[Lead poisoning caused by prolonged use of kohl, an underestimated cause in French-speaking countries]

Abstract

Use of kohl (called surma in India and Pakistan) as an eye cosmetic is very common, especially among women, children, and babies, not only in North Africa (Morocco, Algeria, Egypt), but also in the Near East and the Middle East, as well in India and Pakistan. This practice has now become widespread in European countries and North America. The cultural custom is very old and has been in use in Egypt since the Ancient Empire. In a great number of kohls available on the free market, lead sulfide is the main component and the very high lead concentration is a risk, particularly for women and children. We report the observation of a case of lead poisoning in a young Moroccan woman caused by prolonged use of a kohl and provide a review of the published literature. This case study should draw the attention of ophthalmologists in French-speaking areas to a public health problem, largely ignored, although real, considering the high lead concentrations found in the majority of kohls. Actions such as prohibition (importation and sale of eye cosmetics made of lead sulfide) have proved to be inadequate. Appropriate educational campaigns directed toward populations using eye cosmetics will be more effective over the long term.