across the decades, trends in appearance have come and gone but full, long lashes have always been considered desirable. The options available to achieve long, luscious lashes have grown over the years. Cosmetic enhancements including mascara, stick-on false lashes, eyelash tinting and individual eyelash extensions provide a wealth of options within the beauty industry. As the aesthetic specialty grows, however, individuals are realising that they now have options to enhance their own lashes, rather than relying on artificial methods. With the option to avoid clumpy mascara or to have temporary stick-on options reapplied, I have seen the demand for eyelash enhancers to increase the length and thickness of the lashes grow. As they are becoming more widely available, they are also becoming more affordable and aesthetic practitioners may now find patients are requesting them from clinic. This article aims to equip practitioners with the knowledge of what agents work, the clinical evidence behind these products, as well as how to use them safely in your practice.
The periorbital area plays an important role in a person’s overall appearance. When communicating with others, eye contact is a large part of our interaction; and hence the periorbital area is often the most noticed and scrutinised area. The eyelashes have an important role in framing and enhancing the appearance of the eyes and, in many cultures, are considered to enhance attractiveness.1,2,3 It is therefore no surprise that the eyelashes play an important role in our overall aesthetic appearance.
Eyelash enhancers can be split into those that contain prostaglandin analogues and those that do not. Prostaglandin analogues are pharmacologically-active substances that have long been used for the treatment of glaucoma. They are lipid-like substances derived from fatty acids.4
For decades, ophthalmologists like myself have observed that as a side effect of treatment with prostaglandin analogues, glaucoma patients develop long, thick lashes. However, it was pharmaceutical company Allergan that introduced the first synthetic prostaglandin analogue, bimatoprost, which gained approval from the Food and Drug Administration (FDA) in 2008 for use as a lash growth treatment in patients with inadequate lashes.5
In 2008, Allergan then launched Latisse, a 0.03% bimatoprost ophthalmic solution, licensed in the US for the treatment of inadequate lashes. Allergan was already the manufacturer of Lumigan, which is the same bimatoprost solution approved for use as an eye drop for the treatment of ocular hypertension and glaucoma.6 Lumigan and Latisse solutions are composed of the same formulation (bimatoprost); the difference being that Latisse is supplied with specifically designed applicator wands. However, this particular product isn’t licensed or available in the European market.
Whilst Latisse is not available in the UK, there are a number of companies who are selling serums with the same active ingredient. One can purchase bimatoprost 0.03% marketed by the generic name of bimatoprost, or under brand names including Lumigan and Eyreida. The major clinical trials for use of prostaglandin analogues have focused on bimatoprost;1,3-5 however, a similar effect has been seen in glaucoma patients on other prostaglandin analogues including latanoprost (brand name Xalatan) and travoprost (brand name Travatan) which are both available and widely used as glaucoma treatments within the UK.1,3
Other cosmetic eyelash serums are available on the market and may contain a range of non-pharmacologically active ingredients such as peptides, vitamins and conditioners. Whilst these may have a conditioning effect on your lashes, the data supporting their effect on eyelash growth is lacking.
It is thought that prostaglandin analogues exert their effect by influencing the eyelash life cycle. The normal eyelash cycle takes approximately four months to complete, and consists of an anagen (growing), catagen (transition) and telogen (resting) phase.7 The telogen (or resting) phase, is the longest phase during which no further growth occurs, and the eyelashes are eventually shed before the cycle restarts in the anagen phase again.8
Prostaglandin analogues act by stimulating hair follicles currently in the telogen (resting) phase to enter the anagen (growing) phase, resulting in more lashes in the active growing phase.4 They may also prolong the length of the growth phase, thereby resulting in longer lashes.4
There have been numerous studies citing the effect of prostaglandin analogues on eyelash growth. The pivotal phase 3 trial that led to the FDA approval of Latisse was carried out as a multicentre randomised controlled trial.9 Many of the UK suppliers of bimatoprost 0.03% solution also quote the results from this trial when discussing efficacy claims for their product.
The main findings of the study (n=278 with 137 patients having Latisse applied – parallel group study) were that after a 16-week period, lashes were 106% thicker, 25% longer and 18% darker.9,10 There have been several other studies from independent groups confirming the efficacy on eyelash growth. The studies measured parameters including eyelash length, thickness and darkness, comparing application of bimatoprost to a placebo. All found a significant increase in these parameters in the group treated with bimatoprost.11,12,13
Not only do we know that prostaglandin analogues like bimatoprost work, but we also know that they can be safely used not only around the eye, but inside the eye, given that they have been used for many years as an eyedrop for glaucoma. There is an abundance of safety data with regards to its use in the eye that can reassure patients as to the safety of the product for periocular use, should they inadvertently get the product in their eye when applying it to the lashes.14,15
However, side effects can occur and include eye irritation, itching, redness of the eyelid, change of iris colour (which is likely to be permanent) and darkening of the periocular skin;10 however, these effects have been found in less than 4% of patients.10
Patients need to be counselled on the above before being started on treatment because, as mentioned, some of the effects may be permanent. The change of iris colour can be as dramatic as changing blue eyes to brown and occurs due to the prostaglandin stimulating an increased melanin content in the melanocytes.10 It would be important to warn patients regarding this potential side effect, and to counsel them that should they notice any darkening of their iris colour to cease use of the product. Darkening of the periocular skin is normally reversible when stopping treatment, but can be permanent in a minority of patients.10
There are some considerations to make with regards to patient choice when considering offering a prostaglandin analogue-based eyelash enhancer. Whilst the only definite contraindications are hypersensitivity to the active ingredient or pregnancy and breast-feeding,10 there are certain factors to take into account when considering patient selection. I would advise caution when using the prostaglandin analogue-containing lash serums in patients who have coexisting glaucoma or ocular hypertension, as there is some concern that its use on the lashes can reduce the intraocular pressure lowering effect.16 These patients should be under the care of an ophthalmologist (eye specialist) and have close monitoring of their intraocular pressure. The risk-benefit analysis of using a prostaglandin analogue eyelash enhancer may not be in their favour if it can impact their glaucoma; a potentially blinding disease.10
Just as the prostaglandin analogues can cause inflammation and irritation on the eyelid, they can also cause the same within the eye. Patients with pre-existing eye conditions such as uveitis (inflammation within the eye) or aphakia (had their natural lens removed) or pseudophakia with a torn lens capsule (have had a complicated cataract extraction and an artificial lens implant) are at higher risk of developing an inflammatory response that results in macula oedema (swelling of the retina) that can cause blurring of vision.10 For patients who have blepharitis (a common condition associated with inflammation of the eyelids) or who are sensitive to preservatives in drops, one may wish to consider a preservative-free preparation.17
Considering these potential adverse effects, eyelash serums containing prostaglandin analogues should prompt a patient consultation to discuss the potential risks and benefits, as well as considering the above factors that may influence your patient selection.
The recent option of prostaglandin analogue-containing eyelash serums offer a pharmacologically active and clinically proven way for patients to enhance their own lashes, unlike mascara or artificial lashes. Like any drug, they should be used with caution and with appropriate counselling of the patient with regards to the risks and benefits. They offer another potential treatment modality to aesthetic clinics which can be a popular, affordable way for patients to further enhance the appearance of the periorbital area.
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12. Zaheri et al. Successful use of bimatoprost in the treatment of alopecia of the eyelashes. Clinical and Experimental Dermatology (2010), 35: e161–e162.
13. DuBiner et al. Efficacy and safety of bimatoprost in patients with elevated intraocular pressure: a 30-day comparison with latanoprost. Surv Ophthalmol, 2001 May; 45 Suppl 4: S353-60
14. Wirta D, Vandenburgh AM, Weng E, Whitcup SM, Kurstjens S, Beddingfield FC. Long-term safety evaluation of bimatoprost ophthalmic solution 0.03%: a pooled analysis of six double-masked, randomized, active-controlled clinical trials. Clin Ophthalmol. 2011;5:759-65.
15. Allergan. Is Latisse right for your patients? 2017. <http:// professional.latisse.com/About-Latisse/Patient-Selection>
16. Pillunat LE, Eschstruth P, Häsemeyer S, et al. Preservative-free bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension in clinical practice. Clin Ophthalmol. 2016;10:1759-65. Published 2016 Sep 12.