Journal of Pioneering Medical Scienceshttps://doi.org/10.47310/jpms2026150120Research ArticleKnowledge, Pattern of Use and Outcomes of Eyelash Cosmetic Products among Women in Saudi Arabia: A Cross-Sectional StudyAlyahyaJanajana13alyahya@gmail.combin YousefSarahAlhadbanHindBin MohammadRaghadAlshehriYaraAlhuthailReemAlessaDalalAlhajressDanahCollege of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi ArabiaDepartment of Ophthalmology, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi ArabiaObjectives: Eye cosmetics such as eyeliners, eyelash extensions, contact lenses and mascara are widely used for aesthetic purposes, yet improper or prolonged use may harm ocular health. This study aimed to evaluate the knowledge, practices and self-reported ocular symptoms associated with eyelash and eyelid cosmetic use among a convenience sample of Saudi women. Methods: A cross-sectional survey was conducted between October 2024 and March 2025 among 448 women predominantly aged 18-24 years recruited via social media and online forums. Participants completed a structured questionnaire on demographics, cosmetic use and ocular complaints. Data were analyzed using descriptive statistics and chi-square tests. Composite outcome variables (‘ocular complaints’) were defined as the presence of any self-reported symptom, including allergic reactions, lash thinning, itching or discomfort. STROBE guidelines were followed for reporting observational studies. Handling of missing data: all questions were mandatory in Google Forms, preventing incomplete responses; remaining missing data were minimal (<5%) and not imputed. Results: Overall, 93.3% (n = 418) reported using eyelash or eyelid cosmetics, with 75.4% n = 338) using them for >3 years. While 50.2% n = 225) reported no symptoms, others noted self-reported complaints such as allergic reactions (33.5%, n = 150), lash thinning (16.5%, n = 74), itching (22.8%, n = 102) and discomfort (21.4%, n = 96). Only 8.3% (n = 37) sought medical care. Awareness of potential risks was noted in 30.1%, Higher awareness was significantly associated with reduced periorbital irritation, swelling and rash around the eye, (p = 0.054) but did not consistently influence future use intentions among those prioritizing aesthetic outcomes. Unsafe practices, including prolonged reuse of eyelash extensions and inadequate makeup removal, were significantly associated with ocular complaints (p <0.05). Conclusions: Eyelash and eyelid cosmetics are highly prevalent among the studied population and linked to preventable ocular surface irritation. User-dependent behaviors, particularly reusing extensions and inconsistent removal, remain key risk factors. Public health initiatives, particularly via social media, are needed to promote behavior change and safer cosmetic practices.Eyelash ExtensionsMascaraContact LensesOcular SymptomsCosmetic SafetyRisk AwarenessPreventionSaudi Women18112025112202528122025522026This article is distributed under the terms of the Creative Commons Attribution 4.0 International License.INTRODUCTION

The global cosmetic industry has witnessed unprecedented growth in recent years, with eyelash and eyelid enhancements becoming increasingly mainstream [1,2]. While these procedures are primarily sought for aesthetic purposes, their rising popularity has raised critical public health concerns regarding user-dependent safety practices [3,4]. In Saudi Arabia, the cosmetic sector is among the largest in the region, with high consumption rates already documented among university students [5].   Despite increasing use, regulatory oversight remains inconsistent. While the Saudi Food and Drug Authority (SFDA) regulate the safety of cosmetic ingredients [6], the clinical impact of improper consumer practices, such as reusing extensions, remains largely unmonitored [7,8]. Previous local research has established a link between frequent eye cosmetic use and self-reported ocular symptoms, such as dry eye or irritation, among Saudi women [9]. However, a significant gap remains in understanding the relationship between users’ risk awareness and their actual behavioral attitudes [10,11].   We hypothesize that despite high reported awareness, unsafe practices remain prevalent due to strong aesthetic motivations. Therefore, this study investigates the knowledge, attitudes and self-reported symptoms associated with eyelash and eyelid cosmetic enhancements among Saudi women, distinctly categorizing risks associated with different products [1,4,12,13]. Findings from this research provide critical insights to guide safer beauty practices in regions where cosmetic enhancements are rapidly expanding.

METHODS

Study Design A cross-sectional survey was conducted from October 2024 to March 2025. Due to the online recruitment method, a convenience sampling approach was employed, reaching a younger, digitally active demographic. This study was conducted following the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines to ensure transparent and complete reporting [14].   Study Population and Sampling A minimum of 385 participants was calculated using OpenEpi [15] (95% CI, 5% margin of error).   Inclusion and Exclusion Criteria Inclusion: Female participants ≥18 years with prior eyelash/eyelid cosmetic use.   Exclusion Males and individuals <18 years [1].   Data Collection Instrument The questionnaire was adapted from prior studies [1,3,5], refined through a pilot study with 30 participants and included 30 questions covering demographics, cosmetic usage, health history and risk awareness. Validity was confirmed through the pilot study, ensuring clarity and comprehensibility of all questions.   Data Collection Procedure The questionnaire was distributed electronically via Google Forms on social media, forums and beauty salons. Participation was voluntary, anonymous and took 10-15 minutes. To prevent multiple submissions by the same participant, Google Forms was set to accept only one response per user.   Statistical Analysis Data were analyzed using SPSS v27 (IBM Corp., Armonk, NY, USA). Descriptive statistics were calculated for all variables. Associations between cosmetic usage, ocular complaints and awareness were assessed using the Chi-square test. Fisher’s exact test was employed when the expected frequency in any cell was less than five. Actual p-values are reported (e.g., p <0.001) to ensure statistical clarity. A p-value <0.05 was considered statistically significant [15].   Ethical Considerations The study adhered to the Declaration of Helsinki [16] and received approval from the Institutional Review Board of Imam Mohammad Ibn Saud Islamic University (Project number: 771/2025, Date of approval: 12/02/2025). Electronic informed consent was obtained from all participants and data were stored securely.

RESULTS

Participant Characteristics Table 1 shows a total of 448 participants were included, predominantly aged 18-24 years (77.9%, n = 349), with 71.7% (n = 321) residing in the Central Region. Most participants held a Bachelor’s degree (63.2%, n = 283). Cosmetic enhancements were primarily used for aesthetic purposes (93.3%, n = 418), with 75.4% (n = 338) reporting usage durations exceeding three years. Regarding pre-existing ocular health, a significant portion of participants reported having a diagnosed eye disease, with dry eye disease (DED) being the most prevalent condition, reported by 33.5% (n = 150) of the sample. This high prevalence is particularly noteworthy, as it explains the frequent reliance on lubricant eye drops, which were used by nearly half of the participants (49.2%, n = 220). The data suggest that while long-term use of cosmetic enhancements is prevalent, most ocular symptoms remain mild and self-managed, indicating a strong trend toward managing chronic dryness without formal clinical intervention. Furthermore, while systemic diseases were uncommon (13.8%, n = 62), over half of those affected (58.1%, n = 36) were not receiving active treatment. This gap in formal treatment uptake, combined with the preference for over-the-counter lubricants, suggests that users often prioritize immediate symptomatic relief over professional medical consultation, even when dealing with diagnosed chronic conditions.   Table 1: Demographic and clinical characteristics of participants Variables n (%) Age, years 18-24 349 (77.9) 25-29 29 (6.5) 30-34 19 (4.2) 35-39 14 (3.1) 40-44 17 (3.8) 45-49 11 (2.5) 50+ 9 (2) Region Central Region 321 (71.7) Eastern Province 56 (12.5) Western Province 39 (8.7) Northern Province 23 (5.1) Southern Province 9 (2) Educational level I don't have an educational qualification 1 (0.2) Primary Stage 1 (0.2) Intermediate Stage 3 (0.7) High School Diploma 134 (29.9) Bachelor's Degree 283 (63.2) Higher education 26 (5.8) Which types of cosmetic enhancements do you use? Contact lenses 4 (0.9) Eye Makeup (Mascara, Eyeliner, eyeshadow) 145 (32.4) Eyelash extension 8 (1.8) Eyelash extension, Contact lenses 4 (0.9) Eye Makeup (Mascara, Eyeliner, Eyeshadow), Contact lenses 94 (21) Eyelash extension, Eye Makeup (Mascara, Eyeliner, Eyeshadow) 94 (21) Eyelash extension, Eye Makeup (Mascara, Eyeliner, Eyeshadow), Contact lenses 99 (22.1) Reason for using cosmetic enhancements? Aesthetic enhancement 418 (93.3) Hide imperfections of the eyelids and eyelashes 30 (6.7) How long have you been using these enhancements? Less than 6 months 16 (3.6) 6 months to 1 year 25 (5.6) 1 to 3 years 69 (15.4) More than 3 years 338 (75.4) Do you have any eye diseases? Blepharitis 10 (2.2) Conjunctivitis 4 (0.9) Dry eyes 150 (33.5) Other 114 (25.5) No 170 (37.9) What ocular medications do you use? None 170 (37.9) Antibiotic eye drops 2 (0.4) Eyedrops containing steroid 8 (1.8) Redness relief eye drops 8 (1.8) Lubricants 220 (49.2) Anti allergic eye drops 14 (3.1) Other 26 (5.8) How long have you been affected by this condition? Don't have any condition 281 (62.7) Less than 6 months 95 (21.2) 6 months to 1 year 35 (7.8) 1 to 3 years 25 (5.6) More than 3 years 12 (2.7) Do you have any systemic diseases? No 386 (86.2) Asthma 19 (4.2) Diabetes 5 (1.1) Hypo/Hyperthyroidism 15 (3.3) Rheumatoid arthritis 5 (1.1) Other 18 (4) Do you use any treatment for systemic disease? Yes 26 (41.9) No 36 (58.1)   Eyelash and Eyelid Cosmetic Practices Most participants, as shown in Table 2, (76.6%, n = 343) reported not following any specific eyelash care routine, indicating that proper maintenance practices are uncommon.   Occasional use of eyelash extensions and eyeliner was reported by 33.7% (n = 151) and 41.7% (n = 187) of participants, respectively, suggesting that intermittent application is more common than regular use. Mascara was used several times per week by 32.6% (n = 146), reflecting consistent cosmetic use among a notable portion of the sample.   Awareness of potential risks varied: 30.1% (n = 135) reported being very aware, while 17% (n = 76) were not aware at all, highlighting a gap in knowledge that could influence safe usage behaviors. Social media was the most common source of information (50.9%, n = 228), underscoring the influence of digital platforms on cosmetic practices.   Regarding future intentions, 39.1% (n = 175) stated they were very unlikely to continue using eyelash extensions, whereas only 9.4% (n = 42) indicated they were very likely to continue, suggesting that a substantial proportion may reconsider use after experiencing ocular complaints or gaining awareness of risks.   Table 2: Eyelash and eyelid cosmetic practices, awareness and spending habits among participants Variables N (%) What eyelash care routine do you use? Nothing 343 (76.6%) Eyelash growth serum 46 (10.3%) Oil (like castor) 18 (4%) Petroleum jelly (Vaseline) 14 (3.1%) Eyelash growth serum, Oil (like castor) 9 (2%) Eyelash growth serum, Petroleum jelly (Vaseline) 8 (1.8%) Oil (like castor), Petroleum jelly (Vaseline) 6 (1.3%) Eyelash growth serum, Oil (like castor), Petroleum jelly (Vaseline) 4 (0.9%) How often do you use the following enhancements? [Eyelash extensions] Never 252 (56.3%) Occasionally 151 (33.7%) Weekly 15 (3.3%) Several times a week 21 (4.7%) Daily 9 (2%) How often do you use the following enhancements? [Mascara] Never 3 (0.7%) Occasionally 125 (27.9%) Weekly 86 (19.2%) Several times a week 146 (32.6%) Daily 88 (19.6%) How often do you use the following enhancements? [Eyeliner] Never 54 (12.1%) Occasionally 187 (41.7%) Weekly 68 (15.2%) Several times a week 89 (19.8%) Daily 50 (11.2%) How long have you been using these enhancements? Less than 6 months 16 (3.6%) 6 months to 1 year 25 (5.6%) 1 to 3 years 69 (15.4%) More than 3 years 338 (75.4%) Source of eyelash extension? Beauty Shops 66 (14.7%) Drug store/pharmacy 42 (9.4%) Online retailers 72 (16.1%) Salon 21 (4.7%) What type of eyelash extensions do you use? Strip lashes 88 (19.6%) Individual lashes 83 (18.5%) Magnetic lashes 11 (2.5%) Semi-Permanent Eyelashes 19 (4.2%) What type of glue do you use? Cyanoacrylate Glue 9 (2%) Waterproof Glue 34 (7.6%) Unkown type 155 (34.6%) Have you ever experienced an allergic reaction to the type of glue you use? Yes 25 (5.6%) No 173 (38.6%) How do you take off your eyelash extensions? Adhesive Remover 36 (8%) Fall off naturally 18 (4%) Get professional help 8 (1.8%) Pull on them 139 (31.1%) Do you reuse eyelash extension more than the intended use? Yes 31 (6.9%) No 170 (38%) Do you take off eye makeup, lashes and contact lenses when going to sleep? Rarely 6 (1.3%) Sometimes 40 (8.9%) Nearly all the time 92 (20.5%) Always 310 (69.2%) How much do you typically spend on eyelash cosmetic enhancements each month? Don't spend anything 310 (69.2%) Less than a 100 Riyals 93 (20.8%) From a 100-150 Riyals 11 (2.5%)   Table 2: Eyelash and eyelid cosmetic practices, awareness and spending habits among participants From a 150-250 Riyals 21 (4.7%) More than 250 Riyals 13 (2.9%) Has your usage of cosmetic enhancements increased or decreased over the past year? Decreased 90 (20.1%) Increased 56 (12.5%) Stayed the same 302 (67.4%) Are you aware of potential risks and complications associated with cosmetic enhancements? Not aware 76 (17%) A little aware 117 (26.1%) Somewhat aware 120 (26.8%) Very aware 135 (30.1%) Where did you first hear about the potential risks of eyelash extensions? Friends/Family 62 (13.8%) Social media 228 (50.9%) Beauty professionals 19 (4.2%) Healthcare professionals 52 (11.6%) Other 87 (19.5%) How likely are you to continue using eyelash extensions in the future? Very unlikely 175 (39.1%) Unlikely 58 (12.9%) Neutral 102 (22.8%) Likely 71 (15.8%) Very likely 42 (9.4%)   Ocular Complaints and Healthcare-Seeking Behavior Half of the participants (50%, n = 224) reported no ocular complaints, indicating that a substantial proportion did not experience noticeable adverse effects. The most frequently reported complaints were itching (22.8%, n = 102), eye discomfort or sensitivity (21.4%, n = 96) and watery eyes (18.5%, n = 83). Thinning or loss of natural lashes was reported by 16.5% (n = 74), highlighting cosmetic-related changes in lash integrity for a subset of users.   Only 8.3% (n = 37) consulted a physician after symptom onset, whereas 41.7% (n = 187) did not seek professional care despite experiencing symptoms, suggesting a preference for self-management or underestimation of symptom severity. These findings are illustrated in Figures 1 and 2.     Figure 1: Self-reported ocular complaints (n = 448)     Figure 2: Healthcare-Seeking Behavior Among Participants (N = 448)   Association Between Awareness of Risks and Ocular Complaints Table 3 shows no significant associations were observed between awareness levels and specific ocular complaints, including redness (p = 0.088), itching (p = 0.716) and eye discharge (p = 0.699). However, periorbital irritation, swelling or rash around the eye, showed a notable trend toward lower frequency among participants reporting being “very aware” (1.5%, n = 2) compared to those who were “a little aware” (9.4%, n = 11; p = 0.054) suggesting a possible trend toward reduced risk with higher awareness levels.   Participants experiencing any ocular complaints were slightly less prevalent in the “very aware” group compared to the “not aware” group (43.7% vs. 53.9%; p = 0.200), although this difference did not reach statistical significance, highlighting that awareness alone may not consistently translate into protective behaviors.   Table 3: Association Between Awareness of Cosmetic Enhancement Risks and Reported Ocular Complaints Complaints Awareness of potential risks and complications associated with cosmetic enhancements p-value Not aware A little aware Somewhat aware Very aware Redness Yes 8 (10.5%) 28 (23.9%) 18 (15%) 23 (17%) 0.088 No 68 (89.5%) 89 (76.1%) 102 (85%) 112 (83%) Itching Yes 19 (25%) 28 (23.9%) 29 (24.2%) 26 (19.3%) 0.716 No 57 (75%) 89 (76.1%) 91 (75.8%) 109 (80.7%) Discharge Yes 8 (10.5%) 9 (7.7%) 7 (5.8%) 10 (7.4%) 0.699 No 68 (89.5%) 108 (92.3%) 113 (94.2%) 125 (92.6%) Watery eyes (increased tearing) Yes 12 (15.8%) 27 (23.1%) 26 (21.7%) 18 (13.3%) 0.159 No 64 (84.2%) 91 (76.9%) 94 (78.3%) 117 (86.7%) Discomfort or sensitivity in the eye area Yes 17 (22.4%) 22 (18.8%) 29 (24.2%) 28 (20.7%) 0.784 No 59 (77.6%) 95 (81.2%) 91 (75.8%) 107 (79.3%) Thinning or loss of natural lashes Yes 13 (17.1%) 15 (12.8%) 25 (20.8%) 21 (15.6%) 0.409 No 63 (82.9%) 102 (87.2%) 95 (79.2%) 114 (84.4%) Swelling or Rash around the eye Yes 5 (6.6%) 11 (9.4%) 8 (6.7%) 2 (1.5%) 0.054 No 71 (93.4%) 106 (90.6%) 112 (93.3%) 133 (98.5%) Any Complaints Yes 41 (53.9%) 66 (56.4%) 58 (48.3%) 59 (43.7%) 0.200 No 35 (46.1%) 51 (43.6%) 62 (51.7%) 76 (56.3%)   Impact of Eyelash Extension Reuse on Ocular Complaints The reuse of eyelash extensions beyond their intended duration was significantly associated with an increased prevalence of several ocular complaints. Participants who reused extensions reported higher rates of redness (38.7%, n = 12 vs. 12.6%, n = 21; p = 0.001), itching (38.7%, n = 12 vs. 21.6%, n = 36; p = 0.041), periorbital irritation, swelling or rash around the eye, : 16.1%, n = 5 vs. 3.6%, n = 6; p = 0.014, discharge (19.4%, n = 6 vs. 7.2%, n = 12; p = 0.030) and watery eyes (32.3%, n = 10 vs. 15%, n = 25; p = 0.020) compared to participants who did not reuse extensions (Table 4).   Furthermore, the overall prevalence of any ocular complaints was significantly higher among participants who reused extensions (80.6%, n = 25 vs. 48.5%, n = 81; p = 0.001), highlighting the substantial impact of extension reuse on ocular surface irritation and the importance of adhering to recommended usage guidelines.   Table 4: Association between reuse of eyelash extensions and ocular complaints Complaints Reusing eyelash extensions more than the intended use p-value Yes No Redness Yes 12 (38.7%) 21 (12.6%) 0.001 No 19 (61.3%) 146 (87.4%) Itching Yes 12 (38.7%) 36 (21.6%) 0.041 No 19 (61.3%) 131 (78.4%) Discharge Yes 6 (19.4%) 12 (7.2%) 0.030 No 25 (80.6%) 155 (92.8%) Watery eyes (increased tearing) Yes 10 (32.3%) 25 (15%) 0.020 No 21 (67.7%) 142 (85%) Discomfort or sensitivity in the eye area Yes 11 (35.5%) 27 (16.2%) 0.012 No 20 (64.5%) 140 (83.8%) Thinning or loss of natural lashes Yes 6 (19.4%) 35 (21%) 0.840 No 25 (80.6%) 132 (79%) Swelling or Rash around the eye Yes 5 (16.1%) 6 (3.6%) 0.014 No 26 (83.9%) 161 (96.4%) Any Complaint Yes 6 (19.4%) 86 (51.5%) 0.001 No 25 (80.6%) 81 (48.5%)   Impact of Pre-Sleep Removal Practices on Eye Health Participants who rarely removed cosmetic enhancements before sleep showed higher rates of ocular complaints compared to those who consistently removed them (Table 5). Specifically, increased prevalence of itching was observed among participants who rarely removed enhancements (33.3%, n = 2 vs. 20.3%, n = 63; p = 0.040), as well as watery eyes (42.5%, n = 17 vs. 15.8%, n = 49; p = 0.002).   Overall, the presence of any ocular complaint was also more prevalent among participants who rarely removed cosmetic enhancements before sleep (50%, n = 3 vs. 51.9%, n = 161; p = 0.007), suggesting that inadequate removal practices may contribute to ocular surface irritation and symptom development.   Table 5: Impact of Makeup, Eyelash and Contact Lens Removal (Safety practice) Before Sleep on Eye Health. Complaints Taking off eye makeup, lashes and contact lenses when going to sleep p-value Rarely Sometimes Nearly all the time Always Redness Yes 0 (0%) 9 (22.5%) 10 (10.9%) 58 (18.7%) 0.176 No 6 (100%) 31 (77.5%) 82 (89.1%) 252 (81.3%) Itching Yes 2 (33.3%) 16 (40%) 21 (22.8%) 63 (20.3%) 0.040 No 4 (66.7%) 24 (60%) 71 (77.2%) 247 (79.7%) Swelling Yes 1 (16.7%) 1 (2.5%) 4 (4.3%) 10 (3.2%) 0.294 No 5 (83.3%) 39 (97.5%) 88 (95.7%) 300 (96.8%) Rash around the eye Yes 0 (0%) 1 (2.5%) 3 (3.3%) 6 (1.9%) 0.555 No 6 (100%) 39 (97.5%) 89 (96.7%) 304 (98.1%) Discharge Yes 0 (0%) 7 (17.5%) 6 (6.5%) 21 (6.8%) 0.144 No 6 (100%) 33 (82.5%) 86 (93.5%) 289 (93.2%) Watery eyes (increased tearing) Yes 1 (16.7%) 17 (42.5%) 16 (17.4%) 49 (15.8%) 0.002 No 5 (83.3%) 23 (57.5%) 76 (82.6%) 261 (84.2%) Discomfort or sensitivity in the eye area Yes 2 (33.3%) 14 (35%) 17 (18.5%) 63 (20.3%) 0.116 No 4 (66.7%) 26 (65%) 75 (81.5%) 247 (79.7%) Thinning or loss of natural lashes Yes 1 (16.7%) 3 (7.5%) 14 (15.2%) 56 (18.1%) 0.344 No 5 (83.3%) 37 (92.5%) 78 (84.8%) 254 (81.9%) Any Complaints Yes 3 (50%) 10 (25%) 50 (54.3%) 161 (51.9%) 0.007 No 3 (50%) 30 (75%) 42 (45.7%) 149 (48.1%)   Future Use of Extensions Participants who expressed a high likelihood of continuing to use eyelash extensions in the future (“very likely”) reported significantly higher rates of thinning or loss of natural lashes (31%, n = 13 vs. 10.9%, n = 19; p = 0.023). Notably, periorbital irritation, swelling or rash around the eye, also showed a significant association with future intentions, with the highest prevalence observed among those “very likely” to continue use (16.7%, n = 7) compared to only 3.4% (n = 6) in the “very unlikely” group (p = 0.012). No other statistically significant associations were observed for the remaining ocular complaints, suggesting that lash thinning and periorbital irritation are the most noticeable consequences influencing user experience.   Awareness of potential risks showed an inverse relationship with intentions to continue use. Participants who were “very aware” of the associated risks were more likely to report an intention to discontinue eyelash extension use (45.1%, n = 79 “very unlikely” vs. 16.7%, n = 7 “very likely”; p<0.001). In contrast, participants who were “not aware” of potential risks showed a higher tendency toward continued use (31%, n = 13 “very likely”), highlighting the role of risk awareness in shaping future cosmetic behavior.   These findings are summarized in Tables 6 and 7. eye, also showed a significant association with future intentions, with the highest prevalence observed among those “very likely” to continue use (16.7%, n = 7) compared to only 3.4% (n = 6) in the “very unlikely” group (p = 0.012). No other statistically significant associations were observed for the remaining ocular complaints, suggesting that lash thinning and periorbital irritation are the most noticeable consequences influencing user experience.   Awareness of potential risks showed an inverse relationship with intentions to continue use. Participants who were “very aware” of the associated risks were more likely to report an intention to discontinue eyelash extension use (45.1%, n = 79 “very unlikely” vs. 16.7%, n = 7 “very likely”; p<0.001). In contrast, participants who were “not aware” of potential risks showed a higher tendency toward continued use (31%, n = 13 “very likely”), highlighting the role of risk awareness in shaping future cosmetic behavior.   These findings are summarized in Tables 6 and 7.   Table 6: Association Between Future Intentions to Use Eyelash Extensions and Ocular Complaints Complaints How likely are you to continue using eyelash extensions in the future? p-value Very unlikely Unlikely Neutral Likely Very likely Redness Yes 27 (15.4%) 12 (20.7%) 22 (21.6%) 9 (12.7%) 7 (16.7%) 0.515 No 148 (84.6%) 46 (79.3%) 80 (78.4%) 62 (87.3%) 35 (83.3%) Itching Yes 31 (17.7%) 17 (29.3%) 26 (25.5%) 18 (25.4%) 10 (23.8%) 0.324 No 144 (82.3%) 41 (70.7%) 76 (74.5%) 53 (74.6%) 2 (76.2%) Discharge Yes 13 (7.4%) 5 (8.6%) 6 (5.9%) 6 (8.5%) 4 (9.5%) 0.893 No 162 (92.6%) 53(91.4%) 96 (94.1%) 65 (91.5%) 38 (90.5%) Watery eyes (increased tearing) Yes 27 (15.4%) 10 (17.2%) 22 (21.6%) 14 (19.7%) 10 (23.8%) 0.623 No 148 (84.6%) 48 (82.8%) 80 (78.4%) 57 (80.3%) 32 (76.2%) Discomfort or sensitivity in the eye area Yes 34 (19.4%) 15 (25.9%) 20 (19.6%) 12 (16.9%) 15 (35.7%) 0.123 No 141 (80.6%) 43 (74.1%) 82 (80.4%) 59 (83.1%) 27 (64.3%) Thinning or loss of natural lashes Yes 19 (10.9%) 9 (15.5%) 20 (19.6%) 13 (18.3%) 13 (31%) 0.023 No 156 (89.1%) 49 (84.5%) 82 (80.4%) 58 (81.7%) 29 (69%) Swelling or Rash around the eye Yes 6 (3.4%) 3 (94.8%) 6 (5.9%) 4 (5.6%) 7 (16.7%) 0.012 No 169 (96.6%) 55 (8.6%) 96 (94.1%) 67 (94.4%) 35 (83.3%) Any Complications Yes 95 (54.3%) 30 (51.7%) 50 (49%) 33 (46.5%) 16 (38.1%) 0.393 No 80 (45.7%) 28 (48.3%) 52 (51%) 38 (53.5%) 26 (61.9%)   Table 7: Impact of Risk Awareness on the Likelihood of Continued Eyelash Extension Use Awareness of potential risks and complications associated with cosmetic enhancements How likely are you to continue using eyelash extensions in the future? p-value Very unlikely Unlikely Neutral Likely Very likely Not aware 26 (14.9%) 7 (12.1%) 13 (12.7%) 17 (23.9%) 13 (31%) <0.001 A little aware 33 (18.9%) 14 (24.1%) 28 (27.5%) 34 (47.9%) 8 (19%) Somewhat aware 37 (21.1%) 24 (41.4%) 3 (32.4%) 12 (16.9%) 14 (33.3%) Very aware 79 (45.1%) 13 (22.4%) 28 (27.5%) 8 (11.3%) 7 (16.7%)

DISCUSSION

The present study revealed widespread use of cosmetic enhancements, with self-reported symptoms such as allergic reactions being common. The frequent use of lubricant eye drops suggests a tendency toward self-management of symptoms rather than professional consultation. Statistical analysis confirmed that prolonged reuse of eyelash extensions and infrequent removal before sleep and certain awareness levels were significantly associated with increased ocular complaints including itching and periorbital irritation (p <0.05) [1,2,9].   Our findings align with Albdaya et al. [9], who previously established a link between cosmetic frequency and dry eye symptoms in the Saudi population. Aesthetics emerged as the primary motivation for 93.3% of participants [12,13]. The high reliance on social media (50.9%) reflects the digital habits of our younger demographic [5]. Interestingly, while awareness of risks (30.1%) was moderate, ocular complaints remained prevalent. However, our data revealed a significant trend where higher awareness was associated with a reduction in periorbital irritation, swelling or rash around the eye, yet aesthetic desire continued to drive future intentions despite reported symptoms. This highlights a “behavioral gap” where awareness does not necessarily drive preventive practices when aesthetic desire is the primary motivator.   Ocular surface irritation symptoms such as itching (22.8%) align with broader trends [8]. It is important to note that these symptoms were mostly mild, which may explain the low healthcare-seeking behavior (8.3%) observed in this cohort [3].   Notably, participants who intended to continue eyelash use reported significantly higher rates of lash thinning and periorbital irritation, suggesting a high tolerance for complaints in favor of aesthetic outcomes.   Strengths of this study include its large sample size and the detailed examination of user practices, such as reuse and removal habits, in relation to ocular symptoms. It also uniquely highlights the gap between risk awareness and the persistence of cosmetic use despite complications. However, limitations include the online convenience sampling, reliance on self-reported non-clinically verified data and an age-restricted sample, which may introduce selection and recall bias.

CONCLUSIONS

Eyelash and eyelid cosmetic enhancements are widely used among the studied population of young Saudi women. User-dependent behaviors, particularly reusing extensions and inconsistent removal, are strongly linked to preventable ocular surface complaints. While moderate risk awareness showed a potential trend in reducing certain complaints like periorbital irritation, it did not consistently translate into professional healthcare-seeking behavior, likely due to the mild nature of the reported symptoms. To bridge this gap, targeted educational campaigns should be integrated into social media platforms, focusing on practical hygiene protocols and the importance of professional consultation when symptoms persist. Furthermore, there is a need for clearer regulatory guidelines regarding product labeling and salon safety standards to ensure user safety and informed consumer choices. [5,6].   Ethical Statement The study adhered to the Declaration of Helsinki [16] and was approved by the Institutional Review Board of Imam Mohammad Ibn Saud Islamic University (Project number: 771/2025; Date of approval: 12/02/2025). All participants provided electronic informed consent prior to participation and all data were stored securely in compliance with institutional regulations and privacy standards.   The data supporting the findings of this study are included within the manuscript tables and supplementary materials. Additional de-identified data that support the results of this study are available from the corresponding author upon reasonable request, in accordance with ethical and privacy considerations.

ReferencesNayak, Manisha et al. “Awareness regarding adverse reactions caused by cosmetic products among female patients.” Journal of Cosmetic Dermatology, vol. 22, no. 9, September 2023, pp. 2512-2519. https://doi.org/10.1111/jocd.15734.Idu, Felix K. et al. “Ocular side effects of eyelash extension use among female students of the University of Benin, Nigeria.” Cureus, vol. 16, no. 1, January 2024. https://doi.org/10.7759/cureus.53047.Beshtawi, Iman M. et al. “Knowledge, awareness and perceptions of artificial eyelash use and associated ocular side effects among Palestinian females: a cross-sectional study.” Cureus, vol. 17, no. 6, June 2025. https://doi.org/10.7759/cureus.86753.Nisar, Fariha et al. “Cosmetic product use and associated adverse events among women in Abbottabad, Pakistan.” Medical Science Monitor Basic Research, vol. 30, 2024, article e943048. https://doi.org/10.12659/MSMBR.943048.Husain, K. “Usage of personal care products, especially cosmetics, among university students in Saudi Arabia.” Journal of Cosmetic Dermatology, vol. 18, no. 1, January 2019, pp. 271-277. https://doi.org/10.1111/jocd.12773.Aljallal, Mohammed A. et al. “Evaluating reporting trends and adverse effects of cosmetic products in Saudi Arabia based on SFDA cosmovigilance data.” Scientific Reports, vol. 15, no. 1, 2025. https://pubmed.ncbi.nlm.nih.gov/40695878/.Sullivan, David A. et al. “TFOS lifestyle: impact of cosmetics on the ocular surface.” The Ocular Surface, vol. 29, 2023, pp. 77-130. https://doi.org/10.1016/j.jtos.2023.04.005.Nagendran, S.T. et al. “Complications and adverse effects of periocular aesthetic treatments.” Survey of Ophthalmology, vol. 67, no. 3, 2022, pp. 741-757. https://doi.org/10.1016/ j.survophthal.2021.04.009.Albdaya, Noura A. et al. “Prevalence of dry eye disease and its association with frequent usage of eye cosmetics among women.” Cureus, vol. 14, no. 7, July 2022, article e27142. https://doi.org/10.7759/cureus.27142.Alkalash, S.H. et al. “Knowledge, attitude and practices regarding cosmetics among women in the Al-Qunfudah Governorate, Saudi Arabia.” Cureus, vol. 17, no. 12, December 2025. https://doi.org/10.7759/cureus.98239.Udayanga, Lakshmi et al. “Knowledge, perceptions and consumption behaviour of cosmetics among undergraduates of Sri Lanka: a descriptive cross-sectional study.” Frontiers in Public Health, vol. 11, 2024, article 1184398. https://pubmed.ncbi.nlm.nih.gov/38288434/.Masud, M. et al. “Eyelid cosmetic enhancements and their associated ocular adverse effects.” Medical Hypothesis, Discovery and Innovation in Ophthalmology, vol. 8, no. 2, 2019, pp. 96-103. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611311/.Zhu, Angela et al. “Ocular adverse effects of over-the-counter cosmetics and personal care products reported to the Food and Drug Administration.” Ophthalmic Plastic and Reconstructive Surgery, vol. 41, no. 1, 2025, pp. 61-66. https://doi.org/10. 1097/IOP.0000000000002718.Elm, Erik von et al. “The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.” Journal of Clinical Epidemiology, vol. 61, no. 4, April 2008, pp. 344-349. https://pubmed.ncbi.nlm.nih.gov/18313558/.Sullivan, Kevin M. et al. “OpenEpi: a web-based epidemiologic and statistical calculator for public health.” Public Health Reports, vol. 124, no. 3, May 2009, pp. 471-474. https://doi.org/10.1177/003335490912400320.Goodyear, Michael D. et al. “The Declaration of Helsinki.” BMJ, vol. 335, no. 7621, September 2007, pp. 624-625. https://doi.org/10.1136/bmj.39339.610000.BE.