Knowledge, Pattern of Use and Outcomes of Eyelash Cosmetic Products among Women in Saudi Arabia: A Cross-Sectional Study

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.

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.

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

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

Table 2: Eyelash and eyelid cosmetic practices, awareness and spending habits among participants

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

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

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.

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

Table 7: Impact of Risk Awareness on the Likelihood of Continued Eyelash Extension Use

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.

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.

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