The United States’ beauty and cosmetic industry has little regulation regarding potentially harmful ingredients. The European Union Cosmetics Directive was adopted in January of 2003, with the most recent revision in 2013 which bans 1328 chemicals from cosmetics. In comparison, the FDA has only restricted 11 such chemicals! The difference is stark, but perhaps this article can shed some light on consumer protection for cosmetics.
Ingredients
Often tricky marketing terms are used, such as “hypoallergenic”, “dermatology/ophthalmology tested”, “organic”, “clinically proven”, “natural” that are not regulated by the FDA. Prolonged use of some of these products with harmful ingredients cause allergy, irritation, and ocular surface disease.
As optometrists, we need to address cosmetics and eye safety and guard the ocular surface health. It is important to ask patients to read labels. Many ingredients are often ‘unpronounceable’ and there is little peer reviewed data on their ocular safety. Below are ingredients to avoid and/or limit (the bolded ones are found commonly in eye products):
Ingredients to avoid:
- Balsam of Peru: aka myroxylon pereirae, fragrance additive. Known as a top ten contributor to contact dermatitis.
- Benzalkonium chloride (BAK): preservative (further discussed below)
- BHA and BHT: synthetic antioxidants used as preservatives. The International Agency for Research on Cancer classifies BHA as a possible human carcinogen.
- Coal tar: dye derived from petroleum. Some coal tar colours are prohibited as they are recognized as carcinogens. A few others are still used in hair products, food additives, and lipstick, however, there is some literature that links their continued use can lead to cancer.
- Colophony (rosin): common cause of contact dermatitis
- Diazolidinyl urea: preservative, and need for caution with people with allergies to formaldehyde
- DMDM-Hydantonin: preservative, and need for caution with people with allergies to formaldehyde
- Ethanolamines (MEA/DEA/TEA): ammonia compounds used in cosmetics as emulsifiers, foaming agents, and hair color. Repeated and prolonged use may increase risk for cancer.
- Formaldehyde (FA) (DMDM Hydantoin, Ureas, Quaternium-15, Sodium hydroxymethylglycinate): preservative (further discussed below)
- Fragrance: may trigger allergies, migraines, and asthma symptoms
- Glitter/metallic colors: cautious with glitter specks lodging in ocular tissue
- Hydroquinone: skin lightener linked to cancer and organ-system toxicity
- Imidazolidnyl urea: preservative, and need for caution with people with allergies to formaldehyde
- Isopropyl Cloprostenate: commonly found in eyelash growth serums, with side effects of conjunctival hyperemia, skin/iris pigmentation, pruritus, lash loss, and lowered IOP
- Metals (Nickel, cobalt, chromium): potentially toxic with repeated use and skin absorption
- Methylisothiazolinone and methylchloroisothiazolinone: preservatives, known for contact dermatitis and possible neurotoxicity
- Oxybenzone: found in sunscreen, and shows endocrine disrupting characteristics
- Parabens (methyl-, isobutyl-, propyl- and others): preservative (further discussed below)
- Phenoxyethanol: preservative (further discussed below)
- Phthalates: linked to endocrine disruption
- Polyethylene glycol (PEG compounds)
- Quaternium-15: preservative, and need for caution with people with allergies to formaldehyde
- Sodium Lauryl Sulfate and Sodium Laureth Sulfate (SLS and SLES): okay if used in rinse-off agents, otherwise potential for dermatitis
- Talc (that’s not certified asbestos-free)
- Titanium Dioxide (powder form): Low risk of exposure as lotions/creams, but carcinogenic as an inhalant. Be cautious with loose powders around the face.
- Triclosan and Triclocarban: Potential as an endocrine disruptor, bioaccumulation, and the emergence of bacteria resistant to antibodies and antibacterial products.
Obviously, that’s one long list to remember! Thankfully, there are websites and apps dedicated towards ingredient and product checks.
Useful websites for safe cosmetics
*The Environmental Group (EWG) has come under controversy for lacking scientific credibility. It is important for consumers to be wary of where information comes from. Skin Deep can be a starting point, but cross check with other sources if an ingredient looks suspicious.
Preservatives
Out of the list above, there are four preservatives that are most commonly seen in beauty products:
- BAK
- Formaldehyde
- Parabens
- Phenoxyethanol
On a product label, the FDA dictates that the list of ingredients be disclosed in order of predominance, followed in descending order. However, if any ingredient is less than 1% of total volume, it may be listed in any order. It is difficult to avoid all preservatives. If you do see a loved product with one of these ingredients, try to make sure the ingredient is as far down the list as possible.
BAK
Found in: eye drops (glaucoma), eyeliner, mascara, makeup remover, face wash
Studies show that BAK destabilizes the lipid layer and damages the epithelial and goblet cells. Even at low levels of BAK (0.5 mg/ml), it killed meibomian glands within a day even after only 15 minutes of exposure. In an in vitro model, BAK and FA releasing compounds causes cell atrophy and death as well as decreased cell proliferation, and these are at concentrations lower than those approved for consumer use.
Formaldehyde
Found in: makeup removing wipes, shampoo, face washes
Alternative names: quaternium-15, DMDM hydantoin, imidazolidinyl urea, diazolidinyl urea, polyoxymethylene urea, sodium hydroxymethylglycinate, glyoxal
Concentrations greater than 0.2% are associated with contact dermatitis, skin and ocular surface irritation, and even nasopharyngeal and nasal cancers.
Parabens
Found in: cosmetics (especially mascara), lotions, deodorant
Parabens are endocrine disruptors that may alter important hormone mechanisms in our bodies. They can penetrate human skin tissue. In 2004, traces of five different parabens were found in the breast tissue of 95% of women. Parabens are also known to inhibit the function of meibomian glands. Methylparaben demonstrates similar toxicity to human conjunctival and corneal cell cultures like BAK.
Phenoxyethanol
Found in: mascara, eyeliner, eye shadow, concealer, foundation, moisturizers, soaps, makeup removers
Most of us love the smell of roses, but this is one strong rose-like smell that we need to avoid. It is known to cause skin dermatitis, and ocular irritation.
Meibomian gland dysfunction
The lipid layer is the most superficial layer of the tear film secreted by the meibomian glands. This layer inhibits tear evaporation.
Eye makeup are foreign substances that can lead to irritation, inflammation and eye redness. Lingering makeup on or around the eyes can breed bacteria and migrate onto the ocular surface. Research in 2018 suggests that cosmetics in the lipid layer contribute to increase in debris, meibomian gland blockage, and contamination. And makeup that covers the meibomian gland causes the glands to limit expression, and inflame. These habits destabilize the surface tear film lipid layer which can eventually lead to evaporative dry eye.
Things to Avoid
- Tightlining: Liner directly on the waterline and close to the lid margin. Chronic tightlining can severely impact the meibomian glands and cause them to atrophy. There is no cure for that, only management and control.
Figure 1 (A-C) demonstrates eyeliner drift when applied to the eyelid margin with signs of bulbar hyperemia and (D) tightlining causing visible debris within the interpalpebral zone.
Figure 1
In Figure 2, meibography of the meibomian gland orifices show eyeliner residue. Tightlining an eyeliner increases the risk of meibomian gland dysfunction and gland obstruction.
Figure 2
- Waterproof makeup: They have the potential to block the meibomian gland ducts, which also makes it difficult to remove unless you use harsh removal products.
- Retinol around the eyes: Prescription and over the counter anti-aging products have been known to cause chronic meibomitis.
- Eyeliner pencils: Use paraben-free and formaldehyde-free pencils. If the application is too close to the eyelash root and lid margins, it can obstruct the superficial glands.
Demodex folliculorum infections
Human sebum is an optimal living environment for D. folliculorum. These Demodex mites contribute to anterior and posterior blepharitis which causes inflammation, itching, swelling, and loss of lashes. Mascara and eyeliner are the most common makeup products that can breed Demodex, with an average survival time of 21 hours. It is not only important to clean makeup brushes every 3-4 weeks, but also to replace cosmetics, especially mascara.
Figure 3 illustrates narrow, discrete band of pigment located within papillae along the upper tarsal border (left) and chronic mascara wear with poor removal causing follicular conjunctivitis and concretion-like deposits (right).
Figure 3
Not only does mascara often lead to Demodex, but it can also cause conjunctival pigmentation (Figure 3). Especially avoid nylon fibers in mascara which can embed into the lash line and eyelid margin. Nylon has sharp edges noted on electron microscopy, and combined with other chemicals has the potential for inflammation and fibrosis. Keep makeup debris on your list of differentials when flipping eyelids and noticing conjunctival pigmentation.
Things to avoid:
- Eyelash extensions: Not only is surface irritating formaldehyde found commonly in eyelash glue, but eyelash extensions make it difficult to practice lid hygiene. Patients are often worried their expensive lash extensions will fall out if they wash, rinse, and/or clean them.
- Eyelash serums: Beware of growth serums that have prostaglandin analogs (PGAs). Not only are PGAs Category C (beware pregnant women), they are known to cause redness, eyelid and iris pigmentation, and deepening of eyelid sulcus.
Editor's and author's note: As of 4/21, the list of "safe(r)" products has been removed from this article. Thanks to our readers for alerting us to some issues! Companies can change product ingredients at any time, so keep an eye out. If you're interested in Dr. Angel Husher-Rodriguez's research on makeup education, check out her list of tips and safer products.
Conclusion
Beauty now can mean ugly for the ocular surface later. Most patients will not talk to eyecare providers about cosmetics use. And most consumers do not look at ingredients when deciding which products to purchase. Even then, there can be so many hidden chemicals and false marketing claims. It is important to educate ourselves and then discuss unfriendly practices and exacerbating ingredients with our patients.
