Educating Your Patients About Cosmetics Safety


What they need to know about personal care products and eye health

The average person might use a half-dozen personal care products daily: soap, shampoo, conditioner, moisturizer, deodorant, toothpaste. For women, that number is likely even higher if they wear cosmetics such as eyeliner, eye shadow, and mascara. Why should this concern eye doctors?

“Given the uses of these products near the eyes, ODs should be familiar with commonly used cosmetics, typical ingredients, and dangerous substances found in these products,” wrote Tracy Schroeder-Swartz, OD, MS, in the first of a three-part series for the Optometry Times.

What do your patients need to know about the potential dangers of cosmetics?

Outdated product safety laws, lack of regulation

Many people (doctors included) may assume that the U.S. Food and Drug Administration (FDA) regulates cosmetics. Actually, “You can start making a cosmetic and start selling it the next day without any kind of permission from the FDA,” said Steve Xu, a resident physician in dermatology at the McGaw Medical Center of Northwestern University and personal product safety researcher, to NPR.

Things get a little trickier when you cross over into products that blur the lines between cosmetics and drugs, like anti-dandruff shampoo and eyelash-lengthening serums. The Federal Food, Drug, and Cosmetic Act (FD&C Act) determines whether a product is a cosmetic or a drug by its intended use. And even the FDA web site notes, “Firms sometimes violate the law by marketing a cosmetic with a drug claim or by marketing a drug as if it were a cosmetic, without adhering to requirements for drugs.”

The cosmetics industry is largely self-regulated; there is no other class of widely used products in the U.S. with so little regulation and safety monitoring.

In any case, the cosmetics industry is largely self-regulated, with few systems in place to monitor the safety of products once they are on the market. This lack of oversight can have shocking results. As NPR reported, when the FDA began investigating claims that WEN shampoo was causing consumers’ hair to fall out, the agency learned that the manufacturer had received 21,000 complaints of alopecia and scalp irritation. The FDA had only received 127.

“There is no other class of products so widely used in the U.S. with so little regulation,” wrote U.S. senators Dianne Feinstein and Susan Collins in an op-ed published in JAMA Internal Medicine in May, citing the need for commonsense safety rules. Their proposed Personal Care Products Safety Act aims to update the above-mentioned FD&C Act – which was introduced in 1938.

Educating patients on cosmetic safety

While it may be impossible to avoid every potentially unsafe ingredient or product, patients should be made aware of known risks and safer options that are available. For instance, in a previous post we discussed how many blepharitis patients are still using baby shampoo, despite the fact that it contains potentially dangerous ingredients. While Johnson & Johnson removed formaldehyde and 1,4-dioxane from its No More Tears baby shampoo in 2013, updated formulas still contain ingredients like cocamidopropyl betaine (CAPB), a known allergen.

Some eye makeup removers contain benzalkonium chloride (BAK), which has been associated with toxic effects such as dry eye.

As Dr. Schroeder-Swartz noted, “Some common ingredients in cosmetics can be harmful, including parabens, mineral oils, sulfates, and benzalkonium chloride (BAK),” a commonly used eye drop-preservative associated with toxic effects such as dry eye. She added, “Some eye makeup removers still contain BAK and should be avoided.” If a safer alternative exists, like over-the-counter lip wipes, let your patients know.

Also tell patients that if they experience a reaction or problem with a cosmetic product, they can report it to the FDA online. You might also direct them toward, which maintains an easy-to-navigate database of scientist-tested skin products and ingredients.

One way to ensure your patients are getting safe, quality products is to sell them yourself. Many eye doctors have added cosmetic services like Latisse and Botox to their practices for that reason.

For more on this topic, see The Benefits of Adding Cosmetic Services to Your Practice

Practical tips for patients

Encourage patients to come see you if they experience any irritation, redness, or other eye problems. Let them know that only an experienced eye care professional can determine whether the problem is caused by cosmetics or something else, like poor contact lens hygiene, dry eye disease, or pink eye.

Ocular surface disease is more common among people who wear eye cosmetics. Be proactive about educating those patients.

Be proactive about reaching out to patients who wear eye makeup. “It is not surprising that ocular surface disease (OSD) is more common among those who wear eye cosmetics,” wrote Dr. Schroeder-Swartz.

Educate patients on the proper way to use cosmetics – for instance, eyeliner should only be applied to the lids outside the lash line, not inside the lashes. “‘Tightlining’ is term used to describe painting the lid margin and is popular with makeup artists,” noted Dr. Schroeder-Swartz. “This should be discouraged because it may clog the glands on the lid margin.”

Here are more of her tips to share with your patients:

  • Avoid using eye cosmetics if you have an eye infection or the skin around the eye is red or irritated. To prevent reinfection, discard eye cosmetics you were using when you got the infection.
  • Wash your hands before applying eye cosmetics to avoid bacteria that could cause infections.
  • Brushes, sponges, and makeup applicators used in the eye area should be replaced every few months or cleaned regularly.
  • Remove all makeup every night.
  • Do not share cosmetics.
  • Do not use dried-up makeup, and do not add saliva or water to moisten it; this may introduce bacteria.
  • When applying or removing eye cosmetics, be careful not to scratch the eyeball or other sensitive area. Never apply or remove eye cosmetics while in a moving car—even if you are not driving.


To find out more about easy, accessible, effective ways to educate your patients, get in touch with us today for a free trial of Rendia.

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