To the Editor:
We applaud Lockington and colleagues [1] for drawing attention to the ocular surface effects of topical Epimax therapy. This subject is of wide interest and was the impetus for our recently published TFOS (Tear Film & Ocular Surface Society) Lifestyle Report [2]—the culmination of a nearly 3-year global and interdisciplinary evidence-based research initiative including over 200 eye care professionals and focused on the direct and indirect impacts that everyday lifestyle choices have on ocular surface health.
Our report addressed how the use of cosmetics may exacerbate or promote the development of ocular surface and adnexal disease, and shows that many eye makeup and skincare brands contain substances toxic to the eye [2]. Eyelid skin is thin and readily permits penetration and absorption of chemicals. Cosmetics may also migrate onto the ocular surface, move into the tear film, and elicit negative effects [2].
In reviewing the Epimax Paraffin Free Ointment formulation, we can identify known ocular surface offenders and irritants, including castor oil (ricinoleate). The TFOS reports identified that though “castor oil is not a significant skin irritant … ocular surface exposure to a castor oil solution leads to mild and transient discomfort and may promote corneal epithelial cell death and disrupt the epithelium [2]. Ricinoleate is also known to cause a dose-dependent (0.1–2.0 mM) cytotoxicity of other epithelial cells [3, 4].
The ingredients list does not identify Yellow/Red dyes are used in the EPIMAX Paraffin Free Ointment formulation, and these may have also adverse effects on the ocular surface and adnexa.
Periocular cosmetics may be associated with multiple adverse effects on the ocular surface. These may exacerbate or promote the development of ocular surface and adnexal disease. Eye care professionals need to be more aware of the cosmetics that their patients use, as they can not only impact their eye health, but the diagnosis, treatment and management of their disease.
Author contributions
JR conceived of study. The paper was written by AS and edited by RM and JR.
Competing interests
JCPR and RM have no conflict of interest. AGS is the executive director of the TFOSS and also owner of ESSIRI Labs, a manufacturer of cosmetics focused on Eye safety. There was no funding for this research.
Footnotes
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References
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