Infant lead poisoning associated with use of tiro, an eye cosmetic from Nigeria--Boston, Massachusetts, 2011.

Lead is highly toxic and can damage the brain, kidneys, bone marrow, and other body systems; high levels can cause convulsions, coma, and death. Young children are especially susceptible to lead exposures because of their floor-hand-mouth activity, greater gut absorption, and developing central nervous systems. In June 2011, a male infant aged 6 months of Nigerian descent was referred to the Pediatric Environmental Health Specialty Unit (PEHSU) at Boston Children's Hospital because of an elevated blood lead level (BLL). An investigation found no lead exposure except for "tiro," a Nigerian cosmetic that also is used as a folk remedy to promote visual development. The tiro applied to the infant's eyelids contained 82.6% lead. Products similar to tiro, such as "surma" and "kajal" in Asia and kohl in the Middle East, also might contain lead. This case adds to the medical literature documenting nonpaint lead sources as causes of elevated BLLs in children and highlights persons of certain immigrant populations as a risk group. Educational efforts are needed to inform immigrants from Africa, Asia, and the Middle East that tiro and similar products can cause lead poisoning in children. Health-care providers and public health workers should ask about eye cosmetics and folk remedies when seeking a source of exposure in children with elevated BLLs from certain immigrant populations.