Common Cosmetics Cause Corneal Problems

Patient communication can help reduce risks to the ocular surface. Dermot McGrath reports from Paris

Cosmetics and cosmetic procedures pose an underestimated risk of contamination to the ocular surface and can induce several symptoms ranging from mild irritation and red eye to more serious infections and potentially sight-threatening complications, according to Jutta Horwath-Winter MD.

“There are a range of cosmetics and cosmetic procedures on the market that can disrupt the homeostasis of the ocular surface and tear film directly and indirectly via multifactorial pathways. We need to keep up to date with new beauty trends and ingredients used to assess potential risks to the ocular surface,” she said at the first European Dry Eye Society Congress.

Dr Horwath-Winter stressed the importance of patient education in reducing potential risks to the ocular surface from cosmetics.

“We should improve our communication with patients to inform them about cosmetics and the risk they can pose to the anatomy of the ocular surface and meibomian gland orifices. We should also advise our patients to ensure regular replacement of cosmetic products every three months,” she said.

In an overview of the negative effects cosmetic procedures can have on the tear film and ocular surface, Dr Horwath-Winter noted the list of chemicals used to create cosmetic products— including preservatives, retinoids, prostaglandins, and endocrine disruptors—runs to more than 12,000 possible ingredients.

Although European regulations concerning the use of cosmetics have been in place since 2013, vigilance is still required to avoid contamination through misuse or overuse, Dr Horwath-Winter said.

“Even commonly used products such as mascara can be a source of contamination via bacteria, fungi, or demodex mites, especially in humid conditions. One study showed that after three months of use, 36% of mascara products were contaminated,” she explained.

Eyelash dyeing or tinting may cause an allergic reaction, and eyelash extensions and artificial lashes contain glue which may also be toxic to the ocular surface, Dr Horwath-Winter said.

Particular care should be taken with eyeliner application at the inner lid margin, which can cause tear film contamination, blockage of the meibomian gland orifices, tear film instability, and ocular discomfort.

She advised using facial cleansers and makeup removers with caution, as these contain alcohol and fat solvents—and possibly preservatives—all of which can damage conjunctival, corneal, and meibomian epithelial cells. Anti-aging skin creams typically contain retinoic acid, which can reduce the number and size of meibomian gland acini and promote meibomian gland disease (MGD).

Prostaglandins—often used in eyelash serums and gels—may have adverse effects such as conjunctival hyperaemia, itching, irritation, blepharitis, MGD, hyperpigmentation of the skin and iris, and prostaglandin-associated periorbitopathy.

Cosmetics containing endocrine disruptors such as parabens, triclosan, and benzophenone, can all affect sex and thyroid hormones and negatively impact on the tear film and ocular surface homeostasis by accelerating oxidative stress, Dr Horwath-Winter concluded.

Jutta Horwath-Winter MD is Head of the Dry Eye and Cornea Unit and Deputy Head of the Cataract Section in the Department of Ophthalmology at the Medical University of Graz, Austria. jutta.horwath@medunigraz.at