Dry Eye Dx and Tx

Nowhere to Hide From Formaldehyde

Dry Eye Dx and Tx

Nowhere to Hide from Formaldehyde

By Katherine M. Mastrota, MS, OD, FAAO

I learn something new every day, and it is usually taught to me by one of the patients that I have seen during the course of that day. Today was no exception.

In December’s issue of Contact Lens Spectrum, I discussed some details of Sick Building Syndrome and its deleterious effect on our eyes. The following is an excerpt from the column:

“Chemical pollutants from adhesives, carpeting, upholstery, manufactured wood products, copy machines, pesticides and cleaning agents, [which] may emit volatile organic compounds (VOCs), including formaldehyde.”

Well guess what I found out today? It seems that formaldehydes are used routinely in fabrics and garments. Who knew?

Formaldehyde is Everywhere

A little research brought up a New York Times article on the same topic. In it I learned that the antiwrinkle finish used in clothing comes from a resin that releases formaldehyde. The textile industry uses formaldehyde for fire retardation, increased water repellency, and stiffness in fabric. The article says that, “Clothing is not the only thing treated with formaldehyde. Formaldehyde is commonly found in a broad range of consumer products and can show up in practically every room of the house.”

An August 2010 report of the United States Government Accountability Office on formaldehydes in textiles summarized that while formaldehyde levels in clothing generally appear to be low, these resins have been shown to be potent sensitizers in some patients, leading to allergic contact dermatitis (Reich and Warshaw, 2010). However, the World Health Organization (WHO) has reported that formaldehyde levels up to 900 times higher than that considered safe by the WHO have been identified in some imported clothing.

Effects on our Patients

How does this bode for our patients who have ocular surface disease or ocular allergy? Formaldehyde is a known eye, nose, and throat irritant, and in 1991, the U.S. Environmental Protection Agency (EPA) classified formaldehyde as a probable human carcinogen.

Formaldehyde surrounds us at work, with certain professions at higher risk for exposure. Formaldehyde is found in disinfectants used in laboratories, schools (especially gross anatomy labs [Chia et al, 1992]), hospitals, dental facilities, and veterinary settings. It is also abundant in photography, plumbing, agricultural, automotive, printing, and pest control industries. Even hairdressers are at risk, with the Federal Occupational Safety and Health Administration (OSHA) investigating products that have caused eye irritation from certain formaldehyde-releasing hair products.

Eyelash extension procedures, performed in spas, beauty boutiques, and some department stores, may cause ocular disorders such as keratoconjunctivitis and allergic blepharitis that are thought to be caused by glues for eyelash extensions that contain formaldehyde.

Finding the Answers

As part of our ocular history, we inquire how patients use their eyes. I believe it is equally important to understand where patients who have signs and symptoms of ocular surface disease are using their eyes. Perhaps the answer to the question, “What are you wearing?” and more importantly, “Where was it manufactured?” can be the answer to a clinical conundrum. CLS

To obtain references for this article, please visit and click on document #197.

Dr. Mastrota is secretary of the Ocular Surface Society of Optometry. She is center director at the New York office of Omni Eye Services. Contact her at