Dry eyesight disease (DED) is a common condition seen regularly within ophthalmology clinics  and  is associated with multiple factors [1] . It is the disease with the tear film plus ocular surface area that leads to pain, visual disturbance and rip film variability that can harm the ocular surface. In addition, it is associated with an elevated osmolarity of the tears and inflammation from the visual surface [1] . Typically the associated with DED mainly is dependent on often the presenting medical features [2] . The study done in Al-Ahsa, Saudi Arabia, showed  the prevalence of dry eye symptoms  to be 32. 1% [3] . Another study conducted in Riyadh City, Saudi Arabia, estimated your prevalence for DED among adults aged 40 in addition to above to be 34%. The prevalence was increased among females, similar  to the Al-Ahsa research [4] .   This prevalence about DED improved with age, and there was a significant gender difference as women had a higher incidence in getting DED than males [5,6] . Likewise, Asian ethnicity, old  age, smoking, and wearing contact lens  were  associated with a significantly larger likelihood with regard to dry eyes symptoms in a study, as participants frequently reported worse symptoms [3,7] .

There was also an association found among dry vision syndrome (DES)  and systemic diseases such as arthritis, diabetes, thyroid illness, and others [8] . Moreover, a new recent examine revealed that will dry attention symptoms had been reported the who employed eye makeup products [9] . This suggests that eye makeup can change the rip film and even its stability [6] . However, there is a lack from studies of which support the exact link between the usage of cosmetics together with change in the tear movie [10] . Eye cosmetics are made use of daily inside many parts of the world [10] . Eye cosmetics are considered important by both men and additionally women, in order to increase  facial attractiveness  [9] . Although the safety associated with eye cosmetics is guaranteed, through testing, before humans use them, many report  an increase throughout ocular distress [10] . Side effects of eyesight cosmetics range from simple irritation to be able to corneal epithelium inflammation not to mention dry eyeball [11] . Although  numerous studies have addressed the  effect  regarding cosmetics on dry observation symptoms,   the  impact of  different types involving cosmetics and also the regularity of their usage has not yet been established [10] . If dried out eye symptoms are left untreated, they may turn in to a progressive and chronic disease as well as affect the particular quality of life [6] . However, to our knowledge,   there is relatively little published literature on the long-term side effects of eyes cosmetic use; hence, this study targeted to evaluate the frequency and severity of DED among perspective cosmetic customers, and to explore any relationship  between presencial fatigue and cosmetic usage in Riyadh, Kingdom connected with Saudi Persia.

Study design plus population

This specific randomized, cross-sectional study has been performed inside Riyadh, Saudi Arabia. Often the study population included adult Saudi ladies who  used  cosmetics or even had DED. Participants under the age with 18, that failed to sign the informed consent, males, or all those with comorbidities such because rheumatoid arthritis, seborrheic dermatitis, Sjogren syndrome, diabetic mellitus, spring catarrh, or perhaps glaucoma have been excluded.

Study tool in addition to method

Your questionnaire experienced three sections: demographic data, questions related to eyeball cosmetics utilization, and lastly, a well-developed tool for you to assess DED. The Ocular Surface Condition Index (OSDI) questionnaire had been used to evaluate the signs and symptoms and intensity [12] . It will be a 12-item validated questionnaire that measures DED seriousness on some sort of scale for 0 to help 100 and even can distinguish between normal subjects and patients with DES. The better the score, the greater typically the disability. The exact Arabic version of this set of questions was validated by a pilot study including 20 random individuals to assure comprehension and ease of administration together with identify any issues along with the content and additionally language. After obtaining the Institutional Review Board (IRB) approval from Imam Mohammad Ibn Saud Islamic University’s Research Ethical Committee, the customer survey was distributed electronically through an online platform and the study objectives were clarified to this participants. We ensured the fact that no personal information would be taken, and all the participants provided their own consent before answering often the questionnaire. All of us performed all statistical analyses using SPSS, version 21 (IBM Corp., Armonk, NY), and a good p-value lower than 0. 05 seemed to be considered statistically significant for all analyses.

In this particular study, we were able to collect 320 responses. However , we excluded 113 responses for your following reasons: 65 (20. 31%) individuals indicated that they got other comorbidities as systemic diseases, which includes diabetic mellitus, thyroid disorders, rheumatoid arthritis, seborrheic dermatitis, and eye conditions which include spring catarrh and glaucoma, while 20 (6. 25%) responses indicated that they did an eye surgery within the last year; 18 (5. 63%) members reported using some medications that could cause dry eye. All the previous reasons were being excluded because it could cause some conflict and interrupt the study outcomes. Finally, 10 (3. 1%) were ruled out because they do not complete the set of questions or ended up non-Saudi. Therefore , the net sample was initially composed of 207 (64. 6%) responses. Age was categorized into three different age group groups: 18-30, 31-40, not to mention above 40 years;   87. 9%  were definitely in the exact age group of  18-30 years. Moreover, 75. 8% about participants pointed out which they had  university-level education, and 68. 6% happen to be students at the time of the research. Regarding  observation problems, 76. 8% stated that they had no eye problem, while about a quarter of the participants reported eye dryness. Furthermore, we found that 58. 5% of participants indicated using four or more cosmetics for eyes and 17. 9% were using moisturizing eye drops (Table 1 ).

According to individuals, mascara and eye shadow were the most commonly used eye makeup products, with a prevalence of 98. 6% plus 91. 8%, respectively, followed by external eyeliner (78. 8%). In comparison, the least used eye cosmetics include false eyelashes (35. 3%), inner eyeliner (47. 3%), and lenses (54. 1%). Mascara was the most commonly used vision cosmetic when it came to  daily use, with 18. 8% of women using it daily, adopted by external eyeliner (7. 7%) in addition to eye shadow (5. 3%) (Table 2 ).

Also, we found that 33. 3% associated with participants indicated the use of cosmetic lenses while 15. 9% wore them for medical purposes and even 37. 7% wore all of them for more than one year. Furthermore, 34. 3% participants pointed out that they always used the cleanser to remove makeup, while twenty-four. 6% said that they rarely used this. Most of them would remove any cosmetic before sleeping (82. 6%) together with 15. 9% participants might sleep with their attention cosmetics  (Table 3 ).

According to the OSDI tool applied in this study, all of us found that will DES prevalence among women who used eye cosmetics was 70%, where 40. 1% ladies had severe conditions, 18. 8% had mild, not to mention 11. 1% had moderate conditions involving DES (Figure 1 ).

Figure
one:
Prevalence connected with DES according to the OSDI device and severity of conditions

DES, dry eyesight syndrome;   OSDI,   Ocular Surface Disease Index

In Table 4 , we all show typically the relation between demographic factors of members and frequency of DES among this participants; many of us found of which the occurrance and intensity of DES were significantly higher in older contributors than younger ones (p=0. 019). Our results also indicated that the prevalence with DES has been statistically significant in often the retired population and those employed (p=0. 002). Considering the number of utilized cosmetics and also their effect on developing DES, we found no significant difference in your prevalence as well as severity among participants within whom  number of eyes cosmetics applied varied. In contrast, we discovered a significant difference in the seriousness of dry eye conditions in females when the exact frequency for removing makeup using a cleanser (p=0. 018) was considered. The seriousness of DED was higher in girls who did not use a cleanser for removing cosmetic makeup products. Moreover, most of us found that this prevalence and severity about DED had been significantly increased in women of all ages who slept with attention cosmetics than those who removed  them just before sleeping (p=0. 002). Finally, we identified that the prevalence plus severity in DED have been significantly larger in adult females who do not apply moisturizing eyeball drops (p=0. 003).

Increasing the particular frequency of using an inner eyeliner considerably increased typically the prevalence associated with DES from 55% in those using it  less than once a month  to be able to 75% inside those who used it daily (p=0. 001). Furthermore, most people found the fact that those that used false eyelashes, perspective shadow, together with lenses on a daily basis showed the highest and this most significant impact on their eyes, where all people who utilized these beauty products daily experienced DES. Its prevalence increased significantly with increasing the frequency of using them. However, zero significant difference was discovered in the majority of DES cases when  often the frequency regarding using wimperntusche or an external eyeliner (p=0. 234, p=0. 058, respectively) was regarded as (Table 5 ).

Regarding participants’ perception, majority of them agreed that mascara was your main aesthetic that could lead to the exact incidence connected with DES (36. 8%) followed by colorful attention lenses (28. 8%) and also inner eyeliner (16. 9%) (Figure 2 ).

Figure
2:
Cosmetics with the most negative impact on eye dryness according to participants

Cosmetics are a symbol of femininity, representing stereotypical feminine values. When body care products, particularly cosmetic products, are absorbed into the skin, they penetrate and reach the underlying tissues. Based on the latest statistics, cosmetics are widely used by Saudi students and gals. Studies show that Saudi women wear more makeup than most women from your Arab world, the particular West, as well as the Persian Gulf. It was found the number with imported cosmetics exceeded 2. 3 billion in 2015 [13] . Our research discovered that regarding 60% for participants would certainly use more than four types about cosmetics, together with mascara, eyesight shadow, and external eye liner being typically the most popular. A study conducted by Shaaban and Alhajri  among the female population in Saudi Arabia revealed that mascara, eyeliner, eyebrow pencil, and eyes shadow were being probably the most commonly used eyeball cosmetics amongst this population  [14] .

Thinking about the usage from cosmetic observation lenses, we found that will half of this sample indicated using lenses and 33% from the individuals used these people for beauty purposes. A study carried out in Saudi Arabia identified the prevalence of  contact lens  usage among Saudi Arabians  to become 15% [15] . Moreover, we located that 24. 6% of participants hardly ever used perspective cosmetic  cleansers; 4. 3% never made use of them from all  and the ones showed statistically significant severity of DED. Our results were broadly in line with another examine that mentioned that using an eye cleanser can maintain the meibomian gland and prevent dry eye lids symptoms [16] . Previous studies have consistently reported often the migration associated with cosmetic  items towards the eye ball surface, plus tear film contamination through cosmetic  goods has been observed  [11,17-19] . Typically the studies established how the accidental migration regarding cosmetic  merchandise to the periocular area could provoke tear film contamination [17] . This phenomenon is assumed to be involved in some reported ophthalmic side effects, including posterior blepharitis, total eye irritation, rip film instability, conjunctival pigmentation, corneal epithelium defect, in addition to keratitis [20-22] .

In our study, your prevalence involving DED between women who else used a muslim cosmetics had been 71. 6%, where 40. 5% of girls had serious conditions, 17. 6% got mild, and even 13. five per cent had reasonable conditions connected with DED. This prevalence one of the eye plastic user  population is much higher than documented among other populations, including old hospital patients throughout which the exact prevalence with DED seemed to be 54. 3% [23] . Nevertheless , it is known that the prevalence for DED is higher around aging populations than younger ones [24] . This was supported by our study as DED was initially significantly better in older participants. Furthermore, the frequency of DED among the particular normal population ranged from six. 4% for you to 33. 7%, which is a lot lower than the prevalence detected in our own population [25,26] . As mentioned earlier, in typically the Al-Ahsa  region, the occurrance of DED was estimated to become 32. 1% amid the normal population [3] . The higher prevalence in our population indicates that there is a relationship between usage about eye makeup products and a high prevalence in DED; this difference on prevalence may be due to help different tools used in often the diagnosis of DED despite that still being a good indicator toward the relationship between communicate cosmetics together with their unfavorable impact on your eye health. In addition, many previous correctly verified that  women tend to suffer from DED more compared to men, which may further correlate woman cosmetics and additionally dry lady symptoms, because women tend to use makeup more frequently [3,24,25,27] .

However , all of us found of which the prevalence of DED increased substantially with an increase in the exact frequency from using a few eye cosmetic makeup products applied to periocular skin, which includes inner eyeliners, false eyelashes, eye shadows, and female lenses. This particular result shows the fact that bad impact of eye beauty products around the girl increases based on two conditions: the application of cosmetics near  the women as well as the high frequency associated with usage of these cosmetics. The similar pattern of results was obtained in another study the fact that found that eye makeup wearers displayed marginally poorer OSDI scores than members who did not use cornea cosmetics. Nevertheless , the analyze failed to find a correlation between the usage frequency and specific product applied and the frequency of DED [9] . Another review demonstrated that will applying eye liner for one week negatively contributed to ocular comfort [28] .

This specific study included some unavoidable limitations. First, using a self-reported questionnaire may lead to some personal bias exactly where some contributors may not answer all questions honestly in order to appear in a better form, reducing the particular percentage of their use regarding cosmetics upon purpose. Besides, the sample size was basically relatively smaller than expected, which will be believed to be due to an increase in online surveys. As the result, people tend to be able to become less motivated towards internet surveys. Concurrently, to follow preventive measures, an online survey was the best solution to conduct our analysis.

Within conclusion, we all found which the prevalence involving DED among women which used talent cosmetics appeared to be 71. 6%, which is usually much higher as compared to the occurrance of DED in some other populations, indicating that making use of eye cosmetics is a new risk factor for developing DED. We believe that typically the negative effect of eye cosmetics about eye wellness increases dependent on 2 conditions: the  application connected with cosmetics near the vision and this high rate of recurrence of utilization of these types of cosmetics. Further  studies using objective assessments of DED with some sort of more reliable diagnostic approach are needed for you to further assess the effect with cosmetics in DED.