We all know using makeup, and particularly not removing it at night, can have a huge impact on eye health and lead to or worsen conditions such as blepharitis, Demodex and also dry eye. As such, it’s becoming increasingly important to discuss cosmetics and ocular hygiene with our patients. A recent case also highlights the dangers of beauty procedures, which are becoming increasingly popular, in this case eye lash tinting.
|Figure 1. Loss of epithelial cells, limbus to limbus.|
A 49-year old female came to our clinic with a red, painful, irritated left eye that had started in the afternoon. Earlier in the day she had gone to a beauty salon to get her eyelashes tinted. She had reported that nothing happened out of the ordinary during the procedure, but a few hours later noticed that her eyes were in extreme pain.
Her visual acuity was heavily reduced in the left eye and she had trouble keeping it open during slit lamp examination. Her right cornea was perfectly healthy with no pathology. On the affected eye, there was a significant loss in epithelial tissue in the inferior cornea spanning almost from limbus to limbus (figure 1). The edges of the defect were loose but well-demarcated. The conjunctiva appeared severely damaged in the inferior nasal quadrant (figure 2) increasing the likelihood of possible stem cell loss in that area. The fluorescein images below show the extent of the lesion.
|Figure 2. Damaged conjunctiva, inferior nasal quadrant.|
The patient later brought in a picture of the drops that were used to numb her eyes during the eyelash tinting procedure, and it clearly stated “Do not put into eyes.”
When discussing the appropriate treatment, I knew there was only one thing that would make her eye heal in a manner that would reduce her potential for long-term vision defects – PROKERA, cryopreserved amniotic membrane. However, in our conversation she revealed that she was going to Yosemite in three days and leaving very early in the morning for her trip. Having a limited time frame to get maximum therapy further confirmed the need for early intervention with PROKERA®.
We inserted the PROKERA on Tuesday afternoon, and she returned to the office on Thursday at closing time to remove the amniotic membrane. Although the PROKERA was in place for roughly 48 hours, the epithelial defect showed about a 95% healing and a bandage lens was placed to help protect the newly healed corneal epithelial. She returned the following Monday to take the BCL off and she was thrilled that she was able to enjoy her vacation.
|Figure 3. Healed cornea.|
The third picture is from two weeks post-removal and the cornea was perfectly healed with no signs of trauma or loss of conjunctival tissue (figure 3).
We were lucky that such technology as PROKERA is available to prevent scar formation and restore clear vision. The heavy chain hyaluronic acid and PTX-3 molecules that are maintained in the cryopreserved amniotic membrane start a regenerative healing process that does not lead to scarring, which typically happens in normal healing. This pathway ensures that we return the cornea to its natural state. The modulators present also jumpstarted healing that probably would have taken much longer, resulting in this patient’s inability to enjoy her trip to one of our nation’s greatest landmarks.
Mark Schaeffer is a graduate of the Southern College of Optometry. After finishing his residency in ocular disease at Bascom Palmer Eye Institute in Miami, Florida, he moved to be an optometrist at Schaeffer Eye Center in Birmingham, Alabama. He practices in a 16 office, 23 doctor practice along with his father and sister. He currently lectures across the United States on ocular disease. He is an active member in the AOA, AAO, and state and local organizations.