I talk about cosmetics every day with my patients, and most patients mention that I’m the first eye doctor to raise the subject.

While discussing makeup, I often learn that patients are using makeup the wrong way, putting harmful ingredients near their eyes, wearing false eyelashes and extensions, not completely cleaning makeup off and using irritating solutions to remove their makeup. Even if I treat their dry eye disease (DED) and put them in the best contact lenses to fix their refractive error, their vision and comfort will continue to suffer if they sleep in their makeup, don’t gently and effectively clean their face and eye area, and apply eyeliner on their waterline.

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It’s my duty to educate my patients — especially those with DED — and make recommendations like these to help them wear makeup without harming the health of their eyes.

What are you using?

Patients understand that they need to tell their eye doctor about eye care products they’ve been using, like allergy eye drops. But they may not realize that they should also tell their eye doctor about cosmetic eye treatments, like eyelash serums, as well as any false eyelashes or extensions they’ve been applying — even if they have since been removed or only used occasionally.

Other over-the-counter face products are also important to inquire about, so I explain to patients that I also want to know about their facial care, including recent cosmetic treatmentseveryday cleansersmoisturizers and makeup removal products.

Read the labels

Ideally, we recommend in clinic that DED patients bringtheir makeup and face products to the exam. We check each item against printed list of 10 detrimental cosmetic ingredients, which are in Europe than the U.S. They include alcohol, Argireline (acetyl hexapeptide-8, Lipotec), benzalkonium chloride, butylene glycol, ethylenediaminetetraacetic acid, formaldehyde, isopropyl cloprostenate, parabens, phenoxyethanol and retinol.

Most cosmetic products contain at least one of these harmful ingredients. I that my patients — with and without DED — avoid waterproof eye makeup and look for labels that sayapproved and tested by eye doctors.” If interested, they can check out two ophthalmologist-approved brands, Eyes Are the Story and Twenty/Twenty Beauty.

Apply eyeliner correctly

Some patients incorrectly wear eyeliner over the waterline of their eyelid margins. I typically explain the role of the meibomian glands in maintaining a healthy tear film and how they can fail to function if they’re blocked by a layer of eyeliner.

Improperly applied eyeliner also adds makeup debris to the tear film, exacerbating DED and creating contact lens complications. To avoid these problems, I recommend using eyeliner only on the outside of the upper lids.

Focus on hygiene

Patients can keep makeup clean by replacing them frequently and storing in a clean environment. For makeup removal, I recommend iVizia micellar eyelid cleansing wipes (Thea), a preservative-free formula that helps remove makeup gently and completely, with soothing botanicals and zinc. The cleansing wipes are very comfortable and cost-effective, which helps ensure that patients comply with the recommendation.

The iVizia preservative-free artificial tear also is popular with my DED patients, and makeup wearers like that the precise drops give them control while wearing eye makeup.

Skip the false eyelashes, extensions

False eyelashes and extensions can prevent complete blinking, discourage good hygiene (as patients try to avoid damaging their investment) and change the aerodynamics to create a sort of windaround the eyes. I’ve also seen patients have severe reactions to false eyelash adhesives.

I advise patients to try other less harmful alternatives, like certain lash serum or mascaras that enhance the eyelash curl.

Avoid eyeliner tattoo

As someone who works closely with cancer patients, I understand the temptation to improve one’s appearance without eyelashes. I explain how eyeliner tattoos destroy meibomian glands and recommend less harmful alternatives, such as washable eyeliner or an eyelash serum that helps promote natural lash growth.

I hope you’ll have a conversation about makeup and cosmetic products with your patients, even if you just start with the ones who wear false eyelashes or have eyeliner on their waterline. You’ll have happier patients and help them wear makeup safely and minimize negative effects to eyes.

For more information:

Jade Coats, OD, is in practice at McDonald Eye Associates, an OD-MD practice in Rogers, Arkansas.