Q&A: Harry Roberts

Harry Roberts was awarded the British Contact Lens Association’s Bron Award for his research investigating epiphora and chronic tarsal conjunctivitis associated with makeup remover wipes. He discusses his research with OT

How did this research come about?

This was research that just presented itself to us really. We observed this cohort of patients where, to begin with, we didn’t have an explanation for their symptoms. We scratched our heads to think about what the cause of these symptoms in this group of patients might be.

We made an assumption about an association between the symptoms and makeup remover wipes. That led us to hypothesise that there might be a link. The patients all presented with watery eyes. When we examined them there were signs of inflammation on the surface of the eye.

What did the group of patients have in common?

The range of ages went from 20 to 82. All of the patients were female and used cosmetics. It is known that there can be some toxicity to the eye from cosmetics but when we delved a bit deeper and took a more careful history, we found, there was no single consistent cosmetic. Some people were using eyeliner, some people were using mascara, some were using eye shadow. What was consistent in every single patient was that makeup wipes were being used.

When we asked patients to stop using makeup remover wipes, they tended to get better.

What chemicals in makeup remover wipes may be causing this adverse reaction?

There is one group of preservatives called isothiazolinones. There is some research in the dermatology literature about their effect causing hypersensitivity reactions in skin. Interestingly, they are a common preservative in household cleaning agents. It is known that up to 8% of people will have hypersensitivity reactions to the application of isothiazolinone to the skin, but the effect on the eye have not been well investigated. Another common preservative, benzalkonium chloride, is well-known to be toxic to the ocular surface.

What advice would you give to patients about using makeup remover wipes?

There needs to be careful discussion with any person who has ocular surface disease or dry eye about using cosmetics. They need to be warned that cosmetics could be making the situation worse.

Ophthalmology and optometry are both disciplines dedicated to quality of life. We don’t want to make our patients miserable by advocating against cosmetics if patients want to use them. After all, their effects on self-esteem have been well documented.

However, there are ways to mitigate against the toxicity by using them sparingly – not every day – changing makeup remover products and taking other actions to improve the ocular surface. For example, practising lid hygiene and using lubricating drops. With regards to which products of makeup remover to use, we don’t have any evidence, but theoretically we suggest that people use micellar water-based products. Patients should rinse off the remover afterwards so that no residue is left behind.

What questions are still unanswered?

The limitation to the study is that we don’t really know what it is about the makeup remover wipes that is causing the problem. It is not like it is just one product or one single chemical – it is a class of products. Furthermore, there will be many people using makeup wipes who have no issues whatsoever. More research is needed.