According to Cosmetics & Toiletries, a peer-reviewed cosmetic science publication, three out of the four most-used makeup items are applied to the eye area: mascara, eyeshadow, and eyeliner. Add in a host of eye-related beauty trends heavily promoted by social media influencers without disclaimers or cautionary information, and you have a legitimate area of concern for ECPs.
It’s hard to keep up with the massive beauty industry, particularly if you aren’t into makeup and beauty trends yourself. Let’s run down current problematic beauty trends and techniques so you’ll know what to look for, and what to ask about when seeing patients.
Tightlining
You see it all the time, but you may not know the term: Tightlining is a makeup technique where eyeliner is applied directly to the waterline, the skin between the base of the lashline and the cornea. It is likely the most common/popular practice on this list. Potential problems include:
- Blocking meibomian glands, causing MGD
- Increasing the amount of cosmetic that enters the tear film and contacts the surface of the eyes
- Exposure to bacteria from unclean or shared products
- Product transfer onto contact lenses causing vision disruption, irritation, and infection
Many people don’t know to be cautious of tightlining because its complications aren’t common knowledge. Beauty magazines have promoted using eyeliner on the waterline for decades, and even if you do show the risks, as Dr. Brittani Carver did on TikTok in 2021 of a longtime tightliner’s gnarly MGD, many viewers still replied that they would not be deterred. As I said, it’s an extremely popular technique.
Eyeliner Tattoos
This is a permanent makeup trend with an important caveat: None of the pigments used for eyelid tattoos are approved for use by the FDA. Eyeliner tattooing involves multiple application treatments, any one of which can cause an adverse reaction:
The process can cause physical damage to the meibomian glands due to dye obstructing the duct, chronic lid margin inflammation, allergic reactions, and potential severe reactions like full thickness lid margin penetration, infections, and eyelid scarring. Eyeliner tattoos may affect the eyes with individuals that have undergone the procedure showing increased corneal staining, shorter tear break up time, and greater amount of meibomian gland dropout. (Source: Through the Lens of Beauty: Navigating Cosmetic Trends and Their Ocular Effects)
Glitter Eyeshadow
You’ve probably seen glitter in a tear duct or two under your slit lamp, no? Needless to say, anything stuck in a tear duct can cause problems. Glitter can also penetrate the tear film and create corneal abrasions. If people use craft glitter on their face, as opposed to a cosmetic glitter, the risks go up.
In the interest of providing safer solutions to harmful products, you could recommend a cream shadow instead of a glitter powder — it’s less likely to get … everywhere. As with tightlining, having glittery eyelids is a beauty trend that’s not going anywhere, so it’s best to properly advise patients and provide safer alternatives when possible.
Lash Serum
Problems with lash serums are well documented at this point. Serums can cause burning and irritation, iris darkening, conjunctival hyperemia, periorbitopathy due to orbital fat loss, upper eyelid ptosis, and chronic dry eye. Safety information on the packaging is often insufficient and serums are categorized as cosmetics when many actually contain prostaglandin analogues. The good news is that most of these side effects are dose-dependent and may be reversible with treatment discontinuation. (Source: Real Talk About Eyelash Enhancements)
Key lash serum takeaways:
- There is still only one lash serum currently approved by the FDA: bimatoprost 0.3% (Latisse).
- Lash growth serums should not be used while wearing contact lenses.
- Providing visual evidence of potential complications makes patients more likely to consider alternatives.
- Nonprostaglandin analog products like castor oil-based conditioners are not scientifically proven to help lashes grow, but can be a generally safer option for many. Still, there is insufficient research evaluating many of these serums and their safety and efficacy.
Lash Extensions
Lash extensions have exploded in popularity in recent years, despite their regular maintenance requiring two-hour-plus appointments every two to four weeks. Potential complications are numerous:
- Lagophthalmos
- Short-term increases in tear meniscus height and corneal staining
- Risk of chalazia/hordeola
- Keratoconjunctivitis, allergic blepharitis, and conjunctival erosion from the glue used in the application process
- Itching, redness, pain, watery eyes, heavy eyelids, foreign body sensation, and burning
- Hygiene issues from extensions being worn for weeks at a time
Safer practices for extensions include using glues that do not contain cyanoacrylate, latex, or ammonia and removers that are oil-based. You could recommend OTC hypochlorous acid as a cleaning option that will not dissolve the glues. (Source: Lashing Out: Dangerous Beauty Trends)
The DED Factor
We’ve gotten through all this with only one dry eye mention. Let’s remedy that. Current research shows that eye makeup in general is having an impact. In this month’s issue of Contact Lens Update, the Centre for Ocular Research & Education (CORE) highlighted a study that indicates a link between frequent use of eye cosmetics and dry eye symptoms. CORE lists several recommendations you can share with patients:
- Remove contact lenses and all traces of makeup, especially before going to sleep.
- Patients prone to symptoms of DED should consider the following options to mitigate exacerbation of their dry eye symptoms:
- Applying cosmetics further away from the ocular surface
- Limiting eyeliner to the external lids only
- Avoiding eyeshadows that may contain larger shimmery particles
- Avoiding false eyelashes (and lash extensions)
- All cosmetic users should be reminded to discard and replace their eye cosmetics on a regular basis and to ensure applicators are regularly cleaned. (Source: Article Review: Prevalence of Dry Eye Disease and Its Association with the Frequent Usage of Eye Cosmetics Among Women)
I recommend visiting all the sources linked in this article for deeper dives on the treatment of complications resulting from cosmetics and eye-related beauty trends, plus additional ways to educate patients about healthier practices and alternatives. Through the Lens of Beauty: Navigating Cosmetic Trends and Their Ocular Effects is particularly informative.
Keep in mind that you are the trusted authority in a sea of beauty influencers and positive product reviews that do not take eye health into account.
