When beauty is the beast, part 2
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Last month, I set out to discover what is in the cosmetics used around the eye that contributes to worsening dry eye disease.
Ugh, what a cesspool. Potent allergens such as latex as well as molecules that mimic pollens. Gluten and gluten mimetics that are particularly problematic for the gluten sensitive, not to mention true celiacs. All manner of alcohols. Prostaglandins that not only lengthen lashes like some of our glaucoma medications (eg, latanoprost), but prostaglandin analogues that are hidden deep in the ingredients and occasionally not mentioned at all.
And formaldehyde. Yuck.
What is a conscientious eye doctor to do? One could certainly tell all of your patients with dry eye disease (DED) that they are forbidden to wear eye makeup of any kind. There are easier ways to close your DED practice, but that is what will happen if you insist that your female patients abstain from wearing makeup. Right now, you have at your disposal a couple of simple things you can do, suggestions that you can make, that do not require much more than sharing some basic, commonsense “medicine.”
The first two are layups. Wear your eyeliner under the lash line and not on the “wet line” of the lid margin. Total no-brainer. Second, just say no to lash extensions of any kind. As I pointed out in part 1 of this series, just the weight of these extensions harms the natural lashes and lash follicles. Improperly woven extensions can cause the natural lashes to become brittle and break. Any form of extension that must be stuck to the lid or lashes is guaranteed to use a glue that is chockablock filled with toxins that will cause inflammation in lash follicles and meibomian glands. Formaldehyde is a major bad actor in lash glues.
Making matters worse, residue from the glues is hard to remove from the lid margin, another cause of inflammation. Which brings up another low-tech/high-yield intervention: Remove your makeup at the end of every day. Of course, this does introduce the risk of using noxious or toxic cleaners; the cosmetics industry is no less blind to the risks of their favored ingredients in producing lid cleaners. Mascara is the toughie when it comes to removal. For quite a few years, I have been suggesting Blinc mascara by Sephora. It surrounds each lash with a tube of color. Complete removal can be accomplished with warm water and a soft cloth.
And Blinc’s only sketchy ingredients are a couple of alcohols. No prostaglandins or formaldehyde sharers. Phew!
With the help of four ophthalmologist/entrepreneurs, we have some options to offer now and some exciting things that will be available soon. Ashley Brissette, MD (Daily Practice), Shetal “Nicky” Shah, MD (You & Eye by Dr. Nicky), and Diane Hilal-Campo, MD (twenty/twenty beauty) all have eye-safe products available for your patients with DED. Interestingly, all three of them are in the greater New York area. Dr. Brissette is a corneal specialist who is a faculty member at Cornell, Dr. Shah practices in a large group on Long Island, and Dr. Campo is in solo private practice across the river in New Jersey. Let me briefly review some of what they have available that you can suggest to your patients today. All of the products mentioned can be sold from your office or purchased by your patients online.
All three product lines have started with high-quality, lash- and lid-friendly cleaning agents. The simplest and most familiar is a hypochlorous spray from twenty/twenty that comes with a twist sure to give everyone a “d’oh” moment: It is non-preserved. Think about it for a minute — hypochlorous acid kills bacteria. Why put in a potentially toxic preservative?
Daily Practice’s first product on the market is a foaming cleanser that is applied to the lids and lashes before gentle removal of makeup and other debris with a soft cloth. The cleanser contains fruit extract antioxidants (Citrullus lanatus and Pyrus malus), vitamin B complexes and a “natural” moisturizer (sodium PCA). The antimicrobial xylityl sesquicaprylate is added to combat the effects of bacterial overgrowth on the lids.
You & Eye is taking an approach that will be familiar to anyone who cares for DED, building a “foundation” for a family of products. All of the products begin with what You & Eye is calling its EyeMEDIx technology, built around antioxidants and a sulfonated shale oil component (as well as a boatload of cool stuff such as willow bark and neem oil, all of which can be seen on its website). The Keep It Fresh foaming lid cleanser contains a micellar omega-3 and omega-9 complex (shades of the Sun Cequa vehicle), vitamin E and green tea extract.
Remember all of the crazy, yucky stuff in so-called eyelash serums that I mentioned in part 1? You know, the shell game that the major cosmetics companies have played to hide all manner of prostaglandin analogues in their lash growth products. Dr. Shah has made it her mission to introduce the cosmetics industry to the meibomian glands. How good is that? Both twenty/twenty and You & Eye have prostaglandin-free eyelash serums designed to make the lashes fuller and longer without being toxic to the meibomian glands.
twenty/twenty once again takes a straightforward approach with a serum built around the benefits of certain oils for both the lashes and the meibomian glands. Get Growing Lash and Brow Serum is a water-free, preservative-free mixture comprised of 90% castor oil, 6% coconut oil and 4% argan oil (which contains vitamin E) applied to the lids after cleaning. You & Eye begins with the EyeMEDIx complex and adds omega-9 fatty acid and vitamin E. A small brush is coated with the serum and then applied to the base of the eyelashes.
There are other products available from all three companies that you can find on their websites. I had the pleasure of talking with all three of the entrepreneur founders of these companies. For each of them, this is a “passion project” that comes from their experience treating DED. twenty/twenty has a growing collection of eye makeup such as mascara available, and You & Eye has a fully developed portfolio of products that it is ready to bring to the market.
Oh yeah. One final tidbit of information and something to look forward to. Above I mentioned that there are four ophthalmologist/entrepreneurs in this space. What I know about the terrible effects of cosmetics on DED I learned from Drs. Cynthia Matossian and Laura Periman. Dr. Periman is on the cusp of launching her DED-friendly cosmetic company, Quench. I have seen her research and talked with her about Quench. It is stuff to be excited about. We will soon have four options that we can offer to counter the scourge of cosmetics and dry eye.
Wait until my patients learn how much I know about eye makeup now!
- References:
- Daily Practice. https://www.dailypractice.com/. Accessed Oct. 24, 2022.
- twenty/twenty beauty. https://trytwentytwenty.com/. Accessed Oct. 24, 2022.
- You & Eye by Dr. Nicky. https://youandeyecosmetics.com/. Accessed Oct. 24, 2022.
- For more information:
- Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; email: dwhite@healio.com.
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