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Cosmetic dangers: Part 3-Keep patients informed, report cosmetic problems


In the final part of her three-part series on cosmetic dangers, Tracy Schroeder-Swartz, OD, MS, FAAO, explains the importance of keeping patients informed of cosmetic dangers and how to properly report cosmetic problems.

The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

In Part One of this series, I discussed what cosmetics your patients might using daily. In Part Two, we broke down what dangers may be lurking in those cosmetics-particularly those that may increase ocular surface disease. In Part Three, I would like to facilitate your discussions with patients about cosmetics and ocular surface disease and discuss how to report cosmetic problems to the Food and Drug Administration (FDA).

Talking to patients about how cosmetics may impact their eye health is not difficult, but finding the time to discuss it as an exam progresses may be problematic.

Keep patients informed
The best way to communicate the proper use of cosmetics and increase awareness of dangers is by offering patients small doses of information over time.

Here are seven ideas to help keep patients informed about cosmetic dangers:
1. Run informational videos in reception areas or exam rooms for patients to watch.
2. Place tabletop stands with information around the office, in the reception room, dispensary, and lanes.
3. Educate staff on the topic so they can assist you in patient education.
4. Include bullet points on your office webpage or office blog.
5. Provide handouts for patients to take home.
6. Offer seminars at the office to educate teens who may be new to wearing makeup on safety, and how makeup could cause problems with their eyes.
7. Create promotional videos for your YouTube channel.

Communicate FDA-recommended precautions to patients who wear cosmetics:1
• If an eye cosmetic causes irritation, stop using it immediately. If irritation persists, see your eye doctor.
• Avoid using eye cosmetics if you have an eye infection or the skin around the eye is red or irritated. Wait until the area is healed and the redness and irritation are gone. To prevent reinfection, discard eye cosmetics you were using when you got the infection.
• Wash your hands before applying eye cosmetics. Certain bacteria on your hands could cause infections.
• Make sure any instrument you place in the eye area is clean. Brushes, sponges, and applicators should be replaced every few months or cleaned regularly.
• Do not share cosmetics. Bacteria and viruses may be transmitted from person to person via makeup and applicators.
• Keep containers clean. Do not allow cosmetics to become covered with dust or contaminated.
• Mascara should be discarded two to four months after purchase.
• Do not use dried-up mascara. Do not add saliva, petroleum jelly, or water to moisten it; this may introduce bacteria into the mascara.
• Do not store cosmetics at temperatures above 85°F. For example, cosmetics kept for long periods in hot cars are more susceptible to deterioration.
• 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 automobile-even if you are not driving.
• Do not use cosmetics near your eyes unless they are intended for ocular use. For instance, do not use a lip liner as an eye liner. You may be exposing your eyes to contamination from your mouth or color additives that are not approved for use around the eye.
• Avoid color additives that are not approved for use around the eye, such as “permanent” eyelash tints and kohl-based products.

It could be useful to memorize a few cosmetic facts to get your patient’s attention on the subject.

Here are a few facts I suggest you know:
• Carbon black-also known as D & C black, black #2, acetylene/lamp/channel black, furnace black-is a powder often used in eyeliner, mascara, and eyelid and eyebrow shadows that may cause cancers and organ toxicity.2
• Benzalkonium chloride (BAK) is still being used in eyeliners, mascaras, and makeup remover.3
• Prime yellow carnauba wax, or any wax, clogs the meibomian glands. It is used in mascaras and eyeliners to stiffen them and make them waterproof.2
• Formaldehyde in products causes allergic reactions and cancer.4

Report cosmetic problems to the FDA
There have been multiple public health controversies surrounding cosmetics involving lip balms, lipsticks, and eyelash makeups adulterated with prostaglandins.5 Reports of nail polish with dibutyl phthalate were identified in California in 2012. Dibutyl phthalate has been linked to asthma, birth defects and other chronic health problems. Other recent problems include formaldehyde in Brazilian blowouts (a treatment which straightens hair and add shine), lead in lipstick, carcinogens in baby shampoo, and mercury in skin cremes.6

To encourage more reporting, the FDA recommends patients use the Center for Food Safety and Applied Nutrition (CFSAN) Adverse Event Reporting System (CAERS). This system is used to record adverse events related to foods, dietary supplements, and cosmetics. The objective of CAERS is to examine adverse events to inform future policymaking.7

If a consumer experiences an adverse reaction with a cosmetic product, the reaction should be reported by the consumer. Adverse reactions after using cosmetics is reportable even if medical treatment was not required. Reactions include rashes, redness, burning, hair loss, headache, infection, illness, or any other unexpected reaction after using a cosmetic product.

Problems with the quality of cosmetic products should also be reported. This includes a bad odor, color change, contamination, or foreign material found in the product.8

Cosmetic users can use one of these three ways to report problems with cosmetics to the FDA:
• Call an FDA Consumer Complaint Coordinator to speak directly to a person about the problem.
• Complete an electronic Voluntary MedWatch form online.
• Complete a paper Voluntary MedWatch form that can be mailed to FDA.


1. U.S. Food and Drug Administration. Cosmetics Safety Q&A: Eye Cosmetic Safety. Available at: https://www.fda.gov/Cosmetics/ResourcesForYou/Consumers/ucm167467.htm. Accessed 5/7/18.
2. U.S. Food and Drug Administration. Color Additive Status List. Available at: https://www.fda.gov/ForIndustry/ColorAdditives/ColorAdditiveInventories/ucm106626.htm. Accessed 5/7/18.
3. U.S. Food and Drug Administration. Antiseptic FDA Letters. Available at:  https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm538131.htm. Accessed 5/7/18.
4. American Cancer Society. Formaldehyde. Available at: https://www.cancer.org/cancer/cancer-causes/formaldehyde.html. Accessed 5/7/18.
5. Kwa M, Welty LJ, Xu S. Adverse Events Reported to the US Food and Drug Administration for Cosmetics and Personal Care Products. JAMA Intern Med. 2017 Aug 1;177(8):1202-1204.
6. Spear S. The Latest Cosmetics Scandal: Toxic Nail Polish. Available at: https://www.ecowatch.com/the-latest-cosmetics-scandal-toxic-nail-polish-1881609632.html. Accessed 5/7/18.
7. JAMA Network. Research Letter: Adverse Events Reported to the US Food and Drug Administration for Cosmetics and Personal Care Products. Available at: http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2633256. Accessed 5/7/18.
8. U.S. Food and Drug Administration. How to Report a Cosmetic Related Complaint. Available at:  https://www.fda.gov/cosmetics/complianceenforcement/adverseeventreporting/default.htm. Accessed 5/7/18.

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