The use of topical anesthetics around the eye area.

When doing permanent eyeliner it is imperative to understand  the risks involved if the topical anesthetic gets into the eye.  Topical creams or gels which are  indicated for use on normal skin are  under no circumstances allowed to go into the eye.


The cornea is a transparent living tissue which covers the outer part of the eye. It plays an important role in  adapting  light sufficiently to allow proper focus. It also forms a protective barrier against pathogens  entering the eye.

Important points to know about corneal injuries:

Depending on the severity of the injury, the following can be possible:
·       The epithelium (outer layer of the cornea) can be damaged and nerve endings exposed which is extremely painful.
·       Infection can occur and pathogens can enter the eye which can result in permanent eye damage.
·       The endothelium is the deepest layer of the cornea. These cells do not regenerate and this is a very serious injury.

With corneal injuries it can be divided into two categories:

1.    A corneal abrasion:  This refers to a ‘mechanical’ injury for example a fibre from cotton wool or even something as simple as a piece of mascara creates a physical cut or graze on the cornea.

2.    A chemical injury.  There can be two causes for this.

2.1  The preservative component in the product. The general rule is that all preservatives are toxic to the cornea.  It just differs in the percentage and level of toxicity. Of the topical anesthetics available from most distributors in South Africa, most of them contain an ingredient that might cause damage to corneal cells.  Some of those ingredients are actually used in theatre during eye surgery.

2.2  The pH of the product is too alkaline and this causes a chemical burn. The pH of the cornea is 7.1 -8.6.  Outside of the pH range of 6.5 to 8.5, structural and functional alterations occur. Direct cellular damage, as well as disruption of junctional complexes, lead to a breakdown in the barrier function of the corneal endothelium. The extent of this breakdown is dependent upon both the magnitude of the pH change and the exposure time. Alkali chemicals cause liquefactive necrosis and can penetrate through the cornea in 5 –15 minutes.

An example of different pH levels of 5 topical anesthetics mostly used in South Africa.  The measurement on the right refers to the colored blocks on top.  The more yellow/orange, the more acidic the product is.  The more pink/red, the more alkaline it is.
The measurement below shows that the more blue the paper turns, the more alkaline it is.

How to apply topical anesthetic:
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It is advisable to use an eye drop beforehand like Celluvisc that has a thicker viscosity to cover the eye ball.  Make sure that all the lashes and surrounding skin are dried properly before applying your cream / gel. I prefer to apply both the eyelids’ anesthetic with the client’s eyes closed   – so as to minimize the chance of any products going into the eye.

I would not advise for topical anesthetic around eyelids to be on for longer than 10 minutes. The skin around the eyelids is very thin.
Exposure time needed is dependent on the following factors:
1.      Do you use a gel or a cream?  Generally a gel consistency absorbs quicker and needs less time.
2.     Do you cover the anesthetic with a barrier film?  If so, the effect of the topical anesthetic will also be quicker.

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There is a debate around  the use of barrier film.  In my opinion the most important considerations are HOW you use barrier film.  Barrier film is  a nice tool to use to maximize the efficacy of your topical anesthetic.  I also like the fact that the client is less likely to open her eyes by accident if she has it secured.

Things to avoid when using barrier film:

1.      Do not push the barrier film onto the skin with a firm pressure – this will cause the product underneath it to move into the lashes and into the eye.
2.     Never ever leave the room during the time that your client has topical anesthetic on.  Barrier film will cause a rise in temperature on that part of the covered skin.  (This is what makes the topical anesthetic more effective).  When it looks misty, it is time to remove the film and the product. It should not be left on so long that it causes condensation.  Also check that the clients’ eyes are not watering.  Any condensation or watering will cause the product to move and you need to monitor this.
3.     Use proper barrier film.  It has a more sturdy structure and is less likely to ‘collapse’ into the product and on top of the lashes.

Barrier film should only lightly touch the skin and product.

Remove barrier film when heat has built up – before condensation occurs.

Whether you use barrier film or not, it is imperative to monitor the client and this also means that you do not talk too much. Clients cannot hold their eyes closed and still when having a conversation.  Keep the atmosphere relaxing and professional.

When you take all of the above factors into consideration, it is clear to see the responsibility you have as a permanent makeup professional, regardless of which brand name and technique you use.  Be responsible.