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H. Ahmad, F. Malik, E. C. Lazzaro, M. Dweck, D. R. Lazzaro; Assessing the Persistence of the Traditional but Toxic Eyeliner- Kohl: Impact of a Public Health Campaign on Knowledge, Attitude and Behavior of Users of This Health Hazard and Analysis of Kohl Samples for Lead in New York City (NYC). Invest. Ophthalmol. Vis. Sci. 2008;49(13):3614.
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© ARVO (1962-2015); The Authors (2016-present)
Kohl is a traditional eye cosmetic used for millennia within African, Asian and Middle Eastern Cultures. Traditional uses for kohl include beautification, relieving eye disease, and warding off the evil eye. International studies have identified kohl as a serious health concern due to its lead content. Based on this data and recent cases of lead toxicity, the New York City Health Department has issued an advisory warning against Kohl. We report an original study on Kohl for three purposes; 1)To evaluate a public health ban against this eyeliner in NYC 2)Characterize lead and other constituents of samples obtained within NYC 3)To assess current knowledge, attitudes and behavior of kohl users.
A total of 43 stores carrying traditional ethnic products within NYC were surveyed about Kohl. 14 samples in all were obtained for the study; 11 traditional kohls and 3 western based kohls. Samples were sent to a certified public environmental health laboratory for analysis of lead and major constituents using atomic spectroscopy. In addition, a total of 25 women who have used kohl in the past were interviewed on their kohl practices.
Of the 43 stores visited, a total of 31(77%) did not sell kohl samples anymore. Of these stores, 48% reported discontinuing it due to a public ban and 29% specifically reported kohl as a lead hazard. Of the 14 samples purchased, we found a range in lead levels from insignificant(<1.0%) to nearly half of the sample’s content(47%) exceeding the federal guideline for cosmetics. In addition, other metals such as antimony and copper were identified. Of the 25 women questioned, an overwhelming majority reported not using kohl daily, but approximately two thirds were not aware of the health hazard of kohl due to its potential for lead toxicity.
Although efforts of the public health department have led to a significant decline in the selling of kohl products, kohl still poses a health hazard in NYC. Worldwide, lead toxicity represents the most dangerous environmental health concern. Kohl has been shown to induce high serum lead levels in adults and children of breast feeding mothers. We report that most kohl users are not aware of this hazard and use remains persistent within certain communities. In our cosmopolitan society, it is crucial that physicians particularly ophthalmologists be aware of the compelling evidence of this third world danger to educate, inform and deliver a lasting impact on patient and public awareness.
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