Dr. John Burroughs, Oculofacial Plastic Surgeon & Medical Director of Springs Aesthetics, discusses the potential impact of makeup of eye health.
1. Can cosmetics be harmful to the eyes?
There are many things we apply around our eyes and on our eyelids that may be harmful, including cleanser, moisturizer, under eye cream, concealer, eye shadow, mascara, eyeliners and more. These products may contain wax (synthetic, paraffin or beeswax) as well as potentially toxic chemicals such as carcinogens and parabens. Although parabens are antibacterial, they can be absorbed and transmitted into the bloodstream. Parabens can also worsen dry eye as they can reduce the secretion of the important oil glands that line the eyelid margin and are essential to a healthy tear film. Also, because the eyelid skin is the thinnest skin on our body it can be more sensitive and susceptible to reactions.
2. Why is makeup even more harmful to patients with dry eye and blepharitis?
The chemicals in makeup can be toxic and even more so for people with dry eye or blepharitis who already have sensitive eyes and may be undergoing treatment. Blepharitis is a common condition of the eyelid margin that can manifest with burning, crusting, mattering, and itching of the eyelid margin. Dry eye is also worse in patients with blepharitis. Dry eye can manifest as eye stinging, burning, foreign body sensation, blurred/unstable vision, and chronic redness. Makeup can worsen blepharitis, and for patients with severe flares or chronic ongoing problems necessitate a makeup “holiday.” Many patients can resume makeup once the blepharitis is improved, but it is best to choose brands formulated without the more synthetic parabens and waxes.
The major forms of blepharitis:
1) anterior form;
2) posterior form; and
3) mixed anterior and posterior.
Severe blepharitis can cause bleeding of the eyelid margin, permanent loss of eyelashes, infections of the eyelid skin/eye, and corneal scarring.
3. Are some makeup techniques more harmful to the eyes?
There are new techniques for applying makeup that can be harmful to your eyes, and the current trends of heavier eyeliner is compounding this issue. “Tight lining” is application of eyeliner directly over the “water line” and oil glands. Eyeliners typically have parabens, synthetic wax, or bee’s wax, which can block these essential oil glands. For someone with dry eye or blepharitis, who already has inflammation, this can make the oil glands clog and allow particles of makeup to migrate into the tear film. Mascara and other gel products also have a lot of wax that can have the same affect. In general, the mineral-based makeups are better tolerated, but should be avoided being placed too closely to the lid margin.
Images of Tight Lining (seen on the upper eyelids with makeup covering over the entire eyelid margin whereas a space between the lower eyelid eyeliner and the the back of the eyelid.)
“Baking” is when you apply cream under eye concealer then lay translucent powder over it. This gets rid of all the creases and looks amazing, but when you then put drops in your eyes, the powders can get into the tear film and cause burning, stinging, and tearing. This can also cause more inflammation and affect tear quality. I’ve also seen tattooing of the conjunctiva where patients have worn makeup for so long, it’s gotten underneath the mucus layer and becomes tattooed there. Another problem is that the makeup can plug the tear drains and/or cause inflammation within them and cause drainage issues leading to increased eye irritation and infection risks.
4. What can patients do to help protect their eyes when wearing makeup?
Primers make powders stick, particularly those with sunscreen, so can be helpful and safer as the eye makeup stays in place better lessening unwanted migration into the tear film and eye surface. There are also permanent makeup options, including eyeliner that is applied to the skin outside of the lid margin. Its iron oxide pigments are safe and there is no migration of pigments to the glands. However, since the application may cause some swelling, it is best that patients wait until the active inflammation is controlled. Springs Aesthetics can recommend a permanent makeup artist for those interested. Permanent makeup can also be a significant time saver.
5. When should one consider avoiding eye makeup?
There are many patients, who should not be wearing makeup. However, this can be hard to do as there is a high expectation in our culture for wearing makeup. It can be fun and help women feel better about themselves, but for dry eye and blepharitis sufferers it can be harmful and hamper recovery. It’s all about stopping the inflammation. Patients should temporarily hold off on makeup while until their eyes are being actively treated to allow proper healing. We at Springs Aesthetics recommend these patients try more natural brands with fewer chemicals.
6. What is Demodex? Is it associated with cosmetics use?
Demodex is an 8-legged mite that can infest on the eyelids and eyelashes. It can be hard to see without high power magnification, which will often show layers of dead skin, collarettes, stuck mascara, and eye shadow particles entrapped in the sleeves of debris on the lashes. Since some ingredients in makeup are toxic for dry eye patients who are already very sensitive, this is just one more insult to their eyelids. They typically have red, irritated eyes, and with makeup they are adding waxes and parabens that block the glands thereby worsening inflammation. Inflammation of the eyelid margin can make the eyes more susceptible to infection including Demodex.
7. Will patients that don’t clean their eyelids daily make this worse?
Yes, when patients don’t clean their lids properly and daily it adds to the infestation. Mascara should be cleaned off daily and thoroughly. I have examined patients, who state to have not worn makeup for several days or more, and yet they still show mascara on the eyelashes and eyeliner on the eyelids. Often, the live Demodex mites can be seen under the microscope actively wiggling around. For most patients, that’s enough to convince them they need to start cleaning their eyelids every night.
8. What are some of the most harmful things patients do related to cosmetics and their eyes?
Tight lining, is probably the most harmful particularly for patients with Demodex. You are applying eyeliner directly over the water line and oil glands. You are basically putting a very waxy pigment right onto the lid margin and at the base of the lashes. If the lashes have debris on them, it’s going to coat them even more, so you are in essence feeding the Demodex and providing a barrier for them to thrive under. Furthermore, the plugging up of the oil gland openings along the lid margin can lead to uncomfortable and unsightly chalazia that often require surgical drainage to resolve (see figure below).
9. What treatment is recommended for patients with Demodex?
For patients with Demodex, I usually first recommend Avenova lid regimen. It is very well tolerated and patients remark how much better their eyes feel after just a few days of nightly use. It is best to avoid makeup until the eyelids have calmed down, and the Demodex is eradicated. Sometimes taking a break from the makeup is the best thing a patient can do. Sometimes getting rid of potentially contaminated makeup is important as well, so that the infection is not re-introduced. Avenova is available for purchase at Springs Aesthetics or requires a physician’s prescription, though not all insurance plans cover. Once patients start on Avenova they rarely want to go back to not using it as their eyes usually feel significantly better. Older regimens of diluted baby shampoo and other treatments actually caused more irritation and inflammation of the lid margin, so Avenova has been a real “game-changer” for patients that need it. Another option is Cliradex, which contains 4-terpineol, the active ingredient in tea-tree oil. Cliradex has antibacterial as well as anti-inflammatory properties that are in a preservative-free solution. OcuSoft has over-the-counter eyelid wipes that contain hypochlorous acid, the same ingredient as in Ocusoft. Lastly, Blephedex is a comfortable office based treatment to help with mechanical debridement along the lid margin of Demodex, oils, makeup that can be used for the most serious of cases that are resistant to other treatments.
10. What advice would you give to other doctors about cosmetics and patients with Demodex?
Even if you don’t know all the latest techniques and types of makeup available, you need to address the issue of cosmetics with patients. Telling patients firmly “now is not the time to be wearing makeup” is key in getting their eyes healthier. They can then actually safely resume makeup. I also tell patients that once we get all the debris off their lashes from the Demodex, that the mascara will actually look better because their lashes won’t be stuck together. Another way to appeal to the “makeup addict” is to let them know that if left untreated, the inflammation can cause loss of lashes and damage to the ocular surface of their eyes. Once patients are educated properly, they will usually make safer decisions for their eye health.
11. What if I don’t know I have Demodex, blepharitis, or dry eyes?
Dr. Burroughs started his career as an ophthalmologist before subspecializing as an ophthalmic and facial plastic surgeon. His office has ophthalmic equipment to make the diagnosis of these conditions. He treats many patients with dry eye and blepharitis, and even before cosmetic surgeries he advises optimizing the health of his patient’s eyelids and skin to ensure the best healing and to reduce infection risk. The great thing about having healthy eyelids is that the eyes not only feel better and are healthier, but the eyelashes are fuller and prettier