It is good to end 2022 plus begin the new year on a positive note. The online CPD exercise designed to encourage discussions about the possible impact associated with eye make-up upon future contact zoom lens wear success seems to have hit a note with readers.

Indeed, the exercise triggered the greatest response out of all of our 2022 interactive exercises. This does suggest that most of you do, indeed, feel that this is an area well worth consideration and agree with the author of the particular source material , Debbie Farrant, that eye care practitioners should be able to offer appropriate advice regarding cosmetics to their patients in contact lens practice.

Background

There is an increasing body of evidence suggesting that many of the components of the particular cosmetic products routinely applied to the periocular skin and lid margins may have a negative impact upon the tears and ocular surface and, in some cases, have been linked with more serious disease. In the current CPD, ‘The impact associated with cosmetics on the ocular surface’ , 1 therapeutic optometrist Sarah Farrant explained how her experience, both with patients attending a dedicated dry eye clinic and in more general contact lens practice, supported this view and offered a review of some of the particular evidence so far published.

One latest study, for example , has highlighted that the prevalence of dry vision disease among women who used attention cosmetics was over 70%, 2 much higher than the 5 to 50% among the particular general population. 3 In addition , approximately 25% associated with participants using eye makeup rarely removed it before sleep. This was shown to be a further significant risk factor in the severity of dry eyesight. Given these figures, the particular impact associated with cosmetic products is something eye treatment practitioners cannot afford to ignore any more. This was further backed by a series of illustrative case studies released in Optician . 4, five

Case scenario for discussion

You were asked to consider the following patient.

A 22-year-old female attends your practice as she would like to try contact lenses for full time wear. Since starting work in an office, where she is required to use a desktop computer throughout the day, she has found that the girl increasingly relies on her spectacles as the clarity they give makes work easier. However, the lady dislikes putting on them because she ‘hates the way I look in glasses. ’

Her refraction is:

  • R: -1. 25 / -1. 00 x 170 (6/4 / N4. 5)
  • L: -1. 00 / -1. twenty five x 180 (6/4 or N4. 5)
  • Figure 1 is an overview of the girl right eyes, the left eye is similar.

    The girl general health is good, though she does smoke ‘socially’. When asked about allergies, she confirms that she does occasionally suffer hay fever (last episode was some six months ago) for which she ‘takes a tablet from the particular chemist’.

    Also, on occasion, she has had soreness around her eyes with some types of make-up. ‘I now always make sure I use the hypoallergenic brand, because there is no way I am going to stop wearing make-up, ’ she states.

    Figure 1: Right eye. (a) Low magnification. (b) Upper lid. (c) Lower cover. (d) Lower palpebral conjunctiva

    Discuss the following points:

    1. Would you go ahead along with fitting contact lenses plus, if therefore, what would be your first choice to fit (material, design and put on modality)?
    2. What factors can you identify which might influence long term success with contact zoom lens wear?
    3. Would you mention her cosmetic use if not prompted by the patient – yes or no?
    4. How would you respond in order to the patient when she asks, ‘It will be OK to carry on putting on make-up, won’t it? ’

    Your Discussions

    Firstly, all respondents were happy to go ahead and fit the individual along with contact lenses. Within every case, a daily disposable option was recommended. Interestingly, there was an almost exactly 50/50 split between those recommending a silicone hydrogel option (popular choices were Clariti 1 Day Toric, Acuvue Oasys 1-Day for Astigmatism) and a hydrogel lens choice (Dailies Total 1 with regard to Astigmatism, 1-Day Acuvue Moist For Astigmatism).

    Everybody felt that the wearing of cosmetics was associated with significance, but there was a few variation within opinion as to the level of intervention regarding this might be appropriate regarding the eye care practitioner. As the patient themselves outlined their aesthetic use themself, all of you felt that it was not really a problem offering some advice in this particular case.

    However, had been the patient not to have made any kind of mention associated with their cosmetic makeup products, many of a person felt that will you might only offer your viewpoint if their make-up application was excessive or adverse changes in order to the ocular surface or adnexa were already present.

    Finally, about half of you gave several indication of the general guidance you would certainly give concerning the correct application and removal of make-up intended for a contact lens wearer to adopt.

    As there was clearly such a bounty of opinion with this exercise, I thought it might be interesting on this occasion to show a wider range of your own responses compared to we would normally do. The following quotes reflect the particular sorts associated with opinions expressed.

    Would you go ahead with fitting disposable lenses and, if so, what would be your first choice to fit?

    ‘With the see to fitting contact lens, no practitioner nowadays can advocate that a young female should not use cosmetics in conjunction with contact lens wear. Ideally, a lens of silicone hydrogel (offering good oxygen permeability to get long office hours) and of toric style (for the patient’s astigmatic prescription) with a daily use modality (for the beauty usage). Monthlies may suffer depositions. ’

    ‘We ideally would such as to make use of a lens that is non-ionic so does not attract particles to the lens surface, which would have an impact on the particular vision plus the comfort of the lens. ’

    ‘I would proceed in fitting get in touch with lenses to this patient. The particular picture of her right eye (figure 1) shows no red eye. The eye make-up is not stuck towards the eye lashes on the particular bottom lid. The meibomian glands look as if they are functioning properly. Silicone hydrogel lenses provide high oxygen content to the eye. A daily lens is chosen as this may stop make-up build-up around the lens, thus reducing the toxic effect of cosmetics to the eye. Wear time for the contact zoom lens should be nine to 12 hours a day five days associated with the week. ’

    ‘We agreed we would go on and fit contacts to this particular patient. The most suitable lens modality is a daily disposable lens that will help in order to reduce the danger of inflammation as a consequence of make-up build-up. We discussed various daily disposable lenses and decided the hydrogel zoom lens surface might be the particular most suitable to repel the non-ionic deposits. It is also a thinner lens compared to the silicone hydrogel, which would help to slow up the likelihood of developing allergic conjunctivitis related to existe fever. While the patient would prefer to wear lenses full time, we might advise on a reduced wearing schedule. ’

    Exactly what factors are you able to identify that might influence upcoming success along with contact zoom lens wear?

    ‘The astigmatism will be a factor that would certainly influence achievement with contact lenses (CLs). It is usually critical that this lenses are comfortable plus stable, remaining in place irrespective of head and vision movements. Additionally, her hay fever, along with heavy make-up use is another good reason pertaining to fitting a daily throw away. ’

    ‘The main factor that might influence future success with CL wear is definitely dry eye. The patient is the smoker and wears weighty make-up daily. So , advising a daily disposable lens within conjunction with lid treatment will help to ensure CL achievement. For example , making use of Blephawipes in order to ensure full make-up removal and the particular likelihood of blepharitis will assist you to stabilise the tear film. Furthermore, a preservative-free dry attention drop will certainly aid comfort and ease. Keeping wear time reduced and putting on glasses whenever at home, even though the patient will not enjoy wearing glasses, will assist to ensure that CL wear is comfortable when away from home. Working in your office environment will impact on the particular dry eyesight too. Therefore , a water gradient lens will help to avoid the dry eyes feeling. The patient has great motivation to follow the suggestions for CL success while she reports hating wearing spectacles plus, as she actually is increasingly reliant on the girl prescription, she is likely to be more motivated to put on CLs over specs. ’

    One respondent noted: ‘The meibomian glands showing upon the inferior tarsal plate look slightly tortuous and inflamed, therefore she might have some evaporative dry eyes. ’

    Could you mention her cosmetic use if not really prompted by the individual – yes or no?

    ‘Addressing the cosmetic usage would not deem to be a routine stipulation. However, excessive applications might be worth mentioning. ’

    ‘Yes. In this instance the sufferer has already drawn attention to her make use of makeup products. ’

    ‘I would point out the use of cosmetic makeup products to the particular patient. We would recommend her in order to insert the girl contact lens before applying any makeup to limit exposure. Never to apply eyeliner within the inner waterline of the eyelid, or even between the eyelashes. Always remove for the purpose of prior to using any make-up remover or face wash. I actually would explain to the individual that false lashes may also cause a risk towards the ocular surface. I would advise the particular patient to use dry eye-friendly cosmetics. Some products, such as eyeliner or mascara, contain carbon black, which has been found to become carcinogenic. Other preservatives (such as phenoxyethanol) are toxic to the meibomian gland epithelial cells. By informing the patient associated with possible harmful effects of certain cosmetics she should be more careful from the cosmetics the girl uses. ’

    ‘It will be OK to carry on wearing cosmetic makeup products, won’t it? ’

    ‘Of course, you are able to continue using your make-up; just take care with your contact lenses. Always use your get in touch with lenses 1st, before a person apply your make-up. This particular reduces the particular risk associated with particles getting onto the lens surface area and into your rip film. Then, remove your own contact lens before removing your make-up. ’

    ‘Clearly, the girl is not going to give up (make-up) make use of and it is better that we motivate her to apply this correctly, rather than offer a counsel of perfection the lady will not follow. All of us also discussed our experience of make-up plus CL use and said we possess seen many examples of badly applied make-up soiling lenses, contaminating the particular tear film and causing ocular irritation. We experienced this patient was likely to end up being successful because she applies it along with care and will likely comply with removal and replacement guidelines. ’

    Dorothy Farrant Adds

    My top 10 points to consider regarding the putting on of cosmetics are as follows:

    1. Be realistic; patients that currently wear any forms of eye make-up are unlikely to want to give it up completely
    2. Advise individuals to eliminate all makeup at the end of the day with a good lid hygiene product (such as those to treat blepharitis)
    3. Be aware; eyeliner, mascara or even eyeshadow can mask or mimic blepharitis (figure 1b). Take a careful look during your consultation and don’t be afraid in order to ask the patient to get rid of their eye make-up meant for a better look if necessary
    4. Don’t forget the men’s beauty market has grown significantly inside recent times
    5. Good patient education is paramount
    6. Labels this kind of as ‘plant-based’, ‘natural’, ‘organic’, ‘vegan’, plus ‘ophthalmologist-tested’ do not equate to ocular surface safety
    7. Be extra aware of the implications associated with cosmetics designed for contact zoom lens wearers
    8. Consider enhanced antimicrobial management in makeup users along with advice on daily hypochlorous acid sprays onto the lids and periorbital skin
    9. Alternatives to daily cosmetics, such as fake lashes, also put the particular ocular surface area at risk
    10. Consider recommending or even stocking dry vision friendly cosmetic makeup products (such as the ‘Eyes Are The Story’ opto-cosmetic range)

    • Debbie Farrant is a therapeutic optometrist with the specialist interest in dry eye disease and myopia management practising in Somerset, UK.

    References

    1. Farrant S. The effect of beauty products on the ocular surface. Optician, 30. 09. 2022, pp23-29
    2. Albdaya NA et al. Prevalence of dried out eye illness and its association with the frequent usage of attention cosmetics amongst women. Cureus, 2022; 14(7): e27142.
    3. Gomes JAP ainsi que al. TFOS DEWS II: Iatrogenic report. The Ocular Surface, 2017, Volume 15, Issue a few, pps 511-538
    4. Harvey B, Farrant S. Making up is hard to do. Optician, 23. 09. 2022, pp32-35
    5. Farrant S. Making up is still hard in order to do. Optician, 11. 11. 2022, pp20-22

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