Ugly Risks of Beauty Routines

, University of Medicine & Dentistry of New Jersey


Medscape General Medicine. 1996;1(1) 

In This Article

Ocular Inflammation

Conjunctivitis is the most common ocular inflammation and can be caused by infection or allergy. Typically, the woman arrives in the clinician's office with teary and inflamed eyes. Initial evaluation begins with a careful history to determine when and how the problem developed, as well as to detail all associated symptoms, such as discharge, pain, itching, and change in vision. If an eye chart is not available, a magazine or newspaper can be used to document visual acuity, since most periodicals can be read with 20/40 vision. The clinician should document the degree (mild, moderate, severe) and location of any lid or conjunctival hyperemia or edema, the character of any discharge (watery, purulent, mucoid), and the reaction of the pupil. While many conditions of the eye respond to the simple measures described here, it is important to consult an ophthalmologist in cases of recent eye surgery, loss of vision, corneal involvement, pain, or failure to respond to care within 72 hours.

While itching and clear mucoid discharge most often indicate allergy, and a thick purulent discharge without itching typically indicates infection, it may be very difficult to tell the difference between the 2, and it can be even more difficult to determine the etiology of the disorder.[1,2] A sterile swab of the lids and conjunctiva should be taken for culture. No anesthetic should be used when taking this culture, because many topical anesthetics have antibacterial properties.

The most common agents infecting the eye are the bacteria Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae.[2] Recent studies have also shown bacterial infections with Pseudomonas and Moraxella to have caused outbreaks of conjunctivitis, which can be precipitated by contaminated eye makeup. One epidemic of conjunctivitis was caused by mascara shared among a group of students.[3]

Mascara contaminated with Pseudomonas has been documented to cause destructive corneal lesions resulting in visual impairment.[4,5] It is therefore important to remind women not to share mascara or other eye makeup and not to allow children to play with makeup that has been used by others. Also, advise women not to use open samples at cosmetic counters, which may have been used by others. In one survey of makeup-counter samples in department stores, the Food and Drug Administration reportedly found that more than 5% were contaminated with fungi and other pathogens.[6]

Because makeup, particularly mascara, may contain moisture and can be stored in dark, moist bathrooms, the wands or pots can become contaminated over time. While the eye normally offers a good barrier against bacterial invasion, a slip of the mascara wand can scratch the cornea and introduce infection. To avoid eye infections, many dermatologists suggest replacement of mascara and other eye makeup every 6 months, or more frequently if there is any change in consistency, color, or odor. In the case of corneal ulcer, it is best to refer the patient to an ophthalmologist to do the scrapings necessary for stain and culture.

Soft contact lens wearers are at high risk for developing conjunctivitis or more severe keratitis (corneal ulceration) as a result of contaminated lens solution or contact lenses.[7] Corneal ulcerations can be central (Fig. 1) or peripheral (Fig. 2). Peripheral (marginal) ulcers are common in bacterial conjunctivitis and are not considered an ophthalmic emergency. Central ulcers, on the other hand, are serious and sight-threatening. Contact lens wearers who complain of eye pain and appear to have a corneal abrasion should be treated as if the abrasion is a corneal ulcer--which it can rapidly become, particularly in the presence of a Pseudomonas infection.[2] Do not patch the eye; this can increase the risk of Pseudomonas infection creating a corneal ulceration.

Figure 1. Staphylococcal ulcer of central cornea.
Figure 2. Acute staphylococcal marginal keratitis. Discrete, white infiltrates are seen in periphery of the cornea.

One of the more serious corneal ulcerations is caused by Acanthamoeba and can result in loss of vision or even loss of the eye.[8] Corneal ulcers usually appear as discrete, gray-white infiltrates. If left untreated, they can spread wider and deeper, eventually perforating the eye and leading to intraocular infection.[2] Since it is difficult to culture Acanthamoeba on standard agar plates, Acanthamoeba should be suspected in resistant stromal keratitis or persistent active corneal infiltration when routine cultures are sterile.

It is mandatory that women who wear soft contact lenses thoroughly wash their hands before handling their lenses, avoid contaminating the lens solution, and use proper procedures to clean, store, and insert the lenses. Contaminated solutions, homemade saline solutions without preservatives or bacteriostatic agents, and failure to perform effective cold sterilization can cause serious infection.[9,10]

If an infection does occur, the contact lens wearer should be referred to an ophthalmologist and told to immediately stop using mascara and other eye makeup, as well as the contact lenses, until the infection has been successfully treated. All used or old makeup and lens solution should be discarded and replaced before wearing lenses and makeup after treatment.

For simple conjunctivitis, an ophthalmologic broad-spectrum antibiotic solution, preferably without hydrocortisone, every 2 to 3 hours for 1 week is usually sufficient. If a Gram's stain or culture result is available, an agent specific for gram-negative organisms, such as gentamicin, or for gram-positive organisms, such as erythromycin, may be used (Table I). In a severe case of keratitis, the ophthalmologist may elect to hospitalize and/or treat with a systemic antibiotic because of the high risk of corneal scarring or perforation if virulent organisms are present.