Counsel patients about cosmetic products and procedures

Faced with an ever-expanding menu of cosmetic eye procedures, consumers may be confused about what is and isn't safe. Jeffrey Walline, O.D., Ph.D., chair of the AOA's Contact Lens & Cornea Section (CLCS), offers suggestions to help doctors of optometry educate misinformed patients.

Colored/decorative contacts

Many consumers consider decorative contact lenses a fashion or costume accessory. In reality, these lenses still pose the same potential safety and health issues as corrective contact lenses, and require a prescription.

"All contact lenses need to be prescribed and monitored by a doctor to make sure they fit properly and provide a healthy environment for the eye. Lenses are medical devices that affect the health of the eye," says Dr. Walline.

This includes people who don't need sight correction but just want to change their eye color.

Make sure patients know not to share lenses with friends, because they risk infection, no matter how much the lenses have been cleaned.

Tattooed/permanent eye makeup

Proceed with extreme caution, says Dr. Walline.

"There really needs to be a major reason for this to be done, such as a person has experienced a disfiguring injury," he says. "There is a risk of a serious allergic reaction, and they won't know that until the tattoo is there already. And once it happens, it can be very difficult to reverse. They have to remove the dye that was injected, and that's not easy to do."

Also, the iron used in the injected paint might interfere with an MRI should a patient ever need one. If a patient is determined, counsel them to research where it will be done. The facility should have a business license and a board of health certificate. Tell them to make sure a fresh needle is used for every color.

Blepharoplasty (eyelid lifts)

Make sure patients know that insurance will only pay for this procedure if it is medically necessary, such as if lids are obstructing their vision. The limited field by the lid must be documented with visual fields, sometimes photos and other measurements.

"Medically, as long as it is done by an experienced surgeon, there isn't much risk," says Dr. Walline. If patients are concerned about getting that cat-eye look, tell them that is the result of too many surgeries. They need a surgeon they can trust to tell them when enough is enough.

Eyelash extensions

There is the potential that extended lashes can break off and scratch the cornea. Again, patients should research any facility for cleanliness and certification.

A more permanent fix would be to use lash enhancer solutions prescribed by a doctor, though these products have side effects of their own. "It would be up to the person's comfort level and which one works best for them," says Dr. Walline.

Ocular tattoos

Sometimes (rarely) there are medical reasons for this, such as to cover a corneal scar. Other than that, counsel against corneal and scleral tattoos. "It is not reversible and there are large risks of infection and blindness," warns Dr. Walline.

Eye jewelry

Eyelid piercings can rub against the eye and potentially threaten sight. As for the latest fad of gluing jewels on the sclera, there are major risks, including infection and blindness.