How do everyday products affect our eyes?

When I see patients with complex problems like dry eye disease, allergies or eyelid skin problems (which are often all interrelated), one of the questions that I ask is - what products do you use in or around your eyes? For everyone, this can include contact lenses and the solutions used to clean, disinfect and moisturize them (see my earlier post on that). Various prescriptive and over the counter eye drops gels and ointments are another group. For most, this can also include skin cleansers, moisturizers or sun-blocking creams. This time of year (being the day before Halloween) it might include face paint or theater glues to apply false moustaches and beards. Colored costume contact lenses. For women, this frequently includes various forms of daily makeup, lid liners, mascara and eyelash extensions - yet all of these products may contribute to the eye problems they present with.

There are many posts (mine and others) denouncing “bad products” and I point out to my patients that in the USA, there is little governance overseeing producers of makeup (EWG offers free online information and is one of a few online consumer protection groups that target makeup and other everyday products that can be bad for you. I quote from some of their online information found here: https://www.ewg.org/news-insights/news/2021/08/protecting-consumers-toxics-cosmetics-us-lags-least-80-countries ). In some countries there are over 1600 ingredients banned from makeup as opposed to just 9 banned by the FDA from makeup for safety concerns and 80 countries lead us (in the USA) in banning harmful chemicals in makeup products.

Once this information is absorbed by our brains, we might pooh pooh it by thinking “my products are:” “all natural” or “organic” or “vegan” or on the label it says “doctor tested and doctor approved.” But what does this really mean? In the USA, it usually doesn’t mean much, since there is so. little oversight to hold these companies accountable - and just because the company has a “big name” or “great reputation” (as in “even my grandmother used this stuff” and “all my friends say it’s great”) - unfortunately these statements can all be false or misleading.

A young patient of mine was recently referred because she had severe scarring of her corneas that was an imminent threat to her vision. She was studying about cosmetics and wore eyelash extensions - which looked great - but her mother stated that her eyes were “blood red” for several hours each time she had them applied. She wore contact lenses that were cleaned daily in an “all purpose” solution and she had makeup on that raised more concerns. Basically, each of these alone might cause a problem like hers, but together, were likely the “perfect storm” to cause this eyesight-threatening scarring. Add to that the usual dry eye problems common to all school-aged children and young adults (again see my earlier posts) - and she was in grave dangers that may haunt her the rest of her (likely long) life.

Why is it so hard to protect people from unscrupulous companies that use toxins in their products and then prey on the public when they hard-sell those products to us? The answer goes beyond the weakness of our political leaders (though this is an obvious start to the fix). As long as corporate dollars can sway the politicians elected by us to protect us, I think we can be sure that our best interests are not sufficiently protected. But that is not the whole answer. Unfortunately once you start adding chemicals and their compounds to other chemicals, the resulting mix can become much better - or much worse - as sum of their parts - than any one or two taken alone or together. This concept was put most articulately in digital ink by my friend, brilliant colleague and lid hygiene product inventor, Peter Pham, MD. Dr. Pham is the inventor or the Zocular lid care products I’ve recommended for years to my patients. He majored in chemistry before going on to his MD degree and then to a career in ophthalmology where he practices in Texas. His recent post to a group of dry eye doctors is quoted here:

“The ingredient list is a whole lot more than the sum of its parts. It's too confusing to try to deduce "goodness" or "badness" from any individual ingredient. A better approach is to understand the purpose of an ingredient or set of ingredients. Is it there to emulsify? Chelate metal ions? Balance pH? Provide bulk? If an ingredient serves a purpose, it's less likely to cause harm - if we grasp the steering wheel with both hands, it's hard to punch our passengers. Similarly, if a hydroxyl group forms hydrogen bonding to another compound, it can't chase a different compound. Chemicals, like hands, can be used to harm or help. Attempts to avoid certain chemicals often abolishes entire classes of molecules that can actually help our patients, and alternatives that appear more organic or pure can have unexpected, unknown properties since there's little data or experience with newer compounds. As an example, EWG classifies behenyl behenate as a safe "1" even though there's no data to support or refute this. As another example, many blogs suggest "alcohols" should be avoided in a formulation with little discussion about the nuances of "alcohol". This would basically remove classes of alcohols that moisturize, preserve, emulsify, etc. And includes one that intoxicates, which feeds into our fear of "alcohol". If it fries our brain with just a few sips, what would it do to our eyes!

To add to the complexity of trying to divine poison or cure from an ingredient list, the list itself is only a partial list of ingredients since many of the listed ingredients have its own set of ingredients that aren't listed. As an example, most surfactants come as a liquid concentrate. This concentrate has its own list of ingredients - stabilizers, preservatives, etc. Listing the ingredients within ingredients of ingredients would make a novel and add little to our ability to predict or understand a formulation.

There is no risk-free activity in life. The very oxygen that gives us life will lead to our demise through secondary oxidative processes. But we should avoid obvious dangers like putting microscopic arrows in a formulation like Laura M Periman said.”

So should we just give up and let the free market determine what products we use? My answer is a hard “NO” and is based on almost 40 years of clinical practice and training. I advocate that we educate ourselves on what is generally known (using apps like “EWG” and “Think Dirty, Shop Clean” - however imperfect they may be), that we listen to the advice of those more medically knowledgeable, like our dry eye specialists and dermatologists and we invest public dollars into research so we can better learn the nuances of how safe or how risky these daily products can be. Meanwhile, use caution and remember that beauty is in the eyes of the beholder. We all have an inner beauty that can be revealed through our actions - and does not necessarily require products to hide what we perceive to be imperfections. Stay safe.

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