j. Soc. Cosmet. Chem., 33, 249-258 August 1982 Adverse reactions to eye area cosmetics and their management FRANCES PASCHER, M.D., 1715 Nottingham Road, Raleigh, NC 27607. Received January 25, 1982. Presented at the Carolina Chapter Society of Cosmetic Chemists meeting, September 15, 1981. Synopsis Adverse reactions to eye area cosmetics are discussed to acquaint the reader with their prevalence, cause(s) and manifestations. Stinging and burning (subjective irritation), "allergic" conjunctivitis, allergic and irritant contact dermatitis of the eye area, ocular infections, conjunctival pigmentation due to eyeliner and mascara, and eyeshadow mimicking orbital calcification are the potential side effects that may be encountered. Management of these undesirable effects and the preventive measures that may be taken by the cosmetic industry and the consumer are considered. Comprehensive care includes not only elimination of the cause and alleviation of symptoms, but the suggestion of an alternate product whenever feasible for those who wish to wear eye makeup. I. INTRODUCTION The true incidence of adverse reactions or injuries caused by eye area products is not readily assessable. Consumer perceived reactions usually remain unconfirmed and reactions observed by physicians often go unreported. Be that as it may, Mausner (1), in a worldwide study carried out over a period of two years to determine the safety in use of several cosmetic categories, found 0.50 reactions (irritation) to eye makeup per 1,000,000 units sold, a low incidence. The National Electronic Surveillance System (NEISS) report (2) by comparing the incidence of reactions to eye area products with other cosmetic-related injuries including skin care products and toiletries also provides some interesting statistics. Of 473 cases of cosmetic injury reported over a period of one year 39 (8.2%)were injuries due to mascara, 17 (3.6%)were due to other eye makeup preparations, a total of 56 injuries in the 473 cases, or 11.83%. These figures are almost mirrored by the Consumers' Association London report for the same period (3). Of 549 cases of adverse reactions to cosmetics reported, 33 (6%) were injuries due to mascara, 39 (7%) were injuries due to eye shadow, 3 (1%) were due to eye liners, a total of 75 adverse reactions in the 549 cases, or 13.66%. II. STINGING AND BURNING (SUBJECTIVE IRRITATION) Stinging and burning appear to be the most common side effects. Why these symptoms are elicited in some individu•:.als by products that are generally well tolerated 249

250 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS is not well understood. Persons with fair skin who tan poorly seem to have a lower tolerance than other skin types. The relevance to eye area products of other factors disclosed by studies of facial stinging due to topically applied substances (4) merits investigation. Stinging and burning are experienced directly or soon after the application of eye makeup. While the discomfort may be considerable it is as a rule transitory and without residual effect. Subjective irritation may be induced by the evaporation of volatile ingredients, e.g., mineral spirits, isoparaffins, and cyclomethicone or by non-volatile chemicals such as propylene glycol, soap emulsifiers, surfactants, and other silicones. Unless the reaction is mild the product has to be discontinued. III. "ALLERGIC" CONJUNCTIVITIS Quotation marks are used to indicate that inflammation of the conjunctiva may be elicited by physical and chemical irritants as well as by allergens. Physical irritants include mascara that may be washed into the conjunctival sac by the lacrimal fluid or the inadvertent entry of lash extenders and flakes of eyeshadow. Solvents, surfactants, and soap emulsifiers are among the chemical irritants involved. Schorr (5) emphasizes the importance of the overuse of eyeliner and mascara and the application of eye cosmetics across the inner and outer canthi in the pathogenesis of allergic conjunctivi- tis. The clinical manifestations are puffiness of the eyelids, chemosis (edema of the conjunctiva), dilatation of the conjunctival vessels, and a watery discharge. Medicihals instilled into the eye and wetting agents for soft contact lenses may induce the same clinical response (6,7). •Allergic" conjunctivitis from eye makeup may be confused with atopic vasomotor rhinitis, vernal catarrh, and pink eye caused by the Koch-Weeks' bacillus (8,9). IV. CONTACT DERMATITIS OF THE EYELIDS AND PERIORBITAL AREA More often than otherwise, contact dermatitis of the periocular area can be traced to cosmetics used elsewhere and conveyed by the fingers to the eyelids, e.g., perfume, hair preparations (dyes, sprays, and setting lotions), facial products including wet facial tissue impregnated with formalin or benzalkonium chloride (Zephiran©), and to non-cosmetic causes such as medicihals, contact lens solutions, and household sprays (10-15). Some of the aforesaid causes may be missed because the sites of application are spared. 1. FORMS OF CONTACT DERMATITIS Eye area cosmetics may be the cause of allergic contact dermatitis or irritant (toxic) dermatitis. Photocontact dermatitis resulting from light activated chemicals that can act as antigens (haptens) has not been reported. This is not surprising since photosensitizing and phototoxic chemicals are rarely incorporated in periocular cosmetics.