I am an optometrist with a special interest in dry eye and beauty trends. When I started noticing more patients in my exam chair with eyelash extensions, I began to take a deep dive into the beauty world, and it became apparent that the information available was not evidence-based medical information, but based on other lash educators or viral trends on social media.
Being a lash artist means you help your clients every day by providing them with a convenient way of looking and feeling beautiful. However, with any beauty procedure, there is always a risk of an adverse reaction occurring. Your clients trust you near their eyes and it should be a priority and your responsibility to understand the negative implications of not following best practices.
One common adverse reaction we see with eyelash extensions is an allergic response like contact dermatitis. Here are 5 common questions I get asked about this topic.
1. What is contact dermatitis and why do my clients get it?
Contact dermatitis is an inflammatory skin condition that can occur when your skin comes into contact with something that you are allergic to (allergic contact dermatitis) or irritated by (irritant contact dermatitis). Contact dermatitis is a Type IV hypersensitivity, a delayed inflammatory response, meaning it can take days for the reaction to occur.
Typical symptoms include redness and swelling of the eyelid, itching and discomfort. When your body does not like something that touches your skin, your immune system responds by sending white blood cells causing the above. The rash may appear in minutes if caused by an irritant or hours or days if exposed to an allergen.
Your clients are more likely to get irritant contact dermatitis from the fumes that are released from eyelash adhesive glues used while lashing. These glues contain ingredients like 85-95% cyanoacrylate which release formaldehyde fumes as byproducts. A true cyanoacrylate allergy is relatively rare, however can happen. The glues also contain thickening agents like 5-10% PMMA or acrylic resin, colour agents like carbon black, and stabilizing agents like hydroquinone or latex, all of which can have a potential to cause a reaction. It is important to know what is in your glues so that you can identify if a client has an allergy or irritation to one of the ingredients to avoid or find a glue to substitute with.
2. What is the best practice / what to do if my client has contact dermatitis?
When an adverse reaction arises, always remember you are not a medical professional, and the best advice you can give is to direct the client to a medical professional. From a legal standpoint, this is also in your favour. An optometrist is an eye doctor who has a professional license and professional liability insurance that helps diagnose, treat and manage certain eye diseases. They also have microscopes called slit lamps that allow a more precise diagnosis than a family doctor at a walk in and most optometrists do fit in emergency visits!. Consider forming a relationship with one or two local optometrists so that you are able to refer a client with any eye concerns to them.
I would recommend removing the eyelash extensions as soon as possible for the client however depending on if there is strong acetone based remover being used to remove the eyelashes, the client may feel worse after removal. If the client is at home, in the meantime, you can advise the client to apply a cool compress on the eye and have them stay upright to reduce blood flow to the area.
3. Is Flonase a good recommendation to treat and manage contact dermatitis?
No, contact dermatitis should not be managed with Flonase.
Although it may seem harmless as Flonase is an ‘over-the-counter’ product, you could be doing more harm than you think. Flonase, fluticasone is a nasal steroid that is used for the management of allergic rhinitis, hence is indicated for use in the nose. The pamphlet advises the user to AVOID the eye as the drug was not tested for the eye area. Fluticasone is a steroid which means it has the potential to cause a steroid response. Approximately 5% of the population are steroid responders, which means their eye pressure can increase significantly to unsafe amounts as quickly as one or two days after using the steroid. The client may be asymptomatic, which is why when optometrists start patients on steroids, they generally follow up with an eye pressure check. Long-term use of steroids can also cause cataracts and glaucoma. Steroids are also not safe to use while the client is pregnant or breastfeeding.
Overall, if your client is having a reaction to lash extensions, you should not be masking the reaction with a steroid. Your client’s eye health should always be a priority.
4. What does an optometrist do for contact dermatitis cases?
Contact dermatitis treatment first involves avoiding the trigger and symptomatic relief with topical medications like steroids. If the patient allows, we will remove their eyelash extensions in the office.
In Canada, we usually start patients in discomfort on a prescription corticosteroid ointment. Depending on how severe their reaction is, we prefer to start them on a milder steroid like loteprednol or fluorometholone. Why? Milder steroids generally have less risks for the above adverse reactions and have a lower risk of causing a steroid response. Of all the steroids indicated for eye care, dexamethasone is a strong choice with the highest risk of causing a steroid response which is why as practitioners, it is usually not our go to.
5. Should I continue lashing my client who continuously gets contact dermatitis?
No. Whether it is an irritant or true allergic response if your client continuously has a reaction, it is your job to educate them on the negative implications this can have on their eye health and stop lashing them.
6. What tips do you have to prevent contact dermatitis?
A) Choose a good quality glue with MSDS document:
As a lash artist, it is important to educate yourself on the ingredients in your glues and choose glues based on your client. Within the cosmetic industry, there are three main cyanoacrylate glues
- Ethyl Cyanoacrylate
- Butyl Cyanoacrylate
- Alcoxy Cyanoacrylates
Each of these releases formaldehyde, but alcoxy cyanoacrylate releases the least amount of formaldehyde which is indicated for your ‘sensitive’ client. Unfortunately there are no glues that do not release formaldehyde at this time. To reduce irritation, consider using a handheld fan while lashing or keep the room ventilated well. Another ingredient that can cause irritation or allergic reactions is carbon black, which gives the glue its colour.
However, no matter which you choose, always make sure you request a Material Safety Data Sheets (MSDS) which is a document that contains information about ingredients and the potential hazards of the chemical product.
B) If you aren’t already, consider using an intake form
Healthcare utilizes intake forms to ask patients for their medical history including medications and allergies, so should you! Consider including questions like “Have you had an allergic response to lash extensions in the past” to highlight any areas of concern for the client before lashing.
C) Consider “patch testing” your allergy prone client:
If your client is prone to allergies, you may wish to recommend a patch test prior to lashing them. There is no ‘standard’ method to patch test for eyelash extensions but two common ways include:
- Placing 3-5 extensions on the outer corner of your client’s eye. This can mimic the response the client will have with a full set but will be easy to remove. Consider testing several lash adhesives (ie. one type on each eye) .
- Placing a small amount of glue behind the client’s ear. There has been some pushback around this as the skin behind the ear is not the same as the eyelid. An irritation is immediate whereas an allergy may take several hours to days to occur.
D) Consider doing a ‘rinse’ after lash extension set complete
Some lash artists offer ‘lash baths’ prior to doing a fill however why not consider doing a cleanse AFTER to remove the potential fumes or irritants around your client’s eye? You may also consider putting a NON PRESERVED artificial tear into your client’s eye to help with discomfort or dryness post lashing.
No one benefits if the client’s eye health is compromised. Lash artists do amazing work by empowering their clients to look good and feel good but should do it in a way that maintains their eye health and longevity. We should be able to choose beauty without compromising health so let’s work together to become eye health partners to make that happen!