Published in Ocular Surface

Cosmetics and Dry Eye Mythbusting

This is editorially independent content
8 min read

Join Damon Dierker, OD, FAAO, and Laura Periman, MD, to discuss the connection between cosmetics and dry eye as well as clarify common misconceptions.

In the sixth episode of Dry Eye Fireside Chat, Damon Dierker, OD, FAAO, and Laura M. Periman, MD, sit around the fire to discuss misinformation surrounding cosmetics and ocular health as well as steps that can be taken to debunk these myths.

Harmful cosmetic ingredients to the ocular surface

Due to the widespread use of cosmetics around the eyes, some common ocular health-related practices have become relatively well-known. Dr. Dierker says that it is best to avoid the waterline, remove makeup before sleeping, and be careful with eyelash extensions and serums.
However, there exists a significant amount of misinformation regarding cosmetics and ocular health. Although it can sometimes be tricky to provide guidance on proper cosmetic use while avoiding misinformation, the inaccuracies surrounding cosmetics can be combated by independently looking at unbiased scientific research and evidence.

Recognizing research-backed harmful ingredients

According to Dr. Periman, identifying a few key ingredients that have been demonstrated as detrimental by extensive research is a good place to start.
Prostaglandin analogs (PGAs) are commonly used for eyelash growth, but are associated with the following side effects:1
These negative side effects may inadvertently cause users to develop a more aged appearance in the pursuit of appearing more youthful, especially when using unregulated products.

Being leary of over-the-counter eyelash serums

Even ingredient labels may contain misleading information for consumers. Roughly ⅓ of over-the-counter (OTC) eyelash serums contain adulterated PGAs, and some have even been caught omitting PGAs from their ingredient lists.2,3
Unlike FDA-approved products, such as Latisse, which is an approved eyelash growth serum that has been studied with known effects, OTC serums are not required to undergo safety testing and may fail to disclose their potential risks to the public.
If she suspects a patient is using products with PGAs, usually by their abnormally long lashes and/or common side effects, Dr. Periman finds it best to approach the matter from an angle of ocular health with gentle concern.

Preservatives in cosmetics

Preservatives are always a topic of concern when it comes to ocular health, whether it be in eye drops or cosmetics. However, not all preservatives are the same. For instance, the use of formaldehyde-donating preservatives around the eyes has been shown to be harmful, as they can cause damage to the cornea even at very low concentrations.4
One of the most common preservatives found in cosmetics is hydroxymethylglycinate, which becomes a formaldehyde once it interacts with water.5 This can make avoiding these preservatives more of a challenge as a product can truthfully state that it is free of formaldehyde, but the presence of formaldehyde-donating preservatives can release formaldehyde once the product is applied.

The value of knowing safe preservatives according to scientific research

Additionally, the use of other chemicals, such as DMDM hydantoin, urea, and quaternium-15, should also be avoided around the eyes.6 However, not all preservatives are as inherently harmful.
Parabens are widely maligned preservatives in the cosmetics industry, with many products marketing their “paraben-free” formulas to appear safer for the skin. However, extensive research demonstrates that parabens at low concentrations are effective and safe preservatives.7
In fact, parabens are even found to occur at low levels in nature.8 Therefore, with the right balance of parabens with other molecules, they can be used safely and effectively.
Ethylhexylglycerin and phenoxyethanol are other preservatives that are often inappropriately maligned. Phenoxyethanol, which can be recognized at high concentrations by its rose-like scent, when used at low enough concentrations, especially when it is synergistically combined with ethylhexylglycerin, can effectively protect against ocular pathogens.9

Understanding the complexities of cosmetics chemistry

It is also crucial to remember that preservatives serve a protective purpose. Without preservatives in cosmetics, users would be at risk of using products that could be contaminated with bacteria or other harmful microbes that put the eyes at risk. Therefore, the key is to find the right preservatives in the proper formulations to minimize any negative impact on ocular health.
The manner in which cosmetics are applied and their formulations also play a significant role in their impact on ocular health. For example, products that are applied closer to the eye have a greater chance of causing harm due to their proximity to the ocular surface, while wash-off formulations of cosmetics may be less of a concern.
Additionally, it is important to remember cosmetic chemistry is its own complex science. While we as eyecare practitioners (ECPs) are the experts when it comes to maintaining ocular health, the field of cosmetics research has its own experts whose knowledge of cosmetics chemistry vastly surpasses our own.
Therefore, given this complexity, Dr. Periman suggests that rather than singling out a particular ingredient, it is important to take the entire formula and composition of the product into consideration.

Reliable educational resources on toxic cosmetic ingredients

Many organizations can be found online that list the toxicity of ingredients and claim to have the most accurate information regarding cosmetic safety. However, a large number of these organizations are paid to display certain information and much of the cosmetic research thus far has been done for marketing purposes and contains bias without thorough analysis.
Some of Dr. Periman’s favorite resources include independent cosmetic chemists who present scientific information on popular social media platforms. The Eco Well, for example, seeks to uncover the truth surrounding cosmetic ingredients and formulas from a research-based perspective.
Moving forward, Dr. Periman emphasizes that true transparency should be pushed for as a community. Widespread ocular research does not yet exist in the cosmetics industry, and it is therefore important for doctors and consumers to advocate for a more science-based approach to cosmetics development.

Conclusion

Although the impact of cosmetics, especially in regard to specific ingredients, on ocular health is a controversial topic that is often fraught with misinformation, it remains an important area of eyecare.
It can be misleading to focus on individual ingredients that are perceived as being harmful, as oftentimes, the overall formulation of a product and the application method of these ingredients can influence their impact on ocular health.
The pervasive misinformation surrounding cosmetic safety can be reduced through independent scientific research and an understanding of the fact that cosmetic science is a complex subject that requires expert knowledge to grasp its intricacies fully.
Therefore, ECPs and affected communities should advocate for thorough, evidence-based research rather than market-driven messaging to improve both transparency and safety in the cosmetics industry.
  1. Dorkowski M. A Guide to Applying IOP-Lowering Drugs. Review of Optometry. Published July 15, 2018. https://www.reviewofoptometry.com/article/a-guide-to-applying-ioplowering-drugs.
  2. Swedish Medical Products Agency. Pharmaceutical ingredients in one out of three eyelash serums [press release]. Swedish Medical Products Agency. Published April 15, 2003. Accessed Dec 8, 2023. https://www.dr-jetskeultee.nl/jetskeultee/download/common/artikel-wimpers-ingredients.pdf.
  3. US Food and Drug Administration. Warning letters address drug claims made for products marketed as cosmetics. US Food and Drug Administration. Published June 26, 2019. Accessed Dec 8, 2023. https://www.fda.gov/cosmetics/warning-letters-related-cosmetics/warning-letters-address-drug-claims-made-products-marketed-cosmetics.
  4. Chen X, Sullivan DA, Sullivan AG, et al. Toxicity of cosmetic preservatives on human ocular surface and adnexal cells. Exp Eye Res. 2018;170:188-197. doi: https://doi.org/10.1016/j.exer.2018.02.020
  5. ‌Russell K, Jacob SE. Sodium hydroxymethylglycinate. Dermatitis. 2010;21(2):109-110.
  6. ScienceDirect. Quaternium 15 - an overview. ScienceDirect Topics. Accessed December 9, 2023. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/quaternium-15.
  7. Fransway AF, Fransway PJ, Belsito DV, Yiannias JA. Paraben Toxicology. Dermatitis. 2019;30(1):32-45. doi:https://doi.org/10.1097/der.0000000000000428‌
  8. Gálvez-Ontiveros Y, Moscoso-Ruiz I, Rodrigo L, et al. Presence of Parabens and Bisphenols in Food Commonly Consumed in Spain. Foods. 2021;10(1):92. doi: https://doi.org/10.3390/foods10010092.
  9. Dréno B, Zuberbier T, Gelmetti C, et al. Safety review of phenoxyethanol when used as a preservative in cosmetics. J Eur Acad Dermatol Venereol. 2019;33 Suppl 7:15-24. doi: 10.1111/jdv.15944
Damon Dierker, OD, FAAO
About Damon Dierker, OD, FAAO

Dr. Dierker is Director of Optometric Services at Eye Surgeons of Indiana, an adjunct faculty member at the Indiana University School of Optometry, and Immediate Past President of the Indiana Optometric Association. Dr. Dierker is the Co-Founder and Program Chair of Eyes On Dry Eye, the largest event for eyecare professionals in the industry. He has made significant contributions to raising awareness of dry eye and ocular surface disease in the eyecare community, including the development of Dry Eye Boot Camp and other content resources across dozens of publications.

Damon Dierker, OD, FAAO
Laura M. Periman, MD
About Laura M. Periman, MD

Laura M. Periman, MD, is a board-certified ophthalmologist, fellowship-trained cornea and refractive surgeon, and ocular surface disease (OSD) expert. Dr. Periman completed her ophthalmology residency and cornea/refractive fellowship at the University of Washington in Seattle. She has 18 peer-reviewed publications and has written extensively on ocular surface disease.

Her unique and passionate perspective on OSD stems from her work in immunopathophysiology. She is an innovator and enthusiastic speaker who loves bridging the gap between basic science, clinical practice, and patient compassion. Whether delivering top-line care in the sacred 1:1 patient encounter or expanding awareness of the worldwide impacts of dry eye disease, Dr. Periman thrives on contributing to the greater good.

Dr. Periman is the Founder and Director of Dry Eye Services and Clinical Research at Periman Eye Institute in Seattle, as well as the Founder and Chief Medical Officer of Quench Method, an eye-friendly cosmetics company.

Laura M. Periman, MD
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