Thirty-Nine Percent Lead, By Weight

Kohl, kajal, surma, al-kahal, tiro, tozali, kwalli. The names vary by region and so do the recipes, and that variation is the whole problem, because some of them are soot and some of them are lead sulfide and you cannot tell which by looking.

The practice is ancient and it is not superstition. Kohl reduces glare, which matters under desert sun. It is applied to newborns in parts of South Asia and the Middle East and North Africa as protection, as blessing, as something a grandmother does. Dismissing that as ignorance is both wrong and useless, and the case literature makes clear that it is the infant application that produces the worst outcomes.

The CDC case, in numbers

The Morbidity and Mortality Weekly Report, 2024: lead poisoning in a mother and her four children in New York City, identified across 2012 to 2023.

Peak blood lead levels. Child A: 15 to 17 µg/dL. Child B: 18. Child C: 30. Child D: 11. The mother: 15. All declined after the family stopped using the product, over years of follow-up.

The CDC’s blood lead reference value — the level at which intervention is indicated in children — is 3.5 µg/dL.

The source was a single product, Hashmi Surma Special, manufactured in Pakistan. It measured 390,000 parts per million lead. That is 39 percent of the product, by weight.

The FDA’s own fact sheet reports that lead sulfide can make up more than half the weight of some kohl products, and names a tiro sample tested at 82.6 percent lead.

Why lead here is worse than lead elsewhere

Three reasons, and they compound.

The application site. It goes on the waterline, directly against a mucous membrane, with the conjunctiva and the nasolacrimal duct immediately downstream. That is an absorption route, and it is a considerably more efficient one than skin.

The age. The practice is applied to infants and small children in many of the communities that use it. Lead’s neurodevelopmental harm is dose-dependent and age-dependent, and there is no threshold below which it is considered safe in a developing brain.

The invisibility. Chronic low-level lead exposure does not present as poisoning. It presents as irritability, poor appetite, developmental delay, abdominal pain, learning difficulty. Nobody connects a child’s speech delay to an eye cosmetic, and no pediatrician asks unless they already know to.

The FDA maintains an import alert. None of these products is an approved color additive for use around the eyes in the US, and the agency documents pediatric poisoning cases specifically from kohl. There is also case literature from France, and a case report of chronic lead poisoning from daily eyelid application in an adult.

What you can act on, and what you cannot check

The first question is whether your kohl contains lead, and the honest answer is that you cannot determine this from the packaging.

Some products are genuinely soot-based — carbon, oil, ash — and carry no lead at all. Traditional preparation methods vary enormously and many are entirely safe. But the commercially manufactured products that travel, that get brought back in a suitcase, that are sold in shops serving diaspora communities, are the ones in the FDA’s testing data, and they are the ones at 39 and 82 percent.

What you can act on:

Anything imported without a US-compliant ingredient label is untested from your point of view. That is not a judgment about the manufacturer, it is a statement about what you know.

Anything being applied to a child under six is the highest-stakes version of this, and it is the version that produced the CDC case.

A blood lead test is cheap, quick, and available from any pediatrician or GP. If kohl has been used on a child regularly, ask for one. Not because it is probably high — because the harm is silent and the test is trivial and the alternative is finding out later.

And there are manufactured eye pencils and gel liners that produce the same look, are regulated as cosmetics, and have ingredient lists you can read. That is not a request to abandon the practice. It is a different product doing the same job with a supply chain somebody is watching.

The same absence of testing shows up one shelf over, in the oral preparations sold by the same shops: one in five Ayurvedic products, twice, four years apart.

One thing I will not do

I am not going to write this as a story about a foreign practice that endangers children. Lead was in American house paint until 1978 and in American petrol until 1996, and it is still in the water in places where the people affected are not the people making decisions about pipes.

What makes this one different is that it is fixable at the level of a single purchase. Not a policy, not a pipe replacement, not a twenty-year remediation. One jar, and knowing which one.

This article is educational and is not a substitute for care from someone who can look at your skin. Anything new, changing, painful or spreading should be assessed rather than researched.