254 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS Paraben-sensitive individuals, however, do not necessarily have to avoid paraben- containing cosmetics. According to Fisher, patients sensitized to parabens may nevertheless tolerate paraben-containing cosmetics even on the thin skin of the eyelids provided the product is applied to normal skin not subjected to a dermatitis in the past (40). Substitution products can generally be found for individuals sensitive to antioxidants, resins, and the miscellaneous allergens noted above. It is a matter of becoming thoroughly familiar with the large diversity of available formulations and finding one that does not contain the particular allergen involved. Once an allergen is identified the consumer usually can avoid further problems by carefully reading cosmetic labels. b) Replacement products for irritant contact dermatitis The best approach in the author's experience is to recommend a dissimilar or less complex formulation in the hope of circumventing the causative irritant(s). For example, an individual who does not tolerate waterproof mascara or waterproof eyeliner may very well tolerate their water-based counterparts. In the event that neither type of mascara or eyeliner is tolerable, a cake mascara or a cake eyeliner may be tried. Maybelline Cake Mascara ©, Lumilane Cake Mascara © (Orlane), and Maybelline Ultra Liner Cake Eyeliner © have only half the number of chemicals currently found in water-based and waterproof formulations. The potential for irritation is thus consider- ably reduced. This is not true for Chanel's Compact Mascara which is highly complex. Similarly, individuals who cannot use cream eyeshadow may tolerate pressed powder eyeshadow and vice versa. V. OCULAR INFECTIONS Chronic conjunctivitis and blepharitis due to contaminated eyeliner and mascara have been reported (41). Microorganisms, e.g., S. epidermidis and S. aureus, resident microflora of the outer eye may colonize and proliferate in sufficient numbers in inadequately preserved cosmetics to become pathogenic (42). Such infections are usually mild and respond readily to the withdrawal of the cosmetic, local hygienic measures, and appropriate topical antibiotic therapy. Keratitis that may lead to corneal ulceration and impairment or loss of vision are sequelae of an injured cornea to which contaminated mascara has been applied. Wilson and Ahearn (43) who have done the major work in cosmetic-related eye infections observed seven cases of P. aeruginosa keratitis and corneal ulceration over a period of three years. As of February 1980, 16 cases of corneal ulceration and 32 less serious forms of infection have been documented by the FDA (44). Pseudomonas organisms were implicated in most of the cases with corneal involvement. Wilson and Ahearn's cases had these features in common: a history of trauma to the eye with a cosmetic applicator, isolation of the causative agent from the eye and eye area cosmetic, and cosmetic products that supported reproduction populations of the etiologic agent. Marzulli et al (45), demonstrated the importance of trauma as a predisposing factor. Injury to the cornea by a mascara brush or wand is the most common form of trauma foreign body entry and a fingernail "scratch" are other sources. Pseudomonas keratitis in rabbit and monkey eyes could be achieved consistently only when organisms were

REACTIONS TO EYE COSMETICS 255 introduced into eyes whose corneal epithelium was not intact. Kuehne and Ahearn (46) also reported a case of F. solani keratitis and ulceration due to contaminated mascara. Corneal infections require prompt expert ophthalmologic care. PREVENTION OF INFECTION As yet there are no ofihcial guidelines to ins'ure the adequate preservation of eye cosmetics. During October 1977, the FDA published a notice in the Federal Register (47) proposing the establishment of a regulation regarding preservation of ocular cosmetics. An Eye Area Cosmetic Safety Task Force under the auspices of the Cosmetic, Toiletry and Fragrance Association (CTFA) has since been appointed to arrive at appropriate techniques. This remains to be achieved. Fortunately, despite the absence of standardized preservative systems, awareness of the hazards of inadequately preserved eye cosmetics has sufihced to bring about more effective preservative systems. Currently marketed mascaras appear to be adequately preserved (44). Consumer education as to the proper use and handling of eye cosmetics is of the essence. Printed instructions on the Safe Use of Eye Cosmetics are available (48) or cosmetic companies may choose to compose their own. The adoption of an expiration date should be considered since Bhadauria and Ahearn have demonstrated that some mascaras lose their antimicrobial activity over an extended period (49). VI. CONJUNCTIVAL PIGMENTATION DUE TO EYELINER AND MASCARA This adverse effect is a consequence of eye[inet that is applied to the muscosal aspect of the lid instead of the exterior or of the excessive use of mascara washed into the conjunctival sac by lacrimal fluid. Platia, Michaels, and Green reviewed the literature on the subject a few years ago in addition to citing a case of their own (50). Some reports were overlooked, however (51, 52). The literature may not reflect the true prevalence of this side effect because the condition often is asymptomatic. Moreover, unless the upper lid is everted to bring the aggregates of black pigment deposited along the upper margin of the tarsal conjunctiva into view, the condition is readily overlooked. Congestion of the conjunctival vessels may occasionally be present, and some patients do complain of burning and tearing. There is no known treatment for the condition. Histologic examination of these deposits reveals finely granular pigment in the superficial stroma located intracellularly and extracellularly. Macrophages with pigment and varying degrees of lymphocytic infiltration are also seen. Microincineration and electron microscopic examination suggest the pigment is made up of carbon, ferritin, and probably iron oxides (50). VII. EYESHADOW MIMICKING ORBITAL CALCIFICATION An isolated report of this finding in the medical literature (53) has received considerable attention in the lay press. Bilateral curvilinear supraorbital shadows were found on X-ray examination of the skull of a young girl who complained of severe and increasing