Purpose

To report a rare adnexal and ocular surface manifestation characterized by bilateral madarosis, subsequent distichiasis-like aberrant eyelash regrowth and upper eyelid entropion in a patient receiving adjuvant trastuzumab therapy for HER2-positive breast cancer.

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Methods

A 45-year-old female presented with bilateral ocular burning, foreign body sensation, and abnormal eyelash growth. Her medical history included HER2-positive invasive ductal breast carcinoma treated with mastectomy and followed by adjuvant systemic trastuzumab therapy. Ocular symptoms began approximately three months after treatment initiation. Ophthalmologic evaluation and clinical follow-up were performed.

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Results

The patient initially developed bilateral madarosis, which was followed by the aberrant regrowth of eyelashes exhibiting distichiasis-like characteristics. Best corrected visual acuity was 0.00 logMAR bilaterally. Slit lamp examination revealed bilateral upper eyelid distichiatic lashes, lid margin inflammation, prominent blepharitis with meibomian gland orifice obstruction, thickened secretions, reduced tear meniscus height, and inferior punctate epithelial erosions. Due to persistent symptoms, acquired upper eyelid entropion, and the failure of prior radiofrequency ablation performed elsewhere, bilateral upper eyelid entropion repair was undertaken. However, distichiasis persisted postoperatively, requiring repeated mechanical epilation and radiofrequency ablation under local anesthesia. Symptomatic topical treatment and ocular surface protection were continued during follow up.

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Conclusion

While ocular surface adverse events such as conjunctivitis and keratitis are documented with trastuzumab, severe adnexal and eyelash abnormalities remain exceedingly rare. This case highlights a unique and refractory clinical course of sequential madarosis, distichiasis-like regrowth, and entropion during active targeted therapy. Early oculoplastic evaluation and close oncologic collaboration are essential to manage these complex toxicities and prevent long term corneal morbidity.

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Additional Authors

First name	Last name	Base Hospital / Institution
Buse	Gurcan	Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Ophthalmology, Istanbul
Mehmet Serhat	Mangan	Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Institute,Ophthalmology, Istanbul
Ceyhun	Arici	Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Ophthalmology, Istanbul

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