Kohl is a widely used traditional cosmetic. It is mainly worn around the eyes in the Middle East, Asia and Africa. The elemental composition of twenty-one kohl specimens originating from various parts of Saudi Arabia, India and the Middle East was determined by energy dispersive X-ray analysis (EDAX). The data indicates the presence of significant lead levels in two thirds (14/21) of the kohl specimens ranging from 2.9-100% (mean 48.5%). Other less frequent elements present in kohl preparations include aluminum, carbon, iron, titanium, calcium, magnesium, oxygen, silver silicon, sulfur and antimony. Seven kohl specimens were totally lead-free, four had a lead content in the range of 2.9-34.1% and ten had lead levels in excess of 84%. Carbon levels in excess of 60% were detected in six kohl samples. Antimony was present in only one kohl specimen at a concentration of 7.8%. Five western made eyeliner pencils analyzed for comparative purposes consistently revealed iron as a common constituent (mean 46%) but no lead or carbon were detected in these specimens. The findings of this study indicate that modern kohl preparations contain a number of metals derived from natural sources in addition to carbon. The predominance of lead in the kohl preparations tested is of major concern due to the documented adverse effects in humans and the increased susceptibility of children to lead intoxication. Application of lead-containing kohl needs to be considered as a source of lead in evaluating patients with symptoms of lead intoxication in regions where this tradition prevails. The documented toxic effects of lead in humans and the increased sensitivity of children to lead exposure serve to emphasize potential health risks of using traditional lead containing kohl preparations and the need for increased surveillance and regulation of the manufacture of kohl.