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Microbial Content of Kohl

1987; King Faisal Specialist Hospital and Research Centre; Volume: 7; Issue: 3 Linguagem: Inglês

10.5144/0256-4947.1987.177

0975-4466

Khalid F. Tabbara, Eileen M. Burd,

Ocular Surface and Contact Lens

Original ArticlesMicrobial Content of Kohl Khalid F. Tabbara and MD Eileen M. BurdMS Khalid F. Tabbara Director of Research, King Khaled Eye Specialist Hospital, and Chairman, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia Search for more papers by this author and Eileen M. Burd Microbiologist, Research Department, King Khaled Eye Specialist Hospital, P. O. Box 7191, Riyadh 11462, Saudi Arabia Search for more papers by this author Published Online:1 Jul 1987https://doi.org/10.5144/0256-4947.1987.177SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutABSTRACTABSTRACTThree brands of commercially prepared kohl imported from India were tested and were found to vary widely in microbial content. Heavy contamination, primarily with Bacillus species, Gram-negative bacilli, and a number of fungi, was present in one brand. Moderate contamination was found in the second brand, primarily due to Bacillus species and Staphylococcus epidermidis. The third brand tested contained no microorganisms. Because of the presence of opportunistic organisms in kohl, its use - either cosmetic or medicinal - is not recommended in eyes with diseases that affect the ocular surface. Its use in newborn infants should also be discouraged.INTRODUCTIONKohl (from the Arabic, kuhl) has been used as an eye cosmetic by women of Asia, the Middle East and North Africa since antiquity. It is usually applied to the inside edges of the upper and lower eyelids and may also be used to darken eyelashes and eyebrows. In addition to its use as a cosmetic, kohl has been used for topical folk treatment of eye diseases. Men and women, primarily Bedouins of the Arabian peninsula, use kohl on the eyelid margins to help prevent glare from the bright desert sun. Traditional healers have attributed medicinal qualities to kohl, and it is still used today to treat some eye diseases. Tradition holds that kohl, when instilled into the conjunctival sac, protects against eye disease, promotes good visual acuity and cures conjunctivitis. Even today kohl is painted on the eyelids of babies to protect against eye infections. In the past kohl mixed with rose water was instilled in the eye to treat smallpox pustules.Kohl may be composed of a variety of ingredients, depending on its color and the country of origin. In Egypt, kohl is made primarily from crystals of antimony trisulfide which are ground to a fine black powder. Other colors, such as green (from malachite), blue, gold, gray and white, can also be found. In North Africa, kohl powder is made from a mixture of burnt copper, burnt sandalwood, ambergris and plumbago. In India and the Arabian peninsula, kohl is made from a mixture of various nuts, usually almonds, along with benzoin and incense which are burnt together and then ground to a powder. Various plants and other materials may also be added.Because of the frequency with which kohl is used in the eye and the high incidence in this part of the world of eye diseases with ocular surface defects that predispose to bacterial or fungal secondary infection, we decided to evaluate the microbial content of certain commercially available kohl powders in Saudi Arabia.MATERIALS AND METHODSThree brands of commercially prepared kohl powder were purchased locally. They were Hind Ka Noor (Attari Brothers, Bombay), Ankhon Ka Noor (A. Hami Brothers, Bombay), and Ankhon Ka Noor Surma No. 13 (A. Hami Brothers, Bombay), all of which were imported to Saudi Arabia from India. Ten bottles of each brand were tested. Samples of 0.001 gm each were preincubated in thioglycolate broth for 24 hours and later placed onto the surface of blood agar and chocolate agar plates. The plates were tapped gently to disperse the powder particles. The plates were incubated at 37°C for 24 hours. The numbers and types of bacteria present were counted and identified according to standard microbiologic laboratory methods. Early fungal growth could be appreciated on some of the plates at 24 hours with the aid of an inverted tissue microscope. The culture plates were then incubated at room temperature to promote fungal growth.RESULTSResults of microbiologic evaluation of the three brands of kohl tested are presented in the table. Hind Ka Noor was the most heavily contaminated, with each sample showing significant growth of a number of microorganisms. Bacillus was the most frequent bacterial type isolated and several different species were present. Clostridium species were isolated from six of the ten specimens. A thin, Gram-negative bacillus which produced very mucoid, yellowish colonies was found in all but one of the ten samples. Fungi (three types) were isolated in five samples.The numbers and variety of microorganisms present in Ankhon Ka Noor were less than in Hind Ka Noor. Three of the ten samples of this brand showed no growth. Bacillus again was the most common organism isolated and was present, though in small numbers, in each of the other seven specimens that showed growth. Clostridium species were isolated from one of the specimens and Staphylococcus epidermidis was found in two. Two organisms, both Gram-negative filamentous bacteria, were also isolated but were not identified.The third brand tested, Ankhon Ka Noor Surma, was completely sterile. To ensure that organisms present were not being missed as a result of the small sample size, larger inocula of 0.005 gm were also tested and found to be sterile.Table 1. Microbial content of three brands of kohl.Table 1. Microbial content of three brands of kohl.DISCUSSIONThis study has shown that certain eyeliners in powder form (kohl) commercially available in Saudi Arabia are contaminated with bacteria and fungi. The methods of preparation of kohl from various plant products appear to lack basic sterile techniques. The presence of microorganisms in kohl is serious since most women, and sometimes men, apply the kohl powder on the lid margin (mucocutaneous junction) and may therefore inoculate microorganisms onto the ocular surface. Furthermore, instilling kohl powder in the eye, as practiced by some Saudis, may allow direct inoculation of bacteria and fungi into the conjunctival sac. Since trachoma is highly prevalent in Saudi Arabia, treatment of red eyes with kohl may lead to secondary infection.1 It is believed that secondary bacterial conjunctivitis may aggravate the course of trachoma and may contribute to conjunctival cicatrization.2,3Kohl is also instilled into the eye and/or applied to the lid margins of newborn infants in many Middle Eastern countries, a tradition that may lead to serious ocular infections in infancy if contaminated kohl is used. It should also be recognized that newborn infants have no copious tearing because of lack of nervous stimulation of the lacrimal gland. The accumulation of the foreign particles in the ocular surface will be significant because of deficient tearing and lack of mechanical flushing. Furthermore, the absence of important defense mechanisms such as the antimicrobial constituents of tears would promote adherence and growth of microorganisms on the ocular surface.All the organisms isolated from the kohl samples are potential pathogens.We did not test all brands of kohl on the market. The preliminary results from this study indicate that certain kohl powders may be contaminated and should not be used in or around the eye. The Ministry of Health of the government of Saudi Arabia has been notified and has taken steps to withdraw all commercially available kohl powder. Restrictions on the importation of kohl powder have been enforced.ARTICLE REFERENCES:1. Tabbara KF, Ross-Degnan D. "Trachoma in Saudi Arabia" . Unpublished data. Google Scholar2. Jones BR. "The prevention of blindness from trachoma" . Trans Ophthalmol Soc UK. 1975; 95(l):16–33. Google Scholar3. Darougar S, Jones BR. "Trachoma" . Br Med Bull. 1983; 39(2):117–22. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byAl-Kaff A, Al-Rajhi A, Tabbara K and El-Yazigi A (2019) Kohl-The Traditional Eyeliner: Use and Analysis, Annals of Saudi Medicine , 13:1, (26-30), Online publication date: 1-Jan-1993.Gupta M and Khan S (2019) Kohl Contamination of the Umbilicus Causing X-Ray Opacity: A Case Report, Annals of Saudi Medicine , 10:5, (567-568), Online publication date: 1-Sep-1990.Hussain S (2019) Microbial Content of Kohl, Annals of Saudi Medicine , 8:4, (298-298), Online publication date: 1-Jul-1988. Volume 7, Issue 3July 1987 Metrics History Accepted3 November 1986Published online1 July 1987 KeywordsEye diseases - chemically inducedCosmetics - adverse effectsACKNOWLEDGEMENTSWe wish to thank Monzer Jabak, Research Coordinator, for his great help in this study. We also thank Lorna Arcinue and Emily Rabe for their assistance in the preparation of this manuscript.InformationCopyright © 1987, Annals of Saudi MedicinePDF download