Translation of a-t 2025; 56: 64

LASTING DAMAGE CAUSED BY LASH EXTENSIONS, EYELINER TATTOOS AND OTHER PROCEDURES

Many eye cosmetics can easily be applied and removed by users themselves.¹ The German Society of Ophthalmology (Deutsche Ophthalmologische Gesellschaft, DOG) is now warning about cosmetic treatments such as lash extensions and eyeliner tattoos (permanent make-up), that change a person's physical appearance for a long time or even permanently.²

According to the DOG, allergic contact eczema at the lid edge is one of the most common negative effects of lash extensions. This is mostly triggered by the adhesive² used to fix the artificial or real hairs individually onto a person's own lashes.¹ This was also indicated by a Japanese observational study in which 64 out of 107 women with eye symptoms after lash extensions developed keratoconjunctivitis as a result of getting adhesive or adhesive remover into the eye and 42 experienced allergic blepharitis caused by the adhesive (with 4 women experiencing both simultaneously).³ Infections of the lid edge and conjunctiva, calcifications at the base of the lash and loss of the person's own lashes as a result of damage to the hair shaft are also possible, along with corneal erosion and corneal infections in rare cases.² Caution is also advised during surgery: an Australian report described a 38-year-old woman with lash extensions who developed corneal abrasions in her right eye caused by the artificial lashes following a caesarean section under general anaesthetic in which her eyes were covered with gauze.⁴ Another report relates to a 64-year-old patient whose artificial lashes on her upper left lid caught fire during eye surgery as a result of thermal haemostasis.⁵ According to the DOG, lash extensions must therefore be removed before eye surgery.²

Eyeliner tattoos can also lead to allergic eczema, inflammation and infections (particularly if the work carried out is not hygienic). Chemical burn and mechanical damage are also possible. Patients can develop dry eye as a result of damage to the sebaceous glands on the lid edge.² The results of a Korean observational study are consistent with this: the number of sebaceous glands was significantly lower in 10 women with tattooed eyeliner than in those in the control group without a tattoo of this type (n = 30). The tear film also brakes faster when the eye is opened (measurement of its stability) in this group than in the control group (an average of 4.3 compared to 11.0 seconds; p < 0.001), and corneal erosions are significantly more pronounced.⁶ It should also be noted that tattoo inks regularly contain potentially toxic substances such as cadmium, chromium, nickel or arsenic.^1,2,7

The DOG strongly advises against cosmetic procedures on the cornea and conjunctiva.² Resections of the conjunctiva (which are supposed to make the sclera appear white again in patients with chronically red conjunctiva for example) can have serious consequences such as ulcers on the cornea and conjunctiva, thinning of the sclera and damage to the eye muscles with double vision.^2,8 Serious damage with eye loss has been described in connection with coloured tattoos of the entire conjunctiva.²

Surgery to change the eye colour in which colour pigments are inserted into the cornea also brings with it numerous risks.² In addition to problems with the pigmentation (e.g. uneven distribution, colour leaks into the inside of the eye), increased light sensitivity, dry eye, loss of endothelial cells in the cornea and corneal neovascularisation can also occur. Damage to the cornea can lead to clouding and distortion, as well as a loss of vision, for example.^2,9 The American Academy of Ophthalmology issued a warning about the procedure back in 2024. It is their opinion that purely cosmetic surgery on the eye is "just not worth" the risk of a possible visual impairment.⁹

We advise against lash extensions and eyeliner tattoos and in particular cosmetic procedures on the cornea and conjunctiva.

Where possible, existing lash extensions should be removed not just before eye surgery but in general before all surgical procedures, particularly those performed under general anaesthesia.

©  arznei-telegramm (Berlin/Germany), August 2025, protected by copyright laws.