FormalPara Key Summary Points

Children and teenagers are increasingly exposed to personal electronic devices including smartphones, leading to concerns about potential risks associated with their digital engagement.

TikTok, a popular social media platform with a significant adolescent user base, has given rise to “internet challenges”, some of which pose serious ophthalmological risks.

Specific TikTok challenges related to ophthalmological risks include the “rubbing castor oil trend”, “bleach/bright eye challenge”, “mucus fishing challenge”, “eggsplosions”, “beezin challenge”, “Orbeez challenge”, “blow-drying eyelashes trend”, “sun gazing,” and “popping styes”.

The study highlights the need for monitoring and regulating potentially dangerous content on social media platforms like TikTok to protect vulnerable young users and promote safe online engagement.

Introduction

Children and teenagers today depend heavily on their constantly shifting personal electronic devices. These gadgets (laptops, tablets, and smartphones) are widely used by kids and teenagers to access a variety of platforms that provide captivating content [1]. These devices have become an integral aspect of their everyday existence since they are being employed not only at home but also in educational settings [2].

Many children nowadays have mobile devices at the age of 4 years [3]. Despite the various beneficial potential of technology, heavy media usage has been linked to a number of negative outcomes including poor mental and physical health, increased aggressiveness, conflict with parents and peers, and poor academic achievement [1, 4]. Moreover, studies indicate that the development of nearsightedness is impacted by various environmental and lifestyle elements, with a special emphasis on the significant impact of extended use of digital screens at close proximity [2].

The prevalence of screen time among children is on the rise each year. A global study in 2018 revealed that 5% of 5- to 7-year-olds already own a mobile phone, and 42% have their own tablet [5]. Additionally, children aged 8 to 12 have increased their average daily screen time by 49 min over the past 3 years [6]. This increased screen time raises concerns about its visual implications and the potential risks associated with reduced outdoor activities [5]. The worry is particularly focused on the development of myopia in children [7]. Myopia is recognized as a significant global public health issue. The prevalence of myopia differs across regions, with some parts of Asia reporting rates as high as 80–90% among school-age children. In contrast, the prevalence is lower in Europe; Spanish children aged 5–7 years have a myopia rate of 20% [8].

While the complete mechanism remains unclear, several theories suggest that exposure to UV light leads to the release of dopamine, which in turn reduces the growth of the eye’s axial length. This implies that children who have low exposure to sunlight and spend a significant amount of time on near-vision tasks are at a 2.6 times higher risk of developing myopia [9, 10]. On the basis of the above, the American Academy of Pediatrics advises that children aged 2 years and above limit their screen time to a maximum of 2 h per day, emphasizing high-quality content. For children under 2 years, no screen time is recommended [11].

On average, 8–18-year-old children spend over 7 h a day using entertainment media [4]. Thus, current internet trends cannot be ignored by parents and healthcare providers.

Tiktok is a mobile application that first emerged in 2016. It has become the fifth most downloaded application globally from Apple and the second most downloaded Android application globally [12]. It had 1.7 billion active monthly users in 2023. That number is anticipated to increase to two billion in 2024 [13]. Among these users, it is estimated that around 41% are between the ages of 16 and 24, and a third are 14 years or younger [14].

An emerging popular phenomenon on social media sites, notably on Tiktok, called “internet challenges” has been spreading quickly among young people using the services [14]. It entails a task that must be completed by the user and published as a video online to encourage others to do the same. Most of these challenges are harmless, but some may be hazardous. Teenagers are especially vulnerable to the impact of these social media activities because they depend on “likes” from their peers for validation and attention [14]. A previous analysis of TikTok ophthalmological content was conducted, revealing that the majority of the videos are created by families/patients (60.4%), followed by optometrists (14.4%), non-ophthalmology physicians (4.5%), nurses (4.1%), other (laypeople/unknown) (9.0%), and ophthalmologists (7.7%) [15]. The majority of the videos focused on education (38%) and personal experiences (35.8%), followed by entertainment (14%), patient experiences (7.9%), and promotion (4.3%) [16].

Here, we enumerate some of the trending ophthalmology challenges that pose some risks to the eyes of people who follow them.

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Methods

During the period of July 2023 and September 2023, a search was conducted on TikTok to explore a diverse array of ophthalmologic challenges using various hashtags, including #Castoroilforeyesight, #Brighteye, #Bleacheye, #Mucusfishing, #Eggsplosion, #Beezin, #Orbeezchallenge, #Orbeez, #Orbeezblaster, #Blowdryeyelashes, #Blowdrylashes, #Sunagazing, and #Styepopping. The number of views for each challenge was documented, along with the number of likes and shares for the video with the highest like count. As a result of the extensive number of videos associated with each hashtag, it was challenging to ascertain the number of likes and the share count for every video. Subsequently, a thorough review of the literature and available online articles was conducted.

Results

The Rubbing Castor Oil Trend: #Castoroilforeyesight (4.1 Million Views, 57.3K Likes, 18.4K Shares)

Many TikTok users have been claiming that rubbing castor oil onto the eyes and inside of them results in a decreased number of wrinkles as well as a visual improvement [17]. Although some studies have shown that castor oil can enhance the lipid component as well as decrease the evaporation time of the tear film, using castor oil without medical supervision can still be dangerous [18,19,20,21]. Many of the over-the-counter castor oils can contain other materials such as preservatives that might be irritating to the eye or even harmful. Moreover, excessive eye rubbing has been linked with the development of keratoconus [22].

The Bleach Eye Challenge: #Brighteye #Bleacheye (The Videos Associated with This Challenge Were Removed By Tiktok at the Time of the Review Submission)

This challenge consists of putting a bag filled with jelly, hand sanitizer, bleach, and shaving cream on your eyes in an attempt to make it turn to a lighter color. With a pH of 11–12, household bleach, also known as sodium hypochlorite, is a basic solution [23]. Bleach reacts with living tissues leading to irritation and permanent cellular damage through protein denaturation. This response is particularly harmful for the eyes and the respiratory system [24]. Therefore, such challenges can result in permanent eye damage in case of leaks and extravasation into the eyes. This challenge has currently been removed from Tiktok.

The Mucus Fishing Challenge: #Mucusfishing (20.7 Million Views, 446.5K Likes, 923 Shares)

This Tiktok trend involves forcing out mucus material from an irritated eye using a Q-tip or a finger. This practice, which might seem harmless at first, can be the start of a vicious cycle called “mucus fishing syndrome.” It is defined as a cyclic condition involving the extraction of mucous strands from the eye. It is often triggered by ocular irritation, leading to further mucous discharge which results in a perpetual cycle and eye irritation [25]. To note, mucus fishing can cause mechanical conjunctivitis [26].

The Eggsplosions Challenge: #Eggsplosion (1.4 Million Views, 3947 Likes, 25.9K Shares)

In this trend hard-boiled eggs are microwaved and then cut into pieces so they burst. Steam and egg fragments in the air have the potential to spread across an extensive area which can harm nearby objects including the eye. Although this trend is not directly related to the eye, it can potentially lead to eye trauma.

The Beezin Challenge: #Beezin (20.3 Million Views, 180.9K Likes, 887 Shares)

Another concerning challenge that has circulated is the “beezin challenge.” It involves rubbing Burt’s Bees lip balm on the eyelids before going out at night. TikTok enthusiasts contend that the application of menthol or peppermint balm can augment one’s state of vigilance or intensify a sense of euphoria. However, this practice may lead to hazardous adverse outcomes including ocular inflammation, irritation, the formation of milia, and potentially even impairment of visual faculties. The popularity of this trend has even led the balm company to release a warning statement to avoid applying it on the eyes.

The Orbeez Challenge: #Orbeezchallenge, #Orbeezblaster (281.8 Million Views, 439.7K Likes, 35K Shares)

Another dangerous challenge is the “Orbeez challenge” that has trended in 2022; it involves using paintball guns to shoot gel pellets [27]. This challenge has resulted in 19 serious ocular injuries that were reported in a review published in 2022 that looked at the charts of patients who presented to the Bascom Palmer Eye Institute, University of Mississippi Medical Center, University of Alabama, Retina Consultants of Miami, NJRetina, and the Center for Excellence in Eye Care [27]. The majority of these cases were younger than 18 years of age (11 out of 19 cases) [27].

Blow-Drying Eyelashes Challenge/Trend: #Blowdryeyelashes, #Blowdrylashes (68.251 Million Views, 6060 Likes, 12 Shares)

The lash-curling method gained popularity in 2020 when a TikTok user shared a video demonstrating the use of a blow-dryer to curl her lashes. Although the initial viral video was a brief trend, it has recently experienced a revival. Presently, TikTok users are actively participating in the trend by trying it out and documenting their experiences on the platform. However, the eyes are not built to endure forceful air, and even a brief attempt could cause significant dryness and eye irritation.

Sun Gazing Challenge: #Sunagazing (76.9 Million Views, 445.4K Likes, 12.7K Shares)

The recent trend on TikTok, known as “sungazing,” promotes the idea that staring directly into the sun can enhance eyesight. TikTok videos encourage viewers to remove contact lenses and gaze at the sun for 5–10 s during the initial and final 15 min of daylight. However, this practice poses a significant risk of damaging ocular tissues, leading to conditions like solar retinopathy. This condition can impact visual acuity, causing central or paracentral scotomas. While recovery is possible over several months, some individuals may experience lifelong ocular complications.

Stye Popping Challenge: #Styepopping (11.1 Million Views, 6144 Likes, 22 Shares)

This trend involves users filming themselves popping a stye with their fingers or even using a needle or tweezers. However, popping a stye can harm the eyelid, risking the spread of infection to other areas of the eye or worsening the stye. Complications may include pigmented scars, scar tissue, and pitting scars, highlighting the need for proper medical care.

Discussion

The manner that medical information is shared and transmitted among curious laypeople, patients, and healthcare professionals has changed as a result of social media platforms [28].

Applications (apps) for social media may quickly and easily disseminate content to a large audience [29]. Therefore, it should come as no surprise that healthcare providers, including doctors, have begun utilizing social media to increase patient understanding and advertise their own clinics [30,31,32]. Many patients frequently use social media to look up their symptoms or any potential intervention that interests them before consulting with physicians [30,31,32]. However, it is important to note that the content shared on social media lacks the verification and the peer-review processes that ensure its accuracy and dependability [30]. For example, videos discussing cataract on Youtube are very popular with over a million views. Still, very few are truly educational and can provide accurate information to the patient [33]. This absence of validation raises concerns about the potential for individuals seeking medical information to encounter misinformation online. Even more concerning are the challenges spread on Tiktok as they can be harmful and even fatal. Many of them claim health benefits without any true medical foundation. These challenges span a spectrum of risk levels, varying from minor to significant potential dangers. Among the least hazardous ones is the “blue eyes” challenge, in which the participant shines a bright light on their eye while using a filter in attempts to make their brown eyes look blue. Nevertheless, an example of a challenge with considerably higher risk is the “Tide Pod challenge” [14]. This challenge requires individuals to ingest substantial quantities of Tide Pod laundry detergent packets that are designed to dissolve in water during washing cycles [14]. Upon ingestion, the compounds present within the packet give rise to profound corrosive injuries affecting the oral cavity, esophagus, and the respiratory pathway. This trend of engagement with hazardous substances gained prominence in the latter part of 2017. During the first 2 weeks of January 2018, the American Association of Poison Control Centers (AAPCC) documented 39 instances of deliberate consumption of laundry pods by adolescents [14]. Another life-threatening challenge called “the Benadryl challenge” has also been popular. It involves sharing a video of one’s self hallucinating after taking numerous quantities of over-the-counter Benadryl [14]. Benadryl or diphenhydramine is a popular over-the-counter histamine and muscarinic receptor antagonist used to treat allergies [34]. Several cases of intoxication have been reported in relation to this challenge as well as a death case and a case of seizures, both in 14-year-old children who have ingested Benadryl to follow the trend [35, 36].

In regard to ophthalmological challenges, while some are moderate in risk such as the “mucus fishing challenge,” others can lead to irreversible eye damage such as the “eggsplosion,” “bleach eye challenge,” “Orbeez challenge,” and “blow-drying lashes trend”. In the case of the “Orbeez challenge” ocular trauma arising from the impact of gel pellet projectiles can lead to significant and irreversible visual deterioration [27]. A study conducted at SUNY Upstate Medical University in Syracuse, New York, reviewed records of patients who experienced Orbeez-related ocular trauma between June 2022 and July 2023. The analysis identified 17 cases of Orbeez-related eye injuries, encompassing corneal abrasion, hyphema, commotio retinae, intraretinal hemorrhage, preretinal hemorrhage, vitreous hemorrhage, and retinal tear [37].

As for blow-drying eyelashes, using this hack may result in immediate discomfort like redness and irritation, but the more significant long-term consequences could include corneal abrasions and infections, ultimately threatening vision and potentially leading to blindness especially in contact lens wearers.

Moreover, encountering substandard medical information on social media platforms presents significant hazards to patients. It may lead them to make critical medical choices relying on potentially erroneous data. This could result in adverse consequences, such as applying over-the-counter castor oil to treat various medical conditions [38]. Some of the organic castor oil products were found to be contaminated with fungi, bacteria, and methylsulfonylmethane which can result in significant eye irritation or a possibly vision-threatening infection [39]. However, a study published in January 2023 underscored the importance of healthcare professionals using TikTok as a platform for communicating vision health information among adolescents and young individuals [40].

Conclusion

Online platforms can be a double-edged sword in which valuable educational and empowering material can be shared and life-threatening actions can be encouraged. Therefore, efforts should be made to ban possibly dangerous content from being circulated on social media platforms by the application developers.