Year : 1981 | Volume
: 29 | Issue : 3 | Page : 283--288
Cataractogenous effect of hair dyes
IS Jain, GC Jain, RL Kaul, SP Dhir
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
I S Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh
|How to cite this article:|
Jain I S, Jain G C, Kaul R L, Dhir S P. Cataractogenous effect of hair dyes.Indian J Ophthalmol 1981;29:283-288
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Jain I S, Jain G C, Kaul R L, Dhir S P. Cataractogenous effect of hair dyes. Indian J Ophthalmol [serial online] 1981 [cited 2023 Jun 1 ];29:283-288
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1981/29/3/283/30902
p-phenylenediamine or p-diaminobenzenc or ursol-D (C 6 H 8 N 2 ) is commonly used pro�duct for cosmetic purposes in this modern age of beauty consciousness. Paraphenylene�diamine is an aniline dye, naturally available in white to slightly red crystals. It is readily soluble in water and darkens on exposure to air. By virtue of this property, it is being used as hair dye in humans. Toxic effects in the form of dermatitis, conjunctivitis corneal ulcers, cyclitis, secondary glaucoma, gangrene of lids, optic neuritis and proptosis have been recorded but no harmful effect on the lens have been reported. One of us (ISJ) had observed over the years that hair dye users showed cataractous changes much more oftner than non hair dye users and at a rather younger age. To substantiate this clinical observation, we have undertaken a clinical and experimental study to this effect.
MATERIALS AND METHODS
All the patients attending the Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, were surveyed and persons using hair dye (HD) for more than one year were examined. Examination included, chief complaints, detailed history of the use of hair dye (name of dye, its active ingredients, duration of use, periodicity of use, amount of dye used, any side effect or any allergic manifestation) and detailed ophthalmic examination with more emphasis on slit lamp examination and refrac�tion of the patient.
Concurrently individuals with no history of hair dye, (NHD) of same age, sex and race were cross matched with hair dye group.
Patients having any systemic or local ocu�lar disease liable to cause cataract were exclu�ded.
Albino rats and rabbits of either sex were taken for the study. Whenever dye was applied directly to the eye, the opposite one was kept as control. All animals were examined before the start of experiments and animals having any systemic or local disease were excluded. All experiments were done under full aseptic conditions. Study was divided into following sub groups:�
1. Local instillation of drops in rats' eyes
Three groups were made each having ten rats. 5,10 and 15% drops were made and instilled once daily in each group.
2. Painting of hairs
Ten rats were taken and. hair in the head region and abdomen were painted with 4% paraphenyle diamine every week.
3. Penetration of dye in anterior chamber
Five rabbits were taken and subconjunc�tival injection of dye given. After 15,30 and 60 minutes, aqueous was collected and presence of dye in the anterior chamber was measured by fluorometry.
4. Subconjunctival injection
Five rabbits were taken and 4 mg. dye dissolved in 0.2 ml. was injected every week.
5. Intravitreal Injections
Experiments were conducted in rabbits and graded dose of 1 mg., 0.5 mg., 0.25 mg. and 0.1 mg. dye in 0.2 ml. of normal saline was injected in 5 animals each. Intravitreal injec�tions were done through the parsplana after paracentasis of the anterior chamber.
[Table 1] shows age and sex distribution of hair dye individuals with control group (non hair dye groups). Maximum patients were in the age group of 31 to 50 years (76.0%). Male and female ratio is shown in [Table 1]. Female patients outnumbered male patients.
16% of patients showed allergic reactions [Table 2]. These reactions were mild to mode�rate in severity and did not require discontinu�ation of use.
Patients using hair dye were found to be having changes in lens and the individuals who were under 40 years of age with no lenticular changes had early presbyopia. Though the lens changes were appreciated by slit lamp examination, yet the visual acuity was not affected in most of the cases. 96% of the cases showed lenticular and other changes while in 4% of cases no abnormality could be detected.
Lenticular changes observed were:�
1. Posterior central opacity - where a definite central opacity was seen in the posterior cortex.
2. Posterior/Anterior cortical cataract - where opacity was more diffuse and involving the periphery.
3. Posterior/Anterior cortical changes - included lamellar seperation vacoules, water clefts, polychromatic lustre.
4. Posterior/Anterior capsular changes - included epithelial and sub-epithelial opacities.
5. Increased posterior density - No definite opacity but posterior reflex was dense.
Other changes noted were nuclear cataract, mature cataract and cases operated for cata�ract.
Types of opacities are enumerated in [Table 3].
The exact duration of usage of hair dye could not be ascertained as mostly users being females, they were reluctant to give the exact figures for social reasons. Therefore, it was felt that the duration was always more than quoted in the text. 40 were users of dye of more than 10 years duration and 80 each of 5-10 years and 1-5 years. Maximum duration of use of hair dye was 40 years.
Lenticular changes were definitely related to duration and frequency of use. Average age of senile cataract operations in North Indian population is 58 years while the same was 45.4 years in persons using hair dye with an average duration of use of 14.1 years. Incidence of aphakia was very high (25%) in persons using hair dye for more than 10 years.
Lenticular changes were classified in five grades. Eye having more change was recor�ded in the next grade from a group of indi�viduals with different changes in two eyes. Classification of changes are shown in [Table 4]. Maximum cases were seen with grade II lens changes (42%), while grade III and IV also formed a major group (35%).
Lenticular changes in control (non hair dye) group is shown in [Table 5]. Most of the changes were seen in Grade II and Grade Ill.
Results of experimental study is seen in [Table 6] which shows that:�
a) Pharaphenylene diamine penetrates the blood aqueous barrier.
b) Local application of drug is toxic to the cornea and produces keratitis and corneal opacities.
c) Prolong systemic as well as local appli�cation of dye has deleterious effect on the lens and it produces cataractous changes.
d) A minimum dose of 0.25 mg. para�phenylenediamine inside the eye can cause lens opacities within 24 hours.
paraphenylenediamine is an aniline dye and its molecular weight is 108.14, boiling point 267�C, melting point 140� C, soluble in 100 part cold water. Maximum lethal dose in rabbits is 250 mg/kg body weight.
In the literature two types of reactions have been described with paraphenylenedia�mine. Acute toxic reactions which include conjunctivitis, corneal ulcers, lid gangrene, proptosis and cyclitis. While other reactions are allergic in nature. In includes dermatitis, angioneurotic oedema, allergic conjunctivitis and retrobulbar neuritis. Both these reac�tions are of acute onset and so easily noticea�ble. Some of these allergic reactions have been reported by the hair dye users as mentioned earlier [Table 2].
No lens change has so far been described as a form of toxicity due to this drug. How�ever, no toxic effects in the form of lenticular opacities or cataract formation, have so far been reported in the literature, neither by the manufacturers in the form of warning to the users, or by opthalmologists.
We feel that onset of early presbyopia in hair dye users may be one of the toxic mani�festation on the lens. The patients are not happy with their eyesight and the complaints are vague and illdefined. The lens changes occur over a prolonged period of use and vary in degree being governed by many other common factors of age and duration.
That there is a link between the hair dye and its toxic effect of the lens is amply proved by the experimental data in the present report. What exactly is the mechanism, is purely speculation at this stage. It is known that some types of experimental cataracts are due to a frank coagulation of the lenticular proteins, abnormal ionic interchange, injury to the subcapsular epithelium with consequent damage to the lenticular fibres, osomotic hydration following abnormal metabolic changes, a process which may ultimately result in proteolysis, others to an upset of the metabolism of the lens as by enzyme inhibi�tors or the loss of a substance essential in the biochemical chain of events usually affect�ing the glycolytic or occasionally the lipid or the protein metabolism, and still others to purely cytotoxic causes.
Hair dye can reach the eye and lens in particular through systemic or local absorp�tion. Paraphenolene diamine has got three important properties. Firstly it is an anion, secondly its aqueous solution rapidly absorbs oxygen and lastly it readily reacts with all carbohydrates and forms benzimidazoles.
The exact cause of the development of lenticular opacities is not clear but it will appear that as a surface active agent, it will alter the normal membrane selective permea�bility and osmotic properties of cells and its affinity with oxygen and its reaction with carbohydrates will interfere with oxidative and glycolytic metabolism of lens. Probably com�bination of all these factors will produce the lenticular changes over a period of time.
Observations based on a clinical and ex�perimental study of the effect of hair dye (paraphenylenediamine) on the lens are repor�ted. Two hundred individuals of either sex using hair dye were examined in detail and lenticular changes were found in 89% while only 23% in controls. The lenticular changes were related to duration, amount and indi�vidual sensitivity to dye. Various types of lenticular opacities encountered are mentioned. In addition some individuals (7%) were found to develop early presbyopia. Experimental study which was conducted in rats and rabbits confirmed the cataractogenic effect of hair dye beyond doult.
It is concluded that hair dye is potentially toxic to the human lens.