We see them marching into Starbucks and ordering green tea – with lemon on the side – for lunch. We see them shopping on a Tuesday afternoon, laden with bags overflowing with the latest in fashion. We see them toiling at the gym, often twice a day. We see them purchasing hundreds of tubes of makeup in all shades and brands. And we see them sneaking out the back door of the surgeon’s office, masked with a scarf and oversize sunglasses. Their telltale voluptuous bee stung lips, expressionless eyes, frozen foreheads, and gravity resistant breasts reveal their association with a hidden cult of youth. Their hope is that said investments will put a wrinkle in the passage of time, but the fact is that we all age, some more gracefully than others.
But beauty is a relative term and judging someone on her aesthetic choices is, quite simply, boring. My concern is the health of these women: psychologists and surgeons fear that many patients do not fully grasp the gravity or full spectrum of unintended physical, emotional and cultural side effects associated with cosmetic interventions. At times a fear of aging is more than petty vanity, and it’s not just about looking old, so much as being old; an existential angst about what can no longer be.
Let us take a step back and look at the cosmetic choices made by many women and men: do you remember sitting in your high school science lab, revolted by the dead frog floating in the jar of formaldehyde? Then you should be shocked to know that formaldehyde is used as a preservative in much of the eye makeup your purchase, slowly petrifying your lids so that you are no longer able to blink, just as it petrifies the frog so that it is no longer able to move.
Some might even venture to say that if you cannot eat it, don’t put it on your face. Skin is porous and everything that goes onto your body will eventually go into your body. There has been an active movement in the food industry for regulation across the value chain, inclusive of ingredient sourcing, ethical production, and environmentally friendly processing, packaging and distribution. Driven in part by government, and in part by consumer, the later has battled and lobbied against a profitable industry – concepts such as value stream mapping have penetrated and changed the face of the industry.
It is no coincidence that this green philosophy has extended to the cosmetics industries, penetrating, albeit slowly, mainstream markets in the United States. In fact, it is no longer considered hippie to make your own hair mask or facial scrub or obsessive-compulsive to inquire as to every ingredient in your eye cream. But if this green trend is de rigueur, then why do so many women (and men) blindly use a multitude of cosmetic products that contain harmful ingredients such as lead, mercury, diethanolamine, and phthalates? And even more so, why are they applying these products to the vulnerable skin around the eye?
Doctor Leslie O’Dell, a specialist in the management of glaucoma, diabetic eye disease and ocular surface disease, and an active member of the TFOS DEWS II Public Awareness & Education Subcommittee, is also an influential advocate for clean makeup. During our conversation, she acknowledged a significant increase in patients suffering from dry eye and is frustrated by the fact that “dry eye disease continues to be under-treated and often under-reported by those affected as they blame environment, allergies and lifestyle for discomfort, not realizing the delicate dynamic tear film that bathes their eyes with each blink is often to out of balance and the cause for discomfort and variable vision.” Through research, she demonstrates a connection between the cosmetics they use or the cosmetic procedures they have undergone. She argues that many women are not taking the time to educate themselves but luckily, her “passion is to educate the public at large as well as the doctors managing patients likely to have dry eye to its importance. Like many things, an educated patient and early detection makes treatment easier.” A rise in dry eye disease compelled her to found the Dry Eye Treatment Center to focus on the growing needs of this specialized condition.
As Dr. O’Dell, many doctors don’t mind being the educators, but in order to develop a more effective approach to ocular eye care education, they need a protocol or handbook of sorts. Such a tool would not only define how patients decide which products to purchase and procedures to undergo or avoid, but also chaperone doctors in their diagnosis and treatment of dry eye symptoms. For example, if a patient wishes to have an aesthetic procedure, such as altering the appearance of crow’s feet with a neurotoxin, do they realize that their capability to blink can also be altered? Furthermore, does the patient realize that going to an eyelid specialist rather than a plastic surgeon would be an advisable alternative?
Lets be clear: few large scale cosmetic companies are going to assume the role of educators because this would negatively impact their bottom line and brand, so the onus is on us to propel a change in consumer purchasing habits. “There isn’t a need to single out any one company, but there is a need to educate consumers overall,” claims Dr. O’Dell. First off, basic principles for consumers are as follows: It is not always feasible to go chemical free but as a first step, you can reduce the chemical loads by making safer choices. And as a corollary, if transitioning to purely organic products is not an option for you, in the interim there are decent choices. As soon as consumers demand change, one can assume that the cosmetic industry will follow suit, as did the food industry. Or perhaps this will also urge the government to react accordingly because currently, what kind of messaging is given when there are 1300 products banned in Europe versus 11 in the United States?
Patients are often more frustrated by the concept of not wearing eye makeup than the dry eye symptoms themselves. Dr. O’Dell argues that industry should not have to tell patients to stop using makeup, but rather, give them choices and some basic principles to follow. One hiccup is that it is still quite “early in the game” to provide evidence-based guidelines, laments Dr. O’Dell. Nevertheless, she, in conjunction with TFOS, is putting together a first-stage set of guidelines and in the interim In order to best help patients who have already developed dry eye symptoms, a transparent relationship has to be forged between the practitioner and the patient. Coming to an office, for example, with a face clean of makeup for example, does not help a doctor understand how you apply your makeup daily. Or, if you are following the waterline or tight-lining trend, then Dr. O’Dell could better know how to help assuage your symptoms. In her daily practice, her objective is to “continue to restore hope to my patients that they will get the relief they are searching for. This relief will come from new and more personalized treatments, changes to their reliance on and use of cosmetics and facial cleansers to reduce the daily chemical warfare they are inflicting on delicate glands and the structure of the eye.” And doctors on the other hand, have to know what questions to ask:
– Do you use eye cosmetics and are you familiar with their ingredients?
– How do you apply your makeup?
– How do you remove your makeup?
– Have you undergone aesthetic procedures to treat crow’s feet or acne?
– Have you considered an eyebrow or eyeliner tattoo and do you know that this has been shown to cause tear film instability?
– When treating patients are you considering natural options? One cannot assume that natural treatments are a foolproof solution since they can also have negative repercussions, but they are an option.
Cosmetic use is primarily associated with women, although an increasing number of men invest in products. Currently 70% of ophthalmologists graduating are female, a number that is rising rapidly. Since they can naturally empathize with other women, Dr. O’Dell is optimistic that women will come together develop a voice that speaks in unison, and educate consumers so they do not transform into patients. In fact, she is part of this very movement: the dry eye community recently gave birth to a collaborative group composed of women who share a unique perspective, Dry Eye Divas. Amy Gallant Sullivan, Executive Director of TFOS, created and curated this professional group to educate ECPs about safe ocular aesthetic practices and use of cosmetics in regards to the potential impacts on the ocular surface. Dr. Leslie O’Dell, as well as Dr. Laura M. Periman, another leading dry eye disease expert, are a part of this team. As Melinda Gates once said, “A woman with a voice is by definition a strong woman.”
Director, TFOS Global Ambassador Program