Surma and lead poisoning

Blood lead concentrations were measured in 62 Asian children, of whom 37 had definitely had surma applied to their eyes and 25 were thought not to have done. The mean concentration in those who had not used surma was 0.98 +/- SD 0.42 mumol/1 (20.3 +/- 8.7 microgram/100 ml) compared with 1.65 +/- 0.68 mumol/4 (34.2 +/- 14.1 microgram/100 ml) in those who had. Analysis of 29 different samples of surma showed 23 of them to be composed largely of lead sulphide. We conclude that the use of surma is associated with high blood lead concentrations. In our cases most of it had been obtained abroad, and hence government restrictions might be ineffective in limiting its use: a better method of prevention might be to inform the leaders of Asian communities of the risks.