Makeup Got You Down?

Ocular surface health can be compromised by certain cosmetics used around the eyes. However, because of the psychology behind wearing makeup, it is unlikely that a simple recommendation to stop wearing it will be accepted by most, if any, patients.

As our understanding of how cosmetics affect the ocular surface evolves, we will be able to better recommend healthier products to our patients, such as those created by eye care professionals and those with a long history in the industry (eg, Éyes Are the Story, Daily Practice, Twenty Twenty Beauty). I find it useful to break down the processes affecting the ocular surface into three categories of insult: mechanical (M), pathogenic (P), and chemical (C).¹ Let’s take a look at the two main areas where cosmetic products are applied and what categories of insult, if any, come into play with the use of certain products.

EYELASHES

Generally speaking, thick lashes are healthier than long lashes. Eyelashes are meant to be a specific length to deflect wind and debris away from the eye (M) and are typically one third of the width of the eye.³ Prescription and OTC prostaglandin–infused eyelash growth serums should be avoided, as they have the potential to create inflammatory side effects (C). Advise patients to use amino-acid polypeptide serums instead, as they condition natural lashes. Daily use of ultra-long “glam” lashes with formaldehyde-based glues has a propensity for allergic and inflammatory side effects (M, C).⁷ Wisps or natural lengths and nonformaldehyde glues are preferable. Eyelash extensions should be cleaned daily with either hypochlorous acid or nonirritating lash shampoos to avoid attracting excessive Staphylococcus aureus or Demodex mites (P).

Waterproof mascaras are thought to be the most irritating (C);⁶ however, they may be less likely to migrate from the lashes into the tear film (M).² Some research suggests that the effectiveness of dry eye treatments, such as artificial tears, might be compromised in patients who use cosmetic products around the eye area due to the cosmetics contaminating the artificial tears upon administration (M, C).² A simple change to using an eye-friendly mascara is a great start for many patients with dry eye.

EYELIDS

Shadows

Beware of glitter, which contains mineral, metallic, and plastic particles that can fall into the eye and cause micro-abrasions (M) and colorful tones that use dyes (C).⁴

Liners

Most eyeliners contain waxes that can clog meibomian gland openings. Placement of eyeliners over the top of the glands, known as tightlining or waterlining, is a recipe for meibomian gland dysfunction and dry eye symptoms (M, C).² Patients should be counseled to keep liners outside the lash-line. The melting point of human meibum was found to increase by 4.2°C when mixed with a pencil eyeliner product.² Pencil eyeliner also appears to increase meibum viscosity, which is thought to adversely affect tear film stability.²

Tattooed liners are also associated with meibomian gland dysfunction, so repeated eyelid tattooing should be avoided.⁸

REPLACE AND KEEP CLEAN

As a rule of thumb, cosmetics that require replacement every 6 months or less generally contain less irritating preservatives (C).⁵ Choosing these types of products, along with replacing liquid eye makeup every 3 months and powders every 6 to 9 months helps counter microbial growth (P).⁵ Weekly cleaning of brushes, sponges, and applicators also helps to avoid unnecessary contamination (P).⁵