Eyeworld Daily News

12 | EYEWORLD DAILY NEWS | MAY 5, 2019 ASCRS NEWS by Lauren Lipuma EyeWorld Contributing Writer encouraging patients to read labels and identify toxic ingredients because cosmetics are so poorly regulated in the U.S. Encourage patients to shop at places like Pharmaca and Whole Foods that carry products with few toxic ingredients and teach pa- tients to read cosmetics labels with the same obsession as food labels, she said. Patients can also shop for products while abroad, because countries like Canada, France, and Korea have banned many toxic ingredients from cosmetics that are not banned in the U.S. Overall, she recommends teaching patients to be more cog- nizant about their beauty products and habits because bad choices can lead to permanent, irreparable damage to the ocular surface. "Only take care of the eyeballs you want to keep," Dr. Periman said. Editors' note: Drs. Matossian and Periman have no financial interests related to their comments. N umerous beauty pro- cedures and cosmetics applied on or near the eyes can cause or exacerbate dry eye, according to special- ists. In extreme cases, these products and procedures can cause permanent damage to the ocular surface, meibomian glands, and eyelashes, so ophthalmolo- gists need to be aware of these potential dry eye culprits, said the speakers of the instruction course on the ingredients and habits that affect dry eye disease. Both men and women have used minerals and dyes to enhance their looks, and today they spend nearly $400 billion on cosmetics and procedures worldwide. Wom- en do the majority of spending, and women disproportionately suffer from ocular surface disease, said Cynthia Matossian, MD, Doylestown, Pennsylvania. Dr. Matossian discussed how current trends in lash beauty and eyelid tattoos can impact the ocu- lar surface. Lash extensions, false lashes, and lash embellishments can all damage the natural eyelash- es, even when done properly, Dr. Matossian said. Lashes naturally protect the corneal surface from pollutants and debris, but lash extensions can actually have a reverse effect. Studies have shown that super long lashes can alter the air dynamics around the eye, cre- ating miniature wind tunnels that actually funnel particles toward the eye, she said. In addition, the glue used to affix the extensions to the lashes contains formaldehyde, a known and potent ocular surface irri- tant. False lashes, which are also affixed by glue, can cause similar irritations, but have an additional effect of ripping out the natural, new lashes when they grow in, Dr. Matossian explained. The weight of eyelash embellishments, like rhinestones and feathers, can cause traction alopecia that can lead to permanent lash loss. Part of the problem with these procedures is they are often performed in salons by technicians who have little or no knowledge of ocular surface anatomy or physiology, Dr. Matossian said. Cosmetic eyeliner tattoos can have some of the most dramat- ic ocular surface effects. The needle penetration can destroy meibomian glands, while the ink pigments often contain common irritants like iron oxide or nickel. Some of the pigments can have ingredients that are known to be toxic, like lead and chromium, and some pigments are industrial grade and used for automobile or even airplane paint. Offending ingredients Laura Periman, MD, Seattle, discussed the ocular dangers of various ingredients used in com- mon cosmetics. Eyelash growth serums, wa- terproof makeup, harsh makeup removers, and anti-aging products are among the culprits of cosmet- ics that can have toxic or irritat- ing ingredients. The FDA only requires cosmetics companies to disclose ingredients that make up 1% or more of the total product, but there are often many ingre- dients below this threshold that can cause irritation or toxicity, Dr. Periman said. In addition, product mar- keting can often be misleading. Labeling products as hypoaller- genic, organic, vegan, all-natural, dermatologist tested, and even ophthalmologist tested does not mean they are safe for the ocular surface, according to Dr. Periman. What can ophthalmologists do? Dr. Periman recommends ophthalmologists ask their dry eye patients about their beauty habits to see if the products they're using are causing or exacerbating the problem. She also recommends It's paramount to capture the OCT scan in the very center of the fovea, Ms. Armstrong contin- ued. Most patients have a dip in the inner retinal layers where the fovea is, but not all do. To find the fovea without the dip, look at the outer retinal layers; the higher con- centration of outer retinal layers at the fovea forms a triangle or point you can use for reference, she said. Imaging staff can also find the fovea by using the optic nerve as a reference point. Ms. Armstrong recommends placing the scan at the bottom of the optic nerve and moving it around from there. If the cataract makes it difficult to capture an image, move the scan to a place where the cataract is clearer, she added. Overall, Ms. Armstrong and Dr. Cohen stressed the impor- tance of not accepting preop test results at face value. Go beyond the manufacturer's recommenda- tions and devise your own proto- cols for getting the most accurate results, Dr. Cohen said. "Work out your own protocol so you have adequate data with which to make your decision," he said. Editors' note: The speakers have no financial interests related to their comments. continued from page 10 Vampire on the vanity: Cosmetics that impact dry eye disease Dr. Periman discusses the toxic effects of various ingredients used in common cosmetics.

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