Cosmetic products and the ocular surface
by Harry Roberts
Harry W. Roberts MSc MD FRCOphth
Corneal ASTO, Norfolk & Norwich University Hospital Acknowledgements: Carolyn Cates.
Despite the intended external application of ocular cosmetics, migration of the products onto the posterior lid margin and into the tear film has been well documented[2]. Migration of the make up to the posterior lid margin is a common sign on slit lamp examination of make-up users, this may result in increased meibomian gland plugging and disruption of the lipid layer leading to tear film instability and evaporative dry eye symptoms[3]. Within the tear film, several mechanisms relating to secondary ocular surface insult have been hypothesized, including the detergent and cytotoxic effects of preservatives such as benzylammoni- um chloride (BAK), toxicity of metallic pigments in the product, or the destabilising effects to the lipid layer of lipophilic pigments within the cosmetic[2,4]. Furthermore there may be direct pro-inflammatory effects via an increase in tear film osmolarity as any hydrophilic components dissolve into the aqueous layer[2].
Ocular cosmetics (chiefly mascara, eye-liner and eye shadow) are commonly used world-wide and by predominantly females of all ages and cultures. Unfortunately they are known to be detrimental to the function of the ocular surface via various mechanisms[1,2]. While there is less evidence on the effects of make up removers (MURs), these are also likely to have negative effects on the ocular surface.
In contrast, there is a paucity of evidence on the effects to the ocular surface of the constituents of MURs. Generally speaking, the mechanism of action of MURs is to remove the lipoph- yllic cosmetic from the epidermis and they can be oil-based, water-based with surfactants or micelle-based[5]. Due to their mechanism of action, they are known to destabilise the tear film and increase evaporation. A common type of MUR are make-up remover wipes (MURWs). These are popular due to their convenience, portability, efficacy and cost-effectiveness and there is a predicted growth in their use (global growth of USD 3.71 Billion between 2018-2022) (cite the website https://www.technavio.com/report/global-fa- cial-wipes-market-analysis-share-2018).
MURWs contain surfactants to dissolve the cosmetic, solubilisers and emulsifiers to promote adsorbtion to the cloth and preservatives to prevent bacterial or fungal contamination of this product in its resealable packaging. Possible harms of MURWs may include allergy or toxicity of any of the chemical constituents including the preservative.
Surfactants solubilising the skin sebum may lead to drying of the skin and peri-ocular dermatitis as well as disrupting the tear film lipid layer. The residue of the remaining solution and the cosmetic on the skin and lid margin may lead to bacterial overgrowth, clogging of the Meibomian glands, or migration onto the ocular surface with similar effects as above. Preservatives in MURWs may include BAK, formaldehyde-releasing agents and isothiazolinones. BAK has pro-inflammatory, cytotoxic and surfactant properties[6]. Formaldehyde, a known carcinogen, is pro-allergenic and associated with increased blinking frequency, conjunctival hyperaemia and conjunctival epithelial cell reduced survivability[7,8]. Isothiazolinones have received significant negative attention in the dermatological literature, but there is a paucity of research on their effects on the ocular surface[9,10]. It is known however that there are relatively high prevalence rates of sensitisation to isothiazolinone across developed nations (1.0-8.4%)[11]. In the absence of better evidence, it seems prudent to recommend to our patients to avoid products containing isothiazolinones. Toxic conjunctival reaction to ocular cosmetics and/or MURWs has been previously reported as presenting with epiphora in the absence of other allergic symptoms such as itch[12]. We have previously identified a similar cohort of patients where we have suspected that the patient’s use of MURWs has contributed to the clinical picture of bilateral frank epiphora, usually associated with a chronic tarsal conjunctivitis. In these patients we observed that the ocular cosmetics used varied between patients (mascara, eyeliner, eye shadow) whereas the patients were unified by the use of MURWs without the use of make-up remover liquids or suspensions. This led us to believe that there must be a common substance or mechanism within many MURWs which can be toxic to the ocular surface and/or exacerbate concurrent ocular surface disease (OSD).
Identification of the role of cosmetics and cosmetic remover in OSD patients is important, because once identified, treatment (i.e. cessation of the prod- uct) is relatively simple. Early suspicion of conjunctival toxicity is important in young females with bilateral symmetrical symptoms, thus avoiding unnecessary invasive investigations or treatments. Many patients are not overjoyed to
be told to limit their use of cosmetics and the effects of ocular cosmetics on self-confidence have been previously reported[13]. In these instances, it is important to promote reduction rather than abstinence (depending on the clinical picture) and micellar water may offer less ocular surface toxicity than MURWs, albeit in the absence of specific peer-reviewed evidence. The mechanism of action of micellar water is that it encapsulates insoluble residues on the skin within micelles of surfactant which are subsequently removed, avoiding the use of solvents such as alcohol or requiring rubbing of the skin and associated trauma[14]. It is perhaps even more important to stress the need to remove any residue from MURs with dry adsorbent pads. A course of topical steroids is effective in masking the toxicity from these products, however cessation ought to be considered as the first line treatment in cases where cosmetics are felt to be exacerbating OSD[12].
There are some confounding hurdles in evaluating the role of cosmetics and cosmetic remover in our OSD patients.
Users may vary their choice of cosmetics on a daily basis and in all cases, there is a confounding concurrent use of ocular cosmetics with a cosmetic remover, where there may be an interaction between ingredients of each. Furthermore a cosmetic product is a mixture of many ingredients, each with their own effects on the lid margin and tear film. MURs are first and foremost designed for the skin, which has significantly different local chemistry from the tear film and mucous membrane of the ocular surface, but it remains unknown whether specifically formulated eye make up removers convey an advantage. Despite the negative effects of cosmetics and their removers, there may be a confounding effect when used judiciously with efficacious removal acting as effective lid hygiene which may promote better ocular surface health.
OSD Patients need to be counselled as to the effects of their choice to use ocular cosmetics so they may make a balanced decision. Evaluating the specific effects to the ocular surface in a scientific manner is hampered by the range of products available and the panoply of ingredients within each product.
References:
[1] M.T. Wang, J.P. Craig, Investigating the effect of eye cosmetics on the tear film: current insights, Clin Optom. Volume 10 (2018) 33–40. doi:10.2147/OPTO.S150926.
[2] A. Malik, C. Claoué, Transport and interaction of cosmetic product material within the ocular surface: Beauty and the beastly symptoms of toxic tears, Contact Lens and Anterior Eye. 35 (2012) 247–259.
doi:10.1016/j.clae.2012.07.005.
[3] A. Ng, K. Evans, R. North, C. Purslow, The effects of cosmetic eye pencil application on the tear film and ocular surface, Invest Ophthalmol Vis Sci. 54 (2013) 952.
[4] M.J. Gallardo, J.B. Randleman, K.M. Price, D.A. Johnson, S. Acosta, H.E. Grossniklaus, et al., Ocular Argyrosis After Long-Term Self-Application of Eyelash Tint, Am J Ophthalmol. 141 (2006) 198–200.
doi:10.1016/j.ajo.2005.07.054.
[5] A. Ng, K. Evans, R.V. North, L. Jones, C. Purslow, Impact of Eye Cosmetics on the Eye, Adnexa and Ocular Surface, Eye & Contact Lens: Science & Clinical Practice. 42 (2016) 211–220. doi:10.1097/
ICL.0000000000000181.
[6] J.A.P. Gomes PhD, D.T. Azar MD, C. Baudouin MD PhD, N. Efron BScOptom DSc, M. Hirayama MD PhD, J. Horwath-Winter MD PD, et al., TFOS DEWS II iatrogenic report, Ocular Surface. 15 (2017) 511–538.
doi:10.1016/j.jtos.2017.05.004.
[7] I. Lang, T. Bruckner, G. Triebig, Formaldehyde and chemosensory irritation in humans: A controlled human exposure study, Regulatory Toxicology and Pharmacology. 50 (2008) 23–36. doi:10.1016/j.
yrtph.2007.08.012.
[8] X. Chen, D.A. Sullivan, A.G. Sullivan, W.R. Kam, Y. Liu, Toxicity of cosmetic preservatives on human ocular surface and adnexal cells, Experimental Eye Research. 170 (2018) 188–197. doi:10.1016/j.
exer.2018.02.020.
[9] R. Urwin, M. Wilkinson, Methylchloroisothiazolinone and methylisothiazolinone contact allergy: a new “epidemic,” Contact Dermatitis. 68 (2013) 253–255. doi:10.1111/cod.12064.
[10] G.A. Johnston, contributing members of the British Society for Cutaneous Allergy (BSCA), The rise in prevalence of contact allergy to methylisothiazolinone in the British Isles, Contact Dermatitis. 70 (2014) 238–240.
doi:10.1111/cod.12185.
[11] A.C. de Groot, A. Herxheimer, Isothiazolinone preservative: cause of a continuing epidemic of cosmetic dermatitis, Lancet. 1 (1989) 314–316.
[12] N. Cook, F. Mushtaq, C. Leitner, A. Ilchyshyn, G.T. Smith, I.A. Cree, Chronic tarsal conjunctivitis, BMC Ophthalmol. 16 (2016) 569. doi:10.1186/s12886-016-0294-1.
[13] R. Mulhern, G. Fieldman, T. Hussey, J.-L. Lévêque, P. Pineau, Do cosmetics enhance female Caucasian facial attractiveness? Int J Cosmet Sci. 25 (2003) 199–205. doi:10.1046/j.1467-2494.2003.00188.x. [14] T. Suzuki, M. Nakamura, H. Sumida, A. Shigeta, Liquid crystal make-up remover: conditions of formation and its cleansing mechanisms, J Soc Cosm Chem. 43 (1992) 21–36.
