Download long lashes, but at what price?

Patients must be educated about the side effects of bimatoprost.
BY LESLIE E. O’DELL, OD
Longer, fuller, thicker eyelashes are a highly
sought-after beauty attribute and a big
money maker for the cosmetics industry.
A recent survey by the finance website
Mint.com found that women spend an
average of $15,000 on makeup in their lifetime, with $3,770 going to mascara alone.1
The eyelashes are part of ocular adnexa,
and as eye care providers, we should be talking to our
patients about their make-up habits. Mascara, like most
cosmetic products, is not regulated by the US Food and
Drug Administration. It can contain waxes, pigments, resins, and even talc.
When mascara does not do what it is meant to do,
many women seek some other means to grow their
lashes longer, fuller, and thicker or add to their lashes to
extend them. Vaseline (petroleum jelly; Unilever), lavender
essential oil, coconut oil, talc powder, eyelash enhancing
serums, lash extensions, and fake lashes are a few of the
options available.
A side effect of the glaucoma medication bimatoprost
(Lumigan; Allergan) led to the FDA approval of this prostaglandin analogue as Latisse (bimatoprost 0.03%) in 2008.
Since that time more than 5 million bottles have been
sold, with the average price per bottle ranging from $100
to $120.2
COVER FOCUS
LONG LASHES,
BUT AT WHAT PRICE?
A
B
Figure 1. Lashes shown at baseline (A) and after 16 weeks of Latisse use (B).
JULY/AUGUST 2015 | ADVANCED OCULAR CARE 69
COVER FOCUS
A
B
Figure 2. Right eye, no drops (A); left eye (B), patient shows side effects from chronic use of glaucoma drops. Note iris
darkening, increased superior sulcus, decreased fat, and ptosis.
OUTSIDE OF EYE CARE
What may be surprising to many is that Latisse is
often prescribed by individuals outside of the eye care
profession without a preliminary eye evaluation. Who?
Dermatologists, online websites run by primary care physicians and registered nurses, and beauticians at day spas.
There are even reports of the drug being sold at health
clubs.
The danger of these practices lies in the lack of education that consumers are given at the time of their purchases. Even if Latisse results in 25% longer, 106% fuller,
and 18% darker eyelashes,3 this change does not come
without risks. These risks, although not life-threatening,
can have a negative impact on eyelid appearance over
time.
A term has been coined for the cosmetic changes
patients undergo from prolonged use of topical prostaglandin analogues: prostaglandin associated periorbitopathy.4,5 Signs of prostaglandin associated periorbitopathy
include redness of the eyelid margin, orbital fat atrophy,
superior sulcus deformity, higher lid crease, endophthalmos, increased pigmentation of the adnexa, increased
pigmentation of the iris, lengthened eyelashes that can
become misdirected, and growth of unwanted hair in
areas exposed to the eye drops (Figure 2).5
Orbital fat atrophy causes the patient to have a deepset eye and some ptosis. It also can produce a condition
known as tight orbit syndrome, in which the lid becomes
very tight to the globe, making examination of the superior portions challenging.6 Increased sulcus deformity also
causes a droopy appearance to the eyes. All of these side
effects would be frowned upon by a consumer trying to
enhance her beauty.
When Latisse first became available, I wanted to include
it in my practice so I could provide the much-needed
70 ADVANCED OCULAR CARE | JULY/AUGUST 2015
evaluation, application demonstration, and education of
the potential risks to patients. Also, I am a woman and a
consumer, and I was intrigued by this new application of
an existing medication. I wanted to try it myself.
WHO IS A CANDIDATE?
Some women are not candidates for the drug; anyone
with a history of uveitis, active ocular infection, history of
macular edema, or allergy to any ingredients should avoid
using Latisse. If a woman is a good candidate, the eye care
provider should document hypotrichosis and provide a
baseline examination with “before” pictures of the lids and
adnexa. Baseline intraocular pressure should be measured,
and the color of the iris should be documented. The baseline examination should also include evaluation for any
underlying ocular surface disease, including aqueous or
evaporative dry eye disease, allergy, and blepharitis.
Demodex blepharitis is a common problem, with some
studies showing increased incidence as early as the third
decade of life.7 All prostaglandin analogues, including
Latisse, are contraindicated for these patients due to the
risk for increased mite growth.6 Epilation of a few lashes
should be performed at the baseline evaluation to determine the presence of Demodex.
PROPER TECHNIQUE
If a patient is a good candidate and is willing to invest in
this cosmetic treatment, the next step is to demonstrate
proper technique of application. The patient should be
instructed to use the application brush provided and
apply the solution to the upper eyelid margin at the base
of the lashes.
The need to avoid overuse should be emphasized.
Some women find waiting 4 to 6 weeks for results is just
too long, and they may think that “more is better” and a
way to achieve faster results. Really,
however, overuse is a good way to
increase unwanted side effects and
even unwanted hair. Stray hair will
grow on the cheek, for example,
if Latisse is applied there. Patients
should be educated that Latisse must
be discontinued if they become pregnant or are nursing.
This is also a good opportunity
to talk to your patient about their
makeup habits. You can educate
them on the importance of removing
their makeup every night and recommend products that work without
harsh chemicals: eg, coconut oil as
a natural makeup remover. Educate
them to properly replace their makeup and to avoid sharing cosmetics
with others. Promote the idea that
good lid hygiene is the first step in
achieving long, lush eyelashes.
BACK TO BASELINE
As for me, after a 6-month trial of
Latisse I did have longer lashes, but I
also had redness on my lid margins. I
discontinued use before trying for my
second child, and within 4 months
my eyelashes were back to baseline.
Some of my patients have had great
success with this drug, but most, in
the end, have discontinued it due to
the long-term costs. n
1. Crooks R. Splurge vs. save: which beauty products are worth the extra
cost? http://www.instyle.com/beauty/15-under-15-best-bargain-beautyproducts. Accessed July 13, 2015.
2. Latisse Frequently Asked Questions. www.Latisse.md. https://www.
latisse.md/latisse-frequently-asked-questions. Accessed July 9, 2015.
3. Latisse [package insert]. Irvine, CA: Allergan Inc; 2008.
4. Tan J, Berke S. Latanoprost-induced prostaglandin-associated periorbitopathy. Optom Vis Sci. 2013;90(9):e245-247.
5. Pasquale LR. Prostaglandin associated periorbitopathy. Glaucoma Today.
June 2011; 52-58.
6. Filippopoulos T, Paula JS, Torun N, et al. Periorbital changes associated
with topical bimatoprost. Ophthal Plast Reconstr Surg. 2008;24:4:302-307.
7. Hom M. Treatment approach in addressing Demodex mites on lids.
Optometry Times. October 2013.
Leslie E. O’Dell, OD
Director of the Dry Eye Center at
Wheatlyn Eye Care, York, Pennsylvania
n [email protected];
www.twitter.com/helpmydryeyes
n Financial disclosure: none acknowledged
n