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

256 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS headaches. These shadows were interpreted as calcification requiring further study as to the cause. A keen observer who noted that the patient wore a large amount of eye makeup suggested the possibility of an artifact. After the eye makeup was removed the supraorbital shadows disappeared eliminating caclification as a factor in the clinical picture. A survey made subsequently of 25 types of eye shadows showed that many are radio-opaque because of bismuth, magnesium silicate and iron oxide in the formula- tions (53). SUMMARY Subjective irritation, allergic contact dermatitis and irritant (toxic) contact dermatitis are the most common adverse effects associated with eye area cosmetics. Comprehen- sive care requires discontinuance of the causative product, appropriate therapy, and a replacement or alternate product whenever feasible for those who wish to continue wearing eye cosmetics. Chronic conjunctivitis and blepharitis are relatively minor complications. Keratitis resulting in corneal ulceration and impaired vision is the most serious adverse effect encountered. Most cases have been traced to the use of mascara contaminated with P. aeruginosa following trauma to the cornea. Preventative measures that can be taken by the consumer and the cosmetic industry have been described. Permanent conjunctival pigmentation is attributable to the misuse of eyeliner or mascara. Eyeshadow mimicking orbital calcification has Sherlokian connotations. REFERENCES (1) J. Mausner, "Skin reactions vs. units sold: world-wide study," in Proceedings of the 1st annual Arnold Schwartz memorial program.' an international symposium on landin and landin derivatives, L. Greenberg and J, j. Sciarra, Eds. (Long Island University, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, New York, 1981), pp 142-143. (2) U.S. Dept. of Health and Human Services, Public Health Service. Food and Drug Administration, Cosmetic-related injuries.' a device monitoring branch study of NEISS data January 1, 1979 to December 31, 1979, (GPO, Washington, 1981), p 7. (3) Consumers' Assn., London, Reactions of the skin to cosmetic and toiletry products, (Consumers' Assn., London, 1979), pp 84-85. (4) P.J. Frosch, A.M. Kligman, A method for appraising the stinging capacity of topically applied substances,J. Soc. Cosmetic Chem., 28, 197-209 (1977). (5) W. F. Schorr, Eye cosmetics, DermatoL and Allergy, 4, 45-56 (April 1981). (6) N. B. Pedersen, Allergic contact conjunctivitis from merthiolate in soft contact lenses, Contact Derre., 4, 165 (1978). (7) W. G. van Ketel, F. A. Melzer-van Riemsduk, Conjunctivitis due to soft lens solutions, Contact Derre., 6, 321-324 (1980). (8) M. R. Allansmith, "Vernal conjunctivitis," in External Diseases of the Eye, L. A. Wilson, Ed. (Harper & Row, Hagerstown, 1979), pp 83-89. (9) J. A. Blue, Current concepts of allergy of the eye, Annals of Allergy, 33,267-273 (Nov. 1974). (10) A. A. Fisher, Contact Dermatitis, 2nd ed., (Lea & Febiger, Philadelphia, 1973), pp 4-6 230-232. (11) E. Cronin, Contact Dermatitis, (Churchill, Livingstone, Edinburgh, London, and New York, 1980), pp 93-170. (12) J. G. Marks, Jr., M. E. Bishop, W. F. Willis, Allergic contact dermatitis to sculptured nails, Arch. Dermatol., 115,100 (1979). (13) C. G. T. Mathias, H. I. Maibach, A. Irvine, W. Adler, Allergic contact dermatitis to echothiopate iodide and phenylephrine, Arch. Opthalmol. 97, 286-287 (1979).