Are Beauty “Vampires” Sucking the Life out of Your Dry Eye Patients?

It’s almost Halloween, but candy-seeking ghouls and ghosts aren’t the only creepy characters lurking around. Unbeknownst to your patients, their beauty routines could be insidious interlopers intent on exacerbating their ocular surface disease (OSD).

The good news? Top-notch patient engagement skills can help eye doctors and clinical staff empower patients to defend themselves against a rogues’ gallery of dry eye demons.

In her recent talk at the Millennial Eye Live conference in Nashville, Laura M. Periman, MD of Redmond Eye Clinic in Washington State dubbed these beauty bad boys “the vampires on the vanity.”

“There are lots of popular beauty products and procedures out there that can suck the life out of your dry eye patients.”—Laura M. Periman, MD

Dr. Periman’s tone was occasionally light-hearted during her talk, but very she’s serious about her topic. Eye care clinicians who look out for signs of these OSD vampires and ask patients about their beauty routines can help their patients find relief.

The first ghastly culprit? Makeup and beauty creams.

The cosmetics industry is unregulated by the FDA, Periman reminded Millennial Eye attendees, and some ingredients can “significantly impact” ocular surface disease. Here are some “franken-chemicals” to look out for:

Waterproof eyeliner or mascara

Only eye makeup remover containing harsh chemicals can dissolve the residues that these products leave around the eyes. Patients who wear these products either expose their eyes to harsh chemicals or fail to completely remove potential irritants.

Sparkly eye shadows

Mica and other minerals can cause redness and irritation, while glitter can flake off, causing irritation and infection.

But even regular old eye makeup can cause problems—the key word being “old.” Makeup that’s past it’s “use by” date can become a breeding ground for bacteria and fungus. The expiration date depends on the formula, but most experts recommend tossing products after three months to a year (dry products like powders last longer than creamy ones).

Eyelash growth serums

Some serums contain isopropyl cloprostenate and other prostaglandin analogues, explains Jeffrey M. Joseph, MD in a recent Millennial Eye article. Potential side effects include “lid and ocular surface inflammation” and “orbital fat atrophy.”

Ingredients that release formaldehyde

“We all remember that formaldehyde irritates the ocular surface,” Periman said. And “when you read the back of a cosmetic ingredients label, you’re not going to see formaldehyde listed, but you are going to see these ‘franken-chemical names’ such as DMDM hydantoin, ureas, quaternium-15, and sodium hydroxymethylglycinate.” These ingredients off-gas formaldehyde, she explained, and we know that formaldehyde irritates the corneal nerve even at very low concentrations (0.05ppm).

Retin-A and other retinyl derivatives 

Retinoids and retinol in anti-aging facial lotions and under-eye creams can cause meibomian gland damage. Dr. Periman said she recommends that her dry eye patients stop using retinyl derivatives on the face altogether. “When patients stop using Retin-A around the eyes, their dry eye gets better,” she said.

It’s not just makeup and creams that will bite your dry eye patients.

Makeup application techniques and cosmetic procedures can also be problematic, Dr. Periman warned. A few examples:


Applying eyeliner to the eyelid’s waterline may block the meibomian gland.

Lash Extensions

Lash salons typically recommend that patients keep water away from their eyes during the first 12-24 hours after the application so that the glue can set properly. Women who spend two hours of their time and $100 or more in a lash salon may stop cleaning their lash bases because they want their hard-earned lashes to last longer, Periman explained.

Altering lash length has another insidious side effect for patients at risk for OSD: It changes the lid-lash ratio. Normal-length lashes “have a very important physiologic function—to deflect wind wind, debris, and allergens away from the ocular surface,” Dr. Periman explained, “When you start artificially adjusting that ratio with growth serums and lash extensions, you create a wind-tunnel-effect toward the ocular surface instead of away from the ocular surface—exacerbating dry eye.”

Eyelid tattooing

Folks who don’t want to bother with applying eye makeup every day are getting permanent eyeliner, which can cause “”significant keratitis and lid trauma,” Periman noted.


Tired of crow’s feet? “We need those,” Periman said. Botox works by weakening the orbicularis oculi muscle, creating “an incomplete blink situation” that can worsen dry eye. Brow and lower lid cosmetic surgery can similarly impede blinking and its benefits.

Bro Beauty: Equal Opportunity

Think that only the ‘weaker sex’ is susceptible to these “vampires on the vanity?” Think again. It’s important to ask male patients who report dry eye about their skin care routines, even if they don’t seem like trendy types who would wear makeup.

“Skin care for men is a significant and growing industry,” Periman said. As an example, she looked at one eye cream designed specifically for men with “no fewer than a dozen ingredients” that can irritate the ocular surface.


For an additional article on this topic by Dr. Periman and co-authors Leslie E. O’Dell, OD, FAAO and Amy Gallant Sullivan, BS, go here.

To listen to an interview with Periman, O’Dell, and Sullivan, known together as the Dry Eye Divas, go here.

Take a look at this inventory of ingredients that off-gas formaldehyde, available in a series of Contact Dermatitis research papers by A.C. de Groot and co-authors.

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