Wednesday, 13 April 2016
Eye to Eye – No cosmetic approach shall repair them!
Eyes are the most important constituents of the face. Not only do they define overall beauty and personality of the being but also express emotions and moods. They enable us to see the world and everything around us. Unfortunately they don’t come as spares in our tool kits.
Accentuating the eyes with mascara, eye shadow, Kajal or Kohl and liner to make them look bigger is a trait every woman has. However not so many are meticulous when it comes to wiping these accentuators off in the evening, carefully following the instructions for removal and following them by the book. This is essential because overnight applications of liners,kajal and mascara can result into blocking the tear ducts causing dry eyes or in some cases even damage the cornea by penetrating into the eyes from the corners. In general longer applications of foreign material on delicate areas such as the eyes can cause irritation, infection and allergies or cause blepharitis. In general various adverse effects may occur in the form of acute toxicity, percutaneous absorption, skin irritation, eye irritation, skin sensitization and photosensitization, subchronic toxicity, mutagenicity/ genotoxicity, and phototoxicity/photoirritation.
Generally eye cosmetics are friendly and safe to use. The products list out the ingredients on the packaging and label although more diligently in the US and developed countries and not so much in India due to lax laws and implementations. Cosmetic products generally come in small packs making reading even more difficult. Careful buying of cosmetics needs to be done, avoiding products which have mercury, lead and parabens which are extremely harmful and hazardous. Safe buying is to be adopted which includes branded products and in case of any problems during application you need to discard the product. Using products beyond their validity and keeping them for longer durations since all are expensive products can result into serious eye problems. In such cases bacteria and fungi grow within the gels and liquids which when applied shift their home into our eyes causing havoc. Similarly cosmetics application and removal methods are also as important, for example application on the inner lining of the lid shall ensure inner seepage causing damage to the eyes.
Another option to circumvent the problem of chemicals in eye products is to try out natural herb based products which are authentic although no product whether herbal or otherwise should be used beyond expiry.
Dr. Louise A.Sclafani, OD, FAAO has some candid observations listed on www.healio.com. According to him, “As eye care professionals we should not avoid the topic of cosmetics and lid hygiene because we are afraid of insulting our patients because if we don’t comment on what we see when they are being tested, they assume that all is well.” He further suggests introducing eye make up one by one into routine so that effects and reactions of each can be clearly noticed. He strongly suggests that eye cosmetic make up should never be shared with anyone no matter how intimate as this results in communication of eye infections. He further says,” do not top off mascara with water or be too aggressive on eye lashes with curlers which can cause damage to delicate follicles and respect the eye mucosal line as the meibomian gland can get blocked, resulting in dry eyes.”
Dr. Louise A.Sclafani recommends removal of make up daily before sleeping usually with soap and water, which she says may not be always effective. She recommends using branded soft lid and eye scrubs for removal and even baby oil which is an amazing application for the job in hand.
“For soft contact lens wearers, patients should put on makeup after putting in their soft contact lenses. For gas-permeable lens wears, the opposite is true,” Dr. Sclafani said.
Make up residue or particles tend to enter the eye and disrupt the tear film, causing discomfort and irritation. This is since cosmetics are applied very near to the ocular surface or on the lid margins, giving them ample opportunity to enter the eyes due to rubbing or other reasons. These residual foreign bodies tend to stick on the tear film or even on the surface of contact lenses or cornea, disrupting the tear film stability and function.
Meibomian gland ducts thicken and get keratinized due to prolonged exposure to retinoid which is an ingredient of anti aging and acne products. It causes degeneration and necrosis of meibomian gland acinar cells, peri-acinar fibrosis and decreased lipid content of meibomian tissue. Similarly US FDA approved Latisse (Allergan) applied on the eyelashes for hypotrichosis a condition of abnormal hair patterns - predominantly loss or reduction was found to be responsible for increased frequency of conjunctival eyelid hyperaemia which is excessive supply of blood to the eye lids also called engorgement.
The most feared adverse effect of mascaras is that of infection, particularly Pseudomonas aeruginosa corneal infections, which can permanently destroy visual acuity, due to multiple reuses of applicator and reinsertions into the tube between uses.
Some south Asian, middle eastern countries and parts of Africa are still using old and outdated formulations which include ingredients in cosmetic products suchas lead-compounds and preservatives such as benzalkonium chloride, thimerosol and chlorhexidine. All products containing such heavy metal or compounds are extremely harmful and need to be avoided at all costs.
Products linked with cosmetics have been put to scrutiny and analysis for rate of formation of bacteria and contamination causing organisms and a related study found 30% products affected after 90 days. Once the product has been opened and if being used by more than one user, it is a potential bacteria rearing place. Although preservatives slow bacteria formation they are short spanned and their effectivity diminishes over a period of time.
Contact lens users need to take precautions of cosmetic application in such a way that the lens surface remains free of residual accumulation which not only will bllurr vision but also cause irritation and infection. For users wearing lens regularly, daily disposable lens are recommended as they are more hygienic and do not have to undergo daily cleaning with solutions which is not foolproof if not done properly.
Therefore it is important that knowhow on the use of cosmetics is spread by opticians, cosmetic retailers and manufacturers on the product itself. Patients coming for medical treatment need to be educated on the cause of their disease without any prejudices.Users must be properly told as to where all cosmetics are not to be applied in the eye areas.
The US government on it’s official FDA website warns users of the dangers of using substandard or persistetnt use of Kohl or Kajal as it may contain lead and cause lead poisoning. This is since kohl is made up of lead ( lead sulphide) and some brands may contain excessive percentage of lead apart from other ingredients used in it’s commercial manufacture such as aluminum, antimony, carbon, iron, and zinc compounds, as well as camphor and menthol.
Lead poisoning or exposure to excessive amounts of lead in the environment is particularly harmful for children as they can absorb lead from their surroundings. It can cause a host of diseases such as anemia (iron deficiency), kidney related diseases and neurological disorders. Prolonged exposure to lead can impair learning capability and behavioural patterns.
India which is a major producer of kohl needs to be particularly careful as culturally kohl is used to accentuate children’s eyes and kohl is widely used by all communities both in rural and urban India. It needs to be mentioned here that US FDA had banned kohl or it’s use as a commercially available cosmetic or it’s manufacture.
From a dermatologist’s point of view, cosmetics may be grouped as: (a) skin-care cosmetics (cleansing agents, moisturizing agents, etc.), (b) hair-care cosmetics (shampoos, hair colorants, styling agents, etc.), (c) face-care cosmetics (facial foundations, powders, eye shadows, mascara, lipsticks, etc.), (d) nail-care cosmetics (nail varnishes, paint removers, etc.), (e) fragrance products (deodorants, aftershaves, perfumes, etc.), and (f) ultraviolet (UV) light screening preparations. Skin cleansing agents remain on the body for a very short period of time and rarely cause significant adverse reactions, however, perfume and others constituents may cause skin irritation and allergic reactions. Moisturizers increase the hygroscopic properties of the skin; however, high concentration of these substances may cause irritation and exfoliation.
Dr. P. K. Nigam, Professor and Head, Department of Dermatology and STD, Pt. J. N. M. Medical College, Raipur in a study on effects of cosmetics on skin and body parts and organs states- Ochronosis is a common adverse effect of HQ (skin lightening/depigmenting agents, hydroquinone) characterized by progressive darkening of the area to which the cream containing high concentrations of HQ is applied for many years. ëBlack hennaí tattoo is a chemical stain due to p-phenylenediamine (PPD), in the form of commercial hair dye mixed into the henna paste. Addition of this artificial dye stains the skin in much shorter duration, an hour or less. Adverse reactions to PPD can include stinging sensations, with an erythematous rash, swelling, blisters, and surface oozing. There have been several reports in the literature of immediate allergic (and also anaphylactic) reactions on using henna dyes. Most cases have sneezing, runny nose, cough, and shortness of breath instead of skin reactions. Adverse effects to sun-screening agents may result in irritant, allergic, phototoxic, or photoallergic reactions, and caused not only by the active constituents but also by the additives such as fragrances and stabilizers. Benzophenones are probably the most common sensitizers, while dibenzoylmethanes, para-aminobenzoic acid (PABA), and cinnamates may cause photoallergic dermatitis. The allergic reactions associated with deodorants/antiperspirants and fragrances are usually caused by fragrance or other ingredients. Fragrance can enter the body through lungs, airways, skin, ingestion, and via pathways from the nose directly to the brain and can cause headaches, irritation to eyes, nose, and throat, dizziness, fatigue, forgetfulness, and other symptoms. Fragrance is the number one cause of skin allergic reactions to cosmetics. As much as 15% of the general population may find fragrance a lower airway irritant and as much as 10% of the general population may have skin allergy to fragrance. Fragrance in the air can cause airborne contact dermatitis. Coumarin, methyl eugenol, and others are suspected carcinogens. Some phthalates are suspected hormone disrupters.
Shampoos and conditioners have only a brief contact with the skin and are not a common cause of cutaneous irritant or allergic contact dermatitis. However, eye irritation can be a problem. Possible sensitizers in shampoos include formalin, parabens, hexachlorophene, triclosan, and fragrances. Matting of scalp hair is most commonly a sudden, usually irreversible, tangling of scalp hair resulting from shampooing.
Hair straightening (relaxing) with pressing oils and heated metal combs or round tongs may be associated with hair-shaft breakage and scarring alopecia. Hair removal techniques may partially account for allergic and photoallergic reactions. The adverse effects of shaving include skin irritation, cuts in the skin, ingrown hair (pseudofolliculitis), etc. The active ingredients in hair bleaches are hydrogen peroxide solutions that oxidize melanin to a lighter colour.
The adverse reactions may occur to one of the primary constituents of the cosmetic formulation or contamination or procedural misconduct.
Cosmetics and personal-care products may contain ingredients whose safety is unclear or which are known to pose health risks. Adequate testing or research has not been done on chemical combinations which are being used. Notwithstanding the commercial nature of issue, it is advisable to be prudent in choice, application and duration of use of all such products. Necessary precautions and routines need to be adhered to and most of all awareness needs to be spread around amongst whatever community groups one has access to. It is seldom that an occurance least expected happens despite all non possibilities however we should never extend our luck too far!