Trichotillomania: ophthalmic presentation.

Purpose: A case of trichotillomania, or compulsive hair-pulling, involving the eyelids is presented to alert ophthalmologists to this common, but frequently overlooked cause of eyelash and eyebrow alopecia.

Methods and results: Clinical records of a 33-year-old woman suffering from trichotillomania were reviewed. Compulsive hair-pulling began in childhood and had become chronic. Psychiatric intervention was unsuccessful.

Conclusions: The diagnosis of trichotillomania is made on history and slit-lamp examination findings. A skin biopsy may be necessary to exclude alopecia areata. Adults should be referred to a psychiatrist. Although childhood disease is usually benign, often reflecting a disturbed parent-child relationship, in adults hair-pulling is generally chronic and associated with psychiatric illness.