Myths

Kohl or celak on a newborn's eyes: the tradition, and the real risk

A grandmother lines a newborn's eyes with kohl to make them look bigger, or to ward off the evil eye. The love behind it is real. So is the lead in many of these products, and the risk to an open tear duct.

by Dr Chan Li Yen · MBBS, MOphth (UM), Fellowship in Paediatric Ophthalmology & Strabismus

Practises at Hospital Kuala Lumpur 10 min read · 1,857 words

Key takeaways

Kohl, celak, kajal and surma are often heavy with lead, sometimes accounting for more than half the powder's weight, and lead is why health authorities warn against them.
There is no safe level of lead in a child's blood. Even low exposure is linked to developmental delay, learning difficulty and behaviour problems.
A shared, unsterile applicator or pot can also carry infection straight onto a newborn's eye, separate from the lead risk entirely.
If a family wants to keep the tradition, a mark that uses no traditional eye powder at all, placed away from the eyes, keeps the gesture without the lead.
If kohl has touched your baby's eyes, ask for a lead blood test rather than only watching for symptoms, since early lead exposure often causes no obvious signs.

A grandmother lines a newborn's eyes with kohl, or celak, in the first days of life. The eyes are meant to look bigger and brighter, and in some Malay and Indian families it is also believed to ward off the evil eye. The intention behind it is entirely love. I want to be honest about what is actually happening at the same time, because a soft powder against an open tear duct in the first weeks of life carries two real risks that have nothing to do with tradition being wrong: lead, and infection.

Why do families put kohl on a newborn's eyes?

Because it is old, and because it is meant kindly. Kohl, celak, kajal and surma are names for the same idea across different communities: a dark powder, usually applied with a finger or a small stick, drawn along the eyelid or lash line. Families use it to make a baby's eyes look larger, to mark a milestone, or to protect against the evil eye. None of that is foolish, and I am not writing this to talk any family out of a belief that matters to them. What ah ma got right about your child's eyes goes through several pieces of grandmother advice that hold up well under evidence. This is one that does not, and it is worth knowing exactly why.

What is actually in kohl, celak or surma?

Often, lead. The United States Food and Drug Administration has tested products sold under the names kohl, kajal, al-kahal, surma, tiro, tozali and kwalli, and found that lead, usually as lead sulfide, can account for more than half the weight of the powder. One tiro product linked to an infant's lead poisoning was measured at 82.6 per cent lead. A surma product involved in a documented family poisoning case in New York was measured at 390,000 parts per million of lead, which is close to two-fifths lead by weight.

This is why the FDA classes kohl, kajal and surma as illegal colour additives in the United States and keeps an import alert against any eye cosmetic labelled with those names, meaning shipments can be seized at the border. That is a strong regulatory response, and it exists because the lead risk is well established, not theoretical.

Is there a safe amount of lead for a baby's eyes?

No. There is no level of lead in a child's blood that is considered safe. Even low levels are linked to developmental delay, learning difficulty and behaviour problems, and higher exposure can cause anaemia, kidney damage and, in severe cases, seizures.

There is no safe blood lead level in a child. That is the fact underneath everything else in this article.

The scale of the problem is documented, not rare. The FDA's own public health benchmark allows no more than 10 parts per million of lead in an externally applied cosmetic generally, and it says plainly that kohl and similar traditional eyeliners commonly contain far more than that, along with other heavy metals. The CDC has also published case reports of whole families poisoned this way, including one where surma applied to children's eyes over several years kept every family member's blood lead level elevated, one child peaking at 30 micrograms per decilitre against a reference value of 3.5.

Could it also cause an eye infection, not just lead poisoning?

Yes, and this risk sits alongside the lead risk rather than instead of it. Kohl is usually applied with a finger or the same small stick, dipped repeatedly into a pot that is not sterile and often kept for months. That pot, and the finger or applicator going into it, can carry bacteria straight onto a newborn's eye, and a newborn's tear duct is often narrow or not yet fully open, which makes clearing an infection there harder rather than easier. Sharing one pot of kohl between an adult and a baby, or between several children, adds another route for an infection to spread from one eye to another. Whether the risk on any given day is lead, irritation or infection, the eye surface itself does not benefit from any of the three, in the same way it does not benefit from other unsterile home remedies, which is the subject of what the evidence actually says about breast milk in a sticky eye.

The powder itself is also simply gritty against a surface as delicate as a newborn's eye. Rubbing it in, which a baby will do reflexively the moment it is uncomfortable, can scratch the surface of the eye or push the irritation further in rather than out. A red, watery or sticky eye that follows can look identical to ordinary newborn conjunctivitis, and pink eye in children sets out how to tell the different causes of a sticky red eye apart, though a baby's eye that has just had a foreign powder rubbed into it deserves a look regardless of which category it falls into.

What do health authorities actually say about this?

The FDA's position is unambiguous: stop using the product immediately if lead poisoning is suspected, and ask a doctor to test both the child and any pregnant or breastfeeding mother in the household for lead, because the same pot that touched the baby's eyes has usually touched an adult's fingers too. The agency also makes the point that this exposure is easily avoidable, since it comes from a product rather than from food, water or the environment. I have not found a specific Malaysian Ministry of Health or NPRA notice naming kohl or celak by product name, so I am not going to claim one exists; the FDA and CDC evidence above stands on its own regardless of which country a particular pot was bought in.

What can I do instead if the tradition still matters to my family?

Keep the meaning; keep the powder away from the baby. If a family wants to mark the baby, a mark that uses no traditional eye powder at all, placed away from the eyes, keeps the gesture without the lead. Because a lead-containing powder on any part of a baby's skin can reach the hands and then the mouth, the safest choice with kohl, celak, kajal or surma is not to use it on a baby at all, and that is a conversation worth having gently rather than as a confrontation over someone else's love for the baby.

What should I watch for if kohl has already been used on my baby's eyes?

A red, watery, sticky or swollen eye that does not settle with ordinary gentle cleaning is worth having looked at, particularly in the first weeks of life when a newborn's own defences against infection are still limited. Lead poisoning itself very often causes no obvious symptoms early on, which is exactly why testing rather than watching is the right response once you know kohl, celak, kajal or surma has touched your baby's eyes, even a single time. Bring the product itself to the appointment if you still have it; a doctor cannot judge lead content by looking at a powder, and a blood test is the only way to know where your child actually stands.

See a doctor promptly if…

Your baby's eye is red, watery, sticky or swollen and is not settling with gentle cleaning.
Kohl, celak, kajal or surma has touched your baby's eyes, even once, and no lead blood test has been done.
Your baby seems unusually sleepy, feeds poorly or is unusually irritable after repeated use of a traditional eye cosmetic.
You are unsure what is in a product you have been using and cannot confirm it is lead-free.

Common questions

Is kohl or celak safe to put on a newborn's eyes?

Not reliably. Many kohl, celak, kajal and surma products tested by health authorities contain high levels of lead, sometimes making up more than half the powder's weight, and there is no safe level of lead exposure for a baby. Separately, the way it is applied, usually with a finger or stick dipped repeatedly into an unsterile pot, can carry infection onto a newborn's eye.

Why do lead levels in kohl matter so much for a baby specifically?

A baby's skin and eye surface absorb lead readily, and infants also touch their eyes and mouths constantly, adding a second route of exposure. There is no safe blood lead level in children: even low levels are linked to developmental delay, learning difficulty and behaviour problems, and higher exposure can cause anaemia, kidney damage and seizures.

What does the FDA say about kohl, kajal and surma?

The FDA classes kohl, kajal and surma as illegal colour additives in the United States and keeps an import alert against eye cosmetics labelled with those names, meaning shipments can be seized at the border. Its advice if lead poisoning is suspected is to stop using the product immediately and have both the child and any pregnant or breastfeeding mother in the household tested for lead.

Can kohl cause an eye infection even if the lead level happens to be low?

Yes. The applicator and the pot itself are usually not sterile and are kept for months, and dipping a finger or stick in repeatedly, or sharing one pot between a baby and other family members, can carry bacteria straight onto the eye. A newborn's tear duct is often narrow or not yet fully open, which can make an infection there harder to clear.

How would I know if my baby has been affected by lead from kohl?

Often you would not know from symptoms alone, which is exactly the problem. Early lead exposure very commonly causes no obvious signs. If kohl, celak, kajal or surma has touched your baby's eyes, ask a doctor for a blood lead test rather than waiting to see if something looks wrong, and bring the product itself if you still have it.

Is there a way to keep the tradition without putting anything on my baby's eyes?

Yes. A mark that uses no traditional eye powder at all, placed away from the eyes, keeps the gesture without the lead. Because a lead-containing powder on any part of a baby's skin can reach the hands and then the mouth, the safest choice with kohl, celak, kajal or surma is not to use it on a baby at all.

My baby's eye looks red and sticky after kohl was applied. What should I do?

Clean gently with cool, boiled and cooled water on a fresh piece of cotton wool, one wipe per pass, and see a doctor if it has not settled with ordinary gentle cleaning, or sooner if there is swelling, thick discharge or your baby seems unwell. Mention that kohl, celak, kajal or surma was used, since it changes what a doctor will check for.

References

US FDA · Kohl, Kajal, Al-Kahal, Surma, Tiro, Tozali, or Kwalli: By Any Name, Beware of Lead Poisoning · www.fda.gov
CDC MMWR · Lead Poisoning in a Mother and Her Four Children Using a Traditional Eye Cosmetic, New York City, 2012-2023 · www.cdc.gov
CDC · Pink Eye in Newborns (Conjunctivitis) · www.cdc.gov
US FDA · Lead in Cosmetics · www.fda.gov

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.