Julie Woodward, MD is the chief of oculofacial surgery at Duke University Medical Center, where she is also Associate Professor of Ophthalmology and Dermatology. She specializes in cosmetic and reconstructive surgery of the eyelids and orbit as well as the cosmetic laser surgery of the skin.
August 21, 2017 will be the biggest and best solar eclipse viewable in the United States until April 8, 2024. There are predictions that seven million people will travel to its path to gaze at the eclipse. Many companies have produced glasses labeled ISO, for International Organization for Standardization, to prevent solar retinopathy. Regular sunglasses do not have enough filter to allow an individual to gaze directly at the sun. However, sunglasses are important to filter out harmful rays during an average day for both ocular and periocular skin protection, whether one is at the beach, pool, snow, or simply driving to work. Hats are also helpful to shield the eyes and eyelids from harmful UV, infrared, and visible light rays.
Sunglasses and hats provide good protection but may not eliminate all harmful rays that cause eye damage including eyelid cancer, pterygium, cataracts, and macular degeneration. Much of the damage to our eyes comes from reflected light. Sunglasses may only block 30 percent of the UV rays to our eyes since rays can enter from the peripheral. Sunglasses are also not tightly regulated by the FDA or the American National Standards Institute (ANSI), so there is no guarantee that 100 percent UV protection is truly delivered. In addition, access to sunglasses may be limited.
This is why proper application of daily sunscreen to the eyelids is important. Unfortunately, there have been urban myths in the past that claimed water-proof sunscreen introduced to the eyes could cause ocular damage and vision loss. The organization Prevent Blindness America released a statement that did not support this myth but did stress the importance of eye protection.1
A DRIVE FOR SAFETY
• Front-windshield UV-A blockage: Avg. 96%
• Side-window UV-A blockage: Avg. 71%
• Side-window UV-A blockage range: 44%-96%
• More skin cancers occur on the left (driving side) of the body: 52.6%
—JAMA Ophthalmol. 2016;134(7):772-775; JAAD.2010;63(6):1006-10
Sunscreens for Prevention
Sunscreens can cause stinging in the eye but have never been documented to cause permanent eye damage or vision loss as noted in a press release (July 1999) by the American Academy of Ophthalmology.2 Chemical sunscreens and preservatives are the likely agents that cause stinging in the eyes. The FDA also does not clearly regulate which sunscreens can be safely used around the eyes, but generally those with mineral blocks are less irritating and can be used safely.
Some of the companies that formulate sunscreens for use around the eyes do so with an anhydrous base to prevent migration into the eye. A few companies that make mineral sunscreens that are designed for periocular use include:
1. Physical Eye UV Defense by Skin Ceuticals SPF 50
2. Supergoop! Advanced Anti-Aging Eye Cream Broad Spectrum Sunscreen SPF 37
3. Shisheido Sun Protection Eye Cream SPF 34
4. Ultrasun SPF 30 Eye Cream
5. Lancome Bienfait Multi-Vital Eye SPF 28 Sunscreen
6. Clinique Superdefense SPF 20 Age Defense Eye Cream
7. Kiehl's Clearly Corrective Dark Circle Perfector road Spectrum SPF 30
For an eye product to be labeled with an SPF, the FDA does require testing on humans, which is extremely expensive. Subsequenty each batch of product produced must be tested before it is released. In general, labeled FDA approved products are preferred because they have known SPF values and are less apt to migrate.
Many forms of eyelid cosmetics already contain minerals that are clearly not irritating to the eyes, as they are so widely used around the eyes as makeup and may help provide some protection, but the amount is unknown. Eyeliners are not labeled with SPF protection, but many do contain protective minerals such as ferrous oxide, titamium, or zinc. Of note kohl, which provides the black pigment for many eyeliners, is not particularly protective against UV rays.
Beyond prevention of UV exposure, repair of photodamage is essential. Topical antioxidants are very important to scavenge free radicals produced by UV rays. AOX Eye Gel by SkinCeuticals tops the list in the category.
A Real Risk
The Skin Cancer Foundation states that the eyelid region accounts for about one percent of the surface area of the body, but accounts for five to 10 percent of all nonmelanoma skin cancers.3 The most common area for skin cancer is the lower eyelid followed by the medial canthus, the eyebrow, upper eyelid, then lateral canthus. Dealing with skin cancers can be cosmetically disfiguring and emotionally stressful, especially when they involve the eyelid margins and involve eyelash loss. Involvement of the lacrimal system can cause chronically irritating epiphora.
Early and Often
Because sun damage is cumulative and inadequate protection can happen starting with children on a playground,4 to college athletes,5 to short walks from the car into work, a good daily protection with a non-irritating sunscreen to the periocular area helps to prevent wrinkles and photoaging, as well as disfiguring eyelid cancer, along with other types of ocular ailments.
4. Nyiri P. Sun protection in Singapore's schools. Singapore Med J 2005 Sept;46(9): 471-5
5. Jinna S, Adams BB. Ultraviolet radiation and the athlete: risk, sun safety, and barriers to implementation of protective strategies. Sports Med. 2013 Jul;43(7): 531-7.