The majority of surma samples contained very high levels of lead, a troubling finding that could potentially correlate with lead toxicity in Afghan children. Making available lead-free surma alternatives and providing health education, for both healthcare professionals and the general population, in locations where surma use is prevalent and for those involved in care of refugees and immigrants from Afghanistan, may be strategies to prevent lead poisoning in children. What is Known: • Surma is a traditional cosmetic used as an eyeliner for infants in Afghanistan as well as in many countries in Asia, the Middle East, and Africa. • Surma has been reported to contain lead and to be a source of lead toxicity in children. What is New: • Assessment for lead content in surma found in Afghanistan has not been performed. • In this convenience sample of 10 surma products acquired in Afghanistan, 70% contained very high levels of lead.