Long and thick eyelashes are socially considered to be a feature of attraction and beauty. A number of artificial means have been applied in the world of aesthetics to enhance this feature of beauty. The eye makeup products have been the prime demand in cosmetic industry. However, these methods, including application of cosmetic products such as mascara or placement of artificial eye lashes have their own disadvantages such as damage to the natural eyelashes.
What is Bimatoprost?
‘Bimatoprost’, a synthetic drug, is primarily used for the treatment of glaucoma and, in different studies, has demonstrated to lower the intraocular pressure, a characteristic feature of glaucoma 1. The drug is also used for the treatment of thin or less eyelash as it causes the eyelash to become thick, dark and long. It is an analogue of prostaglandin which is an essential substance formed in the body and plays pivotal role in a number of normal processes of the body, one of which is the stimulation of growth of the eyelash.
How Does Bimatoprost Work?
The eyelash follicle growth is divided into three phases. The first phase of the cycle is characterised by rapid growth of the eyelash and pigmentation of the hair shaft. This is a prolonged phase which lasts for approximately one to two months and is followed by a phase of growth cessation which spans at a duration of approximately fifteen days. The last phase is a resting one after which, exfoliation of the eyelash hair occurs.
There are two mechanisms known via which bimatoprost works to enhance the length and thickness of the eyelash.
•The first one is by increasing the number of eyelash follicles.
•The second mechanism is by increasing the duration of the first phase of the eyelash growth cycle.
Prescription Options and Results for Eyelash Growth:
The FDA approved concentration of topical bimatoprost for the growth enhancement of eyelash is 0.03%. However, olution of 0.01% of bimatoprost is also used and stated by different studies to be efficacious for the growth of eyelash . The recommended regimen is to apply the drug uniformly on the skin of the upper eyelid along the base of the eyelash. The usual application dose is once daily morning. It is recommended to remove contact lenses prior to the application of the drug and with a gap of atleast five minutes before application of other eye drugs. After application, the solution must be stored as recommended by the manufacturer.
Evidence Based Results of Bimatoprost:
Studies in which bimatoprost was used for a year to treat glaucoma by reducing the intraocular pressure have also stated increased growth of eyelashes 2. Another study which solely evaluated the eyelash growth via topical application of bimatoprost also stated significant results 3. The same study also mentioned positive outcomes of the treatment when assessed in social and psychological terms.
Safety of Bimatoprost:
The promising results stated by different studies considering the eyelash growth by the use of bimatoprost raise another question regarding the safety and side effects of the long term use. The safety of the drug has been demonstrated in long term studies and the side effects were reported when the drug was used as drops for glaucoma treatment rather than in the form of topical application on eyelashes. A four year study in which patients were administered with bimatoprost once daily for the reduction of intraocular pressure stated that the drug was tolerated over long-term use 4. Side effects of the drug occur when used intraocular and include,
•Permanent darkening of the iris.
•Permanent darkening of the eyelashes.
•Temporary change of skin pigmentation around the eyelashes / darkening of the eyelids.
•Redness and discomfort of the eyes.
•Burning or itching during use.
There are, however, certain rare side effects of the drug reported when used for eyelash growth and include redness and itching of the eyes. Infection can also occur after dermal application of the drug for eyelash growth but is primarily associated with using the applicator multiple times. Therefore, it is recommended to discard the applicator after single use.
Market Products Containing Bimatoprost:
0.01% and 0.03% bimatoprost ophthalmic solutions are available with the market name ‘lumigan’ which is an isotonic and colourless ophthalmic solution containing 0.1 and 0.3mg of the drug per ml respectively. Lumigan is primarily used to decrease the intraocular pressure but has also shown to escalate the growth of the eyelashes.
Another product containing 0.03% bimatoprost solution is ‘latisse’. In a study in which latisse solution was evaluated for its effect on overall eyelash prominence in comparison with a vehicle, it was quoted that latisse was more effective than the vehicle as measured by scores from the GEA (Global Eyelash Assessment) scale with significant differences seen at eighth week, twelfth week, and sixteenth week. In the same study, patients were also evaluated for the effect of latisse solution on the length, thickness and darkness of their eyelashes. Improvements from baseline in eyelash growth as measured by digital image analysis assessing eyelash length, fullness/thickness and darkness were statistically significant and more pronounced in the bimatoprost group at weeks eighth, twelfth and sixteenth. However, it was also stated that the effect on eyelash growth is expected to abate following longer term discontinuation .
Guidelines for Application of Bimatoprost:
The FDA has approved bimatoprost in a 0.03% solution for enhancement of eyelash length, thickness and darkness in patients with thin, less or absent eyelashes. In order to avoid spillage of the solution into the eyes and causing side effects which have been mentioned above, it has been recommended to put one drop of bimatoprost 0.03% solution on a single-use applicator and application to the upper eyelid margin along the roots of the eyelashes once nightly. A new applicator should be used for each eye. Contact lenses must be removed before using the solution as the latisse contains benzalkonium chloride, which may be absorbed by and cause discoloration of soft contact lenses.
Patients are also instructed that the latisse bottle must be maintained intact and to avoid allowing the tip of the bottle or applicator to contact surrounding areas, fingers, or any other unintended surface in order to avoid contamination of the bottle or applicator by common bacteria which are known causes of eye infections. It is also instructed to use the applicator once and then discard it. Repeated use of the contaminated applicator can result in serious eyes infection.
Comparison of Bimatoprost with Other Drugs:
Latanoprost, another prostaglandin analogue is also used in the treatment of glaucoma and has been compared with bimatoprost in studies assessing the eyelash growth. In one of the studies, the researchers compared bimatoprost with latanoprost in a three months trial and the eyelash growth in the bimatoprost group was observed to be prominent as compared to the latanoprost group. The researchers stated that this potential of bimatoprost could be due to the fact that bimatoprost, unlike latanoprost, does not need to be converted into an active substance for extending its activity 6.
Other Options for Eyelash Growth:
Bimatoprost application is a non-invasive and a relatively predictable option for eyelash growth. There are other options too for treatment of thin, less or absent eyelashes but there are certain disadvantages associated with the procedures. One such option is ‘eyelash transplantation’ in which hair follicles from the scalp are transplanted onto the eyelash area i.e. the margin of eyelid. Certain complications of the eyelash transplantation include pain, bleeding, formation of thick scar, numbness and in rare cases blindness. Furthermore, since the origin of transplanted hair is scalp, therefore, the transplanted hair retain their original characteristics of growth in length and therefore, must be trimmed regularly.
As mentioned above, artificial eyelashes are available and can be adhered to the margin of the eyelid to present a voluminous appearance of the eyelashes. However, they are adhered with methacrylate-based adhesives which can cause allergic reactions and sometimes can be difficult to remove.
Prostaglandin analogues specifically bimatoprost have proved to influence the eyelash growth positively. In comparison with other means of enhancing the eyelash growth, bimatoprost application is a non-invasive method with few adverse effects if used correctly according to the guidelines. The results stated in the light of recent research endorse the drug which offers significant outcomes at efficacious and tolerable dose. It therefore, could be a promising treatment for loss of eyelash due to chemotherapy or in patients with alopecia. However, further research is required to strengthen the evidence in favour of this drug regimen.
There are also all natural solution available such as LashIQ that helps eyelash growth longer and thicker without any side effects of bimatoprost or any other prostaglandin analogues.
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