This MMWR case report describes a 6 month old boy in Boston, Massachusetts, in 2011, with an elevated blood lead level. The investigation found no household lead hazard and identified tiro, a Nigerian eye cosmetic and folk remedy applied to the eyelids several times a week since age 2 weeks. The powder was 82.6 percent lead and was dominated by lead sulfide. Venous blood lead was 13 µg/dL and was 8 µg/dL three months after use stopped.
Key numbers
Figures below are copied as printed. Units are not converted. Species are not merged.
| Analyte | What was reported | Value | Unit | Basis | Where |
|---|---|---|---|---|---|
| Pb | CDC’s reference value of 5 µg/dL, based on the 97.5th percentile | 5 | µg/dL | not stated | Case narrative, p. 1 |
| Pb | A single application of 10 mg of tiro would deliver 8 mg of lead | 8 | mg | calculated illustration | Case narrative, p. 2 |
| Pb | Capillary blood testing performed by the physician indicated a BLL of 13 µg/dL | 13 | µg/dL | not stated | Case narrative, p. 1 |
| Pb | confirmatory venous BLL measured by graphite furnace atomic absorption spectroscopy was 12 µg/dL | 12 | µg/dL | not stated | Case narrative, p. 1 |
| Pb | When the infant was brought to the PEHSU 1 week later, his venous BLL was 13 µg/dL | 13 | µg/dL | not stated | Case narrative, p. 1 |
| Pb | the tiro consisted of 82.6% lead | 82.6% | % | total content | Case narrative, p. 2 |
| Pb | Three months after the family stopped applying tiro, his venous BLL had fallen from 13 µg/dL to 8 µg/dL | 8 | µg/dL | not stated | Case narrative, p. 2 |
Methods (brief)
Capillary blood lead at a well-child visit was 13 µg/dL. Venous blood lead by graphite furnace atomic absorption spectroscopy was 12 µg/dL the next day and 13 µg/dL one week later at the same laboratory. The home, built in 2004, was inspected and other sources, including diet and parental occupations, were ruled out. The family submitted the tiro powder. The clinical laboratory reported 82.6 percent lead. Electron microscopy showed galena.
Evidence fitness
These data support blood lead concentrations in one infant before and after tiro use stopped; lead content of the tiro powder used on that infant, 82.6 percent; identification of the powder as lead sulfide.
They do not support a survey of tiro products; lead in other eye cosmetics measured in this report; a detection limit; a certification limit.
Limitations
One child and one container of powder. The 8 mg figure is a calculation for a hypothetical 10 mg application, not a measured dose on the child. Bioavailability is described as relatively low because the mineral is lead sulfide, but no absorption fraction is measured. No detection limit is given. Similar product type names (tozali, kwalli, kohl, surma, kajal) are discussed and were not analyzed in this report. The file is an HTML conversion and the page warns of possible character translation errors.
Related evidence
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