Dr. Mariam Alkawally is the current Ocular Disease Resident at Empire Eye and Laser Center in Bakersfield, California. Dr. Alkawally obtained her dual OD/MS degree at SCCO under the tutelage of Dr. Jerry Paugh, her thesis being on the effect of marginal eyeliner on meibomian gland function.
Mariam Alkawally and colleagues have examined the effect of eyeliner use on meibomian gland function. She presented her results at the American Academy of Optometry meeting in October 2020 (Nashville, virtual). Her findings echo previous work on the impact of make up such as eyeliner on the lid margins, and help to inform eye care practitioners about the importance of looking for this in their patients and counselling regarding make up use, its placement and thorough daily removal.
AAO 2020 Scientific Program Abstract (link to original abstract to be add when available)
Title: The Effect of Marginal Eyeliner Use on Tears and Meibomian Gland Function
Authors: Mariam Alkawally,1 Rachelle Lin,1 Corina van de Pol,1 Alan Sasai,1 Andrew Loc-Nguyen,2 Jerry R. Paugh.1
Affiliations: 1SCCO at MBKU, Fullerton, CA, 2California State University, Fullerton, CA
Purpose: There is limited research examining chronic use of eyeliner makeup on ocular surface signs and symptoms. This study investigated whether chronic use of ocular cosmetics either around or directly on the eyelid margin may contribute to tear film instability and Meibomian gland dysfunction.
Methods: This was a masked, prospective, observational clinical trial. Subjects were enrolled in one of three groups: those who never or very rarely wore makeup (No-M), those who wore it frequently but only outside the eyelid margin (Min-M), and those who wore it directly on the lid margin 4 or more times per week (W-M). Subject makeup wearing habits had to be consistent for a minimum of 1 year. Following enrollment, subjects were assessed for dry eye signs and symptoms by a masked examiner. The primary outcome measure was lipid layer thickness (LLT) via LipiView II. Other data collected included symptom questionnaires, tear meniscus height (TMH), meibomian gland (MG) expression grade, corneal and conjunctival staining utilizing both NEI and Oxford grading systems, meibomian gland dropout, fluorescein breakup time, and modified MGD score (sum of eyelid marginal signs, MG expression grade, and meiboscore).
Results: Forty-nine (49) female subjects completed the study (10 No-M, 18 Min-M, 21 W-M); there was no difference due to age. Neither race nor contact lens wear confounded the results and there were no differences in symptoms among the groups (modified Schein, OSDI, SPEED), lipid layer thickness, tear breakup time, eyelid marginal signs, or meibomian gland dropout. The Min-M group showed statistically significant reduction in TMH and an increase in NEI and Oxford staining compared to the No-M group (p = 0.027 and 0.023, respectively). The W-M group showed a statistically significant increase in the MG expression grade compared to the No-M group (mean grades 1.1 and 0.55 respectively, 0 – 3 scale, p<0.016).
Conclusion: Eyeliner wear both outside and within the lid margin demonstrated mild deterioration in the health of the ocular surface, specifically with regards to ocular surface staining and gland expression quality, compared to the non-makeup users. The meibomian gland secretion decrement may lead to worsening meibomian gland function and glandular atrophy over time. These results mirror concurrent studies with similar conclusions.