Kohl for the Newborn: An Old Protection and a Modern Poison

In June 2011 a six-month-old boy was referred to a specialist unit at Boston Children's Hospital with a raised blood lead level. The investigators found one source. Since he was two weeks old, his family had been applying tiro, a Nigerian eye powder bought by a grandparent from a street vendor in Ilorin, to his eyelids, to make him more attractive and to help his eyes develop. The tiro was 82.6 per cent lead. Three months after the family stopped, his blood lead had fallen from 13 to 8 micrograms per decilitre.^[1]

The case was reported because it caused harm. The practice it records is ordinary: a dark line drawn around a baby's eyes, one of the first cosmetics a person ever wears.

The reasons are protective as much as decorative. The report on the Boston case notes that tiro has been used to ward off the evil eye, to relieve eyestrain and soreness, to prevent infection of the umbilical stump or a circumcision wound, and to prevent sun glare, and that similar products are known as kohl, surma and kajal.^[2] An Afghan refugee family in Albuquerque, whose two young children were found with raised blood lead in 2013, said that applying kajal to the children's eyelids was meant to promote eye health.^[3]

The United States Food and Drug Administration states it plainly: in some cultures it is common for parents to apply these products to the eyes of infants and children.^[4]

Very. In a 2021 survey of 200 mothers of newborns in a rural area of Lucknow, in northern India, 52.5 per cent had applied kajal to the baby's eyes after birth, and almost as many had put some substance on the umbilical stump.^[5]

The practice travels with the families who keep it. New York City's health department analysed 220 samples of traditional eye cosmetics and cultural powders collected between 2013 and 2022, and found them in use "among children as young as newborns"; most of the surma came from Pakistan, most of the kohl from Morocco and most of the kajal from India.^[6]

A study in Israel published in 1992 measured it. Seven samples of kohl used locally contained between 17.3 and 79.5 per cent lead. Infants aged six to sixteen months who had kohl applied had a mean blood lead of 11.2 micrograms per decilitre, against 4.3 in those who did not, and even infants who were not given kohl had higher levels when their mothers used it.^[7]

In Karachi, a 2002 study of 430 young children found about four in five with raised levels, and listed the application of surma to children's eyes among the factors associated with them.^[8] In the Albuquerque family the kajal was 54 per cent lead, and the four-month-old's level was 33.5.^[9]

The names cover different things. In the New York samples, lead was much higher in surma and kohl than in kajal.^[10] An Indian analysis found that kajal carries the chemical signature of soot, a combustion product, while surma is a different preparation altogether.^[11]

That distinction matters to a family. A soot-black is not free of concern, but it is not the same risk as a mineral powder that is half lead. The difficulty is that the names change from region to region, and a parent buying "kohl" or "surma" cannot see what is in the jar.^[10]

How old the practice is, and how many families keep it safely. Every source here is modern and clinical, and the clinical literature finds the practice where it causes harm. Households whose kohl is harmless do not appear in it.^[12] The ritual's long history is easy to assume and has not been written from evidence like this.