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Application of ‘Kajal’ (also known as kohl or surma) is a common practice in Indian families. Although concerns about its safety have been raised, its use in pediatric age is very prevalent. The beliefs and practices with respect to use of ‘Kajal’ in children attending a tertiary care pediatric hospital in northern India are described.
One hundred consecutive children under 12 years of age of both genders and all religions (65% Hindus, 30% Muslims, and 5% other religions) were examined for use of ‘Kajal’. Eighty-six children had been applied ’Kajal’. Of these, 48 were girls and 38 were boys. Most of the children were under five years of age. On interview, the following information was collected.
‘Kajal’ (Kohl) is a popular eye care product and its use has been reported since ancient times. Kohl (surma) has been defined as an eye preparation in ultra fine form of specially processed “Kohl Stone” (galena) incorporated with some other therapeutically active ingredients. It has been claimed to keep the eyes cool and clean, improve vision and strengthen the eyes. It has also been used for the prevention and treatment of eye diseases such as blepharitis, cataract, conjunctivitis etc. It is also said to ward off an ‘evil eye’.
Most commercially produced ‘kajal’ contain high levels of lead. Studies have revealed that ‘Kajal’ comprises of galena (PbS), minium (Pb3O4), amorphous carbon, magnetite (Fe3O4), and zincite (ZnO). Prolonged application may cause excessive lead storage in the body, affecting the brain and bone marrow, causing convulsions and anemia. Dirty fingers, sharp and uneven fingernails of the caregivers are potentially harmful to the child’s eyes. However, one study has questioned the authenticity of such reports and has claimed that ‘Kajal’ is safe for use. US FDA does not permit its use in a cosmetic or in any other FDA-regulated product.
Despite recommendations against the use of ‘Kajal’, it is routinely used in children. It is necessary that the health care providers should educate the parents regarding the use of Kajal. The steps that can be taken by different agencies can be