Impact of cosmetics on the ocular surface and contact lens wear

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Impact of cosmetics on the
ocular surface and contact
lens wear
49
Course Code C-16942 O/D/CL
Cosmetics such as mascara and eyeliner contain a range of ingredients
including pigments, oils, waxes and preservatives, and their site of
application brings these substances close to, and even in direct contact
Figure 1
Contamination of upper lid margin by eye makeup applied to the lower lid margin (courtesy of
Alison Ng – Cardiff University)
physiology of the tear film. Practitioners
with, the lashes, the ocular surface and surrounding tissues. The effect of
will be familiar with seeing many tiny
these substances on the ocular surface, including the tear film and cornea ,
particles of make-up material floating
is not well understood and the impact of cosmetics contaminating contact
lenses has similarly received little attention to date. Whilst all cosmetics
undergo rigorous testing before being made available to consumers, there
have been a number of undesirable effects of cosmetics and toiletries
described in the literature. This article reviews current knowledge about
cosmetics and their impact on patient symptoms and contact lens wear.
in the tear film of some of their patients
when viewed using a slit lamp (Figure 2).
The migration of cosmetic products
(mascara) onto the ocular surface has
been investigated recently. Goto and
co-workers2 observed relatively large
amounts
of
migration
of
cosmetic
eye products onto the ocular surface
after just 30 minutes of application,
especially amongst those who applied
The cosmetics industry has undergone
Cosmetics and the eye
their cosmetics close to or onto the
another record breaking year with higher
It is estimated that approximately 70%
eyelash line. However, studies that
revenues than ever being generated. In
of women wear cosmetic products for
report
addition, in this ‘recession resistance’,
use around the eyes. Cosmetics are
with cosmetic use implicate potential
the cosmetics industry has seen changes
commonly applied to the lid areas, the
changes
in the demographics of consumers
lashes and also with close proximity
affect the tear film and which warrants
purchasing these products; according to
to the meibomian gland ducts on the
further investigation. Previous findings
the market research company The NPD
lid margin (Figure 1). During recent
have linked the use of make-up with
Group Inc., the average age that a female
years,
manufacturers
meibomian gland dysfunction (MGD).3
began using beauty products was 17
have promoted their products based on
The impact of cosmetic products
years in 2005, compared with 13.7 years
their ability to resist fading, smudging
adhering to a contact lens during wear
today.1 There has also been an increase
or
which
has also received very little attention
in the number of ‘age-defying’ products
consequentially makes removal of these
to date and the precise effects on
and
products more difficult. Often branded
vision, dry eye symptoms and contact
appears set on ‘beautifying’ consumers
as
lens tolerance is poorly understood.
well into their later years of life. Whilst
contain
the predominant users of cosmetics and
agents to aid resistance to the effects of
Cosmetics and contact lenses
eye make-up are female, increasingly
tears and perspiration. Currently there
Patients who combine the use of eye
more males than in previous years
are no published papers that report on
cosmetics
have begun using cosmetic products,
the effects of tear contamination by eye
more likely to expose their lenses to a
especially those for the face and eyes.
make-up on the normal function and
relatively oil-rich environment during
hence
the
cosmetics
industry
eye
wearing
make-up
off
“waterproof”,
oil,
wax
over
time,
these
or
cosmetics
on
to
complications
ocular
associated
physiology
that
silicone-based
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contact
lenses
are
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Dr Cameron Hudson, BSc (Hons), PhD, MCOptom
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wear.4 Differences in the ability
generally results in under-
of
reporting.
different
lens
materials,
the
Association
have been reported previously.
5
advises that both consumers
lens
and health care professionals
include
have a role to play in
effects
of
contact
deposition/spoilation
European
from
to resist oil/lipid deposition
changes to the physical and/
reporting
or chemical characteristics of
effects.
the lens surface and changes
eye
to the clinical performance of
would
the lens including discomfort
reporting
during
effects,
6
wear
and
adverse
Cosmetics
(COLIPA)
of
undesirable
With
care,
respect
to
practitioners
be
justified
in
undesirable
including
but
Amongst
monthly
not limited to, irritant or
lenses,
several
allergic conditions affecting
studies have highlighted the
the skin, eyes or mouth.
relative resistance of the silicone
Guidelines
hydrogel
suggest that each individual
events.
30/09/11 CET
Guidance
particularly silicone hydrogels,
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disposable
material
Lotrafilcon
B (Air Optix Aqua, Ciba Vision) to
lipid deposits over other commercially
available silicone hydrogel lens types, in
Figure 2
Cosmetic ‘glitter’ contaminants suspended in precorneal tear film (courtesy of Alison Ng – Cardiff
University)
from
COLIPA
cosmetics company should have its own
processes for managing and following
up on each undesirable effect received.
both in vitro and in vivo investigations.5,9
This may, at least in part, be attributable
to silicone hydrogel lenses.4 It has been
Implications for practitioners
to the plasma surface treatment feature
shown that this can cause the contact
It is possible that cosmetics could play
of the lens, which resists binding of
lens to swell and become brittle, making
a role in dry eye, tear film instability,
foreign substances including lipid. The
the surface of the lens more prone to
lacrimal gland dysfunction, dermatitis/
plasma surface treatment of Lotrafilcon B
scratching. Therefore thorough washing
hypersensitivity, allergy, infection and
has also demonstrated utility in resisting
of hands prior to lens application
contact lens intolerance. Whilst toxic and
lens deformation, which has been shown
and
serious undesirable effects associated
4
removal
is
strongly
advised.
with cosmetics are generally eliminated
to occur to other types of re-usable lenses
when exposed to, and contaminated
by, oil-based eye make-up removers.
Contamination
in
the
eyes
of
has
contact
been
4
lenses
shown
to
occur by several routes, including:
1.
The case – where eye cosmetic
ingredients
2.
blend
The
hands
previously
make-up
3.
been
with
–
cleansing
Direct
adherence
According
to
European
Union
law
directive 93/35/EEC, a cosmetic product
must not cause damage to human health
when applied in normal or reasonably
foreseeable conditions of use.10 Whilst
tear
fluid
rigorous testing of cosmetic products
that
have
occurs before they are brought to market,
exposed
or
before the product comes to market, mild
Current legislation
to
products
onto
there
are
many
undesirable
effects
undesirable effects may go undetected
and
unreported.
As
the
following
examples describe, cosmetics can be
responsible for a number of undesirable
effects,
which
practitioners
may
be
familiar with managing but may not
necessarily attribute to a particular type
of cosmetic or its normal use/application.
of cosmetics that may exist at mild
the
levels across a particular user group.
Mascara
lens surface during wear, either during
An undesirable effect of a cosmetic
The
application of make-up or by make-
product is defined as a harmful reaction
contamination by a wide range of cosmetic
up floating freely in the tear film
attributable to its normal or reasonably
products, for example, hair spray, eye
In the case of point 2 above, hand
foreseeable use. However, the knowledge
liner, eye shadow, blusher, foundation,
creams that contain an abundance of
of undesirable effects at the population
make-up remover to name just a few.
lipids such as cholesterol, mineral oil
level is limited by the absence of formal
The precise effect of these products
and glycerine appear to readily adhere
and reliable reporting systems, which
either individually or in combination is
corneal
surface
is
exposed
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to
extremely difficult for scientists
that both contact lens wearers
and clinicians to determine. There
and non-contact lens wearers
are several reported cases where
should replace their mascara
patients have exhibited reactions
after
such as contact dermatitis and
reality perhaps is that most
loss
following
people will not replace their
application of mascara.11-13 Such
mascara until it is gone. Some
reactions appear to be more
patients will even add water or
common when using products
saliva to make their make-up
such as tinting mascara, especially
last longer, which introduces
those containing the ingredients
further risk of contamination.18
eye
lashes
Para-phenylenediamine
(PPD)
or
months.20
The
Other guidance for wearers
shellac.11-13
of
make-up
In theory, all pigmented make-
•
Not sharing cosmetics
up products may contain metal
•
R e p l a c i n g
allergens
Eyelid
including
nickel.
dermatitis has also previously
been observed amongst patients with
nickel
allergic
dermatitis
following
exposure to mascara and eye shadow.14
In
addition
to
relatively
acute
conditions such as dermatitis, other
long-term
reported.
keratitis,
associations
These
have
include
pigmented
been
infectious
conjunctival
lesions and a rare case of canalicular
obstruction
caused
by
a
51
mascara-
laden dacryolith15 or rheum (Figure 3).
cosmetics
Figure 3
Mascara laden rheum (courtesy of Alison Ng –
Cardiff University)
•Not
tubes
resist
colonisation.
group
concluded
that
One
study
preservatives
in a range of brands of mascara were
inadequate at preventing colonisation
of
staphylococcus
epidermis
and
pseudomonas aeruginosa organisms.17
The ocular surface, mascara and microbes
This same study observed that six
Whilst relatively rare and typically of low
out of seven cases of pseudomonas
severity, bacterial infections of the ocular
corneal
surface are more prevalent amongst
secondary to scratching the cornea
contact lens wearers than non-contact
with a mascara applicator brush.
infection
infections
old
applicator
make-up
A survey conducted by the University
17
in resisting colonisation has also been
previously.
after
•Applying contact lenses before
The efficacy of mascara preservatives
investigated
an
with a new container of cosmetics
has been implicated in how well
mascara
using
include:21
occurred
17
of
Alabama
showed
the
reported
range of cosmetic age was anywhere
between six months and five years.22
The
investigators
also
reported
that 37% of mascara tubes tested
positive for microbial contamination.
A study by Pack and co workers20
concluded that ‘even though infection
attributable to mascara contamination
is rarely documented, it likely occurs’.
Often in a busy clinical environment,
treating the infection is of greater
concern
(for
practitioners)
than
determining the source of the infection.’20
lens wearers.16 Soft contact lenses are
The repeated use of mascara by
implicated in half of all bacterial corneal
multiple users, for example at cosmetics
infections, and bacterial infection often
counters, creates greater exposure of
Impact on dry eye/discomfort symptoms
occurs with combined contact lens
microbial contamination to mascara
Clinical signs of ocular surface disorders
wear and cosmetics.16 When mascara
tube contents. Even the repeated use
are not always present with patient-
and contact lenses are worn at the same
of mascara by a single user has the
reported symptoms, hence it is likely
time, the bacterial flora around the eye
same effect, albeit at a slower rate.
that many patients who experience
may be increased. Therefore the control
To avoid infection associated with
dry eye/discomfort symptoms (both for
of bacterial growth in the mascara tube
contamination of mascara, historically
contact lens wearers and non-wearers)
is important to minimise the risk of
it has been recommended that mascara
may only have marginal dry eye and
infection. Manufacturers of cosmetics
is replaced every six months for non-
therefore do not have a pronounced
use preservatives to keep cosmetics free
contact lens wearers and every three-
tear film disorder or ocular surface
of microbial contaminants. However,
four months for contact lens wearers.
pathology.
the personal hygiene of the wearer
However, more recent evidence suggests
18,19
Detection
of
dry
eye/
discomfort by clinical means produces
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a smaller prevalence than found by the
use of specially constructed patient
questionnaires. For example, a study
by Caffery and co-workers23 identified
clinical signs of dry eye amongst 13%
of a population of contact lens wearers.
However, a specially formulated dry eye
questionnaire detected dry eye symptoms
in 50.1% of the same study group.23
Whilst questionnaires are a sensitive
means to detect dry eye and discomfort
symptoms, they can often be seen as
cumbersome in clinical practice. In
search of a simple means to identify
such symptoms, Michel Guillon and
Cecile Maissa proposed a series of
questions that can be incorporated into
a primary care routine examination to
permit more effective identification.24
These simple questions were derived
from a large study involving over 800
patients (502 non-contact lens wearers
and 309 non-contact lens wearers) that
sought to identify (a) the prevalence
of symptoms, (b) the severity of
symptoms, (c) the type of symptoms
(e.g. burning, dryness, scratchiness,
soreness),
and
(d)
analysis
of
environments predisposing symptoms.24
The study observed a higher
prevalence of dry eye/discomfort
symptoms amongst contact lens wearers
than non-wearers, but the most common
type of symptom experienced by the
two groups was different. Contact lens
wearers were more likely to describe
their symptoms (according to the
McMonnies dry eye questionnaire)25
in terms of dryness whereas non-lens
wearers are more likely to describe
their symptoms in terms of soreness.
Amongst
contact
lens
wearers
who
were
symptomatic,
26%
experienced
symptoms
at
times
when they were wearing
make24
Amongst
non-contact lens
up.
wearers who were symptomatic,
64% experienced symptoms at times
when they were wearing make-up.24
Another
observation
made
by
this study was the high proportion
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of subjects who were symptomatic
when using moisturisers (81% of
symptomatic contact lens wearers and
84% of symptomatic non-wearers).
However, the authors do not comment
whether this observation was due to
contamination of the ocular surface by
the moisturiser products or whether
individuals who use/require moisturiser
to remove cosmetic contaminants from
(e.g. to treat dry skin) may be more
responsible for a cumulative reduction
susceptible
eye/discomfort
in lens performance over-time despite
symptoms. This study demonstrates that
daily cleaning. Based on this logic, one
the propensity of make-up sensitivity
may also assume that daily disposable
amongst those experiencing dry eye/
lenses may also help to eliminate any
discomfort is common to both contact
decline in lens performance over time
lens wearers and non-wearers and that
as a result of this form of contamination.
to
dry
lenses. However, even during normal
conditions of wear (without the effects
make-up
contamination)
significant
amounts of lipid and protein deposits
have been shown to remain on lenses
even
after
lens
cleaning.26,
27
Thus
repeated exposure of re-useable lenses
to
cosmetic
contaminants
may
be
the importance of asking patients about
the use of make-up products in clinical
Conclusion
practice should not be underestimated.
Whilst the precise association between
24
Despite contact lens wearers having a
cosmetic
eye
products
and
patient
greater propensity to report symptoms
symptoms may be extremely difficult
of ocular discomfort than non-wearers,
to determine, the association produces
the association between eye make-
a high index of suspicion that warrants
up use and dry eye symptomology is
further investigation. The impact of
common to both groups of individuals.
eye make-up contamination of contact
For practitioners, deciding which lens
lenses may have effects that compromise
material and/or lens wear modality is
the performance, physical properties
best suited to a patient who uses eye
and physical structure of the lens. For
make-up has important consequences
example, the use of eye make-up is strongly
regarding
patient
associated
symptoms.
symptoms.
is
to
how
likely
develop
related
that
with
dry
eye/discomfort
Practitioners
should
Re-useable silicone hydrogel contact
therefore be wary of the contribution of
lenses that incorporate a plasma surface
cosmetics to marginal dry eye/discomfort
treatment demonstrate better resistance
symptoms in clinical practice and make
to lipid deposition under normal contact
appropriate recommendations to patients.
lens
wear
conditions,
specifically
Lotrafilcon B. In addition, Lotrafilcon B
About the author
lenses appear to demonstrate resistance
Dr Cameron Hudson is an optometrist
to physical changes in the lens structure
and head of professional affairs for
when exposed to common contaminants
Ciba Vision UK and Ireland. He is
found
responsible
5
in
cosmetic
products.
4
for
professional
training
One may assume that the surfactants
and education in the field of contact
in lens care products may, at least
lenses and current clinical best practice.
in part, be successful in removing
cosmetic
contaminants
from
lenses
References
during cleaning. To date there are
See
http://www.optometry.co.uk
no studies that have investigated the
clinical/index. Click on the article title
ability of the various lens care products
and then download “references”.
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Course code: C-16864 O
Course code: C-16942 O/D/CL
1. Which of the following statements about white without pressure
is TRUE?
a) It represents an area of increased vitreoretinal attachment
b) It is a risk factor for retinal detachment
c) It requires “soon referral” to confirm the diagnosis
d) It requires no action
1. According to market research, what is the current average age that
females begin using cosmetics?
a. 10.9 years
b. 13.7 years
c. 15.2 years
d. 17.0 years
2. Which of the following statements about retinoschisis is TRUE?
a) It requires “soon referral” because of the risk of progression to retinal
detachment
b) It is more common in hypermetropes
c) A relative field defect will be present
d) Shifting fluid causes its position to change if the patient is examined
lying down
2. The silicone hydrogel contact lens material Lotrafilcon B
demonstrates resistance to deposits owing to which of the following
features?
a. Plasma surface treatment
b. Embedded wetting agents
c. High water content
d. Packaging saline additive
3. Which of the following statements about atrophic round holes is
TRUE?
a) They are caused when vitreous traction detaches a circular area of retina
b) They always require referral because they can progress to a detachment
c) They appear more red than the surrounding retina
d)They are more common in hypermetropes
4. Which of the following statements about lattice degeneration is
TRUE?
a) Retinal detachment develops in 8% of patients
b) It is most common after the age of 60 years
c) Referral is not required
d) The white lines visible in lattice represent traction
5. Which of the following statements about CHRPE is FALSE?
a) It is not a retinal degeneration
b) Its appearance always remains stable throughout life
c) It appears to have more well defined borders than a choroidal naevus
d) Multiple CHRPE can be associated with an inherited bowel condition
6. Which of the following statements about retinal degenerations is
TRUE?
a) Patients with lattice degeneration should be advised to give up body
contact sports
b) Women should be counselled about the risk of retinal detachment
during childbirth
c) Pavingstone degeneration is characterised by defects in the outer retina
making it a risk factor for retinal detachment
d) The only peripheral retinal degeneration that may require referral is
retinoschisis
3. Investigators from the University of Alabama discovered microbial
contamination in what percentage of mascara tubes?
a. 25%
b. 32%
c. 37%
d. 45%
4. An association between dryness symptoms and make-up use was
found in what proportion of non-contact lens wearing patients?
a. 19%
b. 26%
c. 53%
d. 64%
5. Contact lens contamination by make-up and/or make-up remover
can cause which of the following?
a. Compromise to the performance of the lens
b. Changes to the physical structure of a lens
c. Changes to the physical properties of the lens
d. All of the above
6. Which of the following is the LEAST appropriate option to select
for a contact lens wearer experiencing an undesirable effect from
ocular cosmetics?
a. Fitting a daily disposable contact lens
b. Fitting a lens with a surface treatment that resists spoilation
c. Use of a hydrogen peroxide cleaning regimen
d. Fitting a RGP contact lens
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Module questions