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    Uncover patient lifestyle habits that lead to OSD



    • Ask patients about sleep habits, water intake, caffeine consumption, smoking habits, and alcohol consumption as part of their personal health information (PHI). These habits can help to uncover exacerbating risks for dry eye disease (DED) at the beginning of a patient evaluation.

    • Ask patients with contact lens discomfort and/or symptoms of DED how their eyes feel upon awakening. Morning symptoms trigger closer evaluation for blepharitis—which is common for women who neglect to properly remove eye makeup before sleep—inadequate nocturnal lid seal,3 and corneal dystrophies. Fluorescein can uncover staining patterns and even subtle islands of elevated epithelium seen in basement membrane disease. Be sure to also evaluate the superior cornea and superior conjunctiva hiding under the upper eyelid margin for clues to systemic diseases such as hypothyroidism. Evert the upper lid to examine for signs of lid wiper epitheliopathy detectable using lissamine green vital dye.

    Before going to bed, the patient removed her waterproof eyeliner, mascara, and glittery eye shadow with a liquid makeup remover containing significantly higher amounts of BAK and ocular surface-drying chemicals than you would ever dream of giving as an ophthalmic drop or medication.4 This makeup remover very effectively removes her makeup, but it also removes the oil reservoir of the lid margin.

    Next, her facial cleanser was applied quickly over her entire face, including over the eyelids and lashes. This helped her get to bed faster, but it also overstripped the delicate oils of the eyelids and lid margin.

    Related: How to know when it’s not dry eye


    • Waterproof eye makeup (eyeliner and mascara) contains ingredients to make them adhere to the lid and lash. Harsh chemicals in eye makeup removers are necessary to dissolve such residues and pigments. This also creates a challenge because removers often leave behind a residue of pigment (Figure 1). Suggest patients avoid products containing parabens, phenoxyethanol, and vitamin A/retinyl derivatives.

    Sparkly eye shadow can exacerbate chronically dry eyes, and glitter is another common cause of corneal and conjunctival irritation. Minerals such as mica that add sparkle can embed in the conjunctival tissues, causing irritation (Figure 2).


    Leslie E O’Dell, OD, FAAO
    Leslie E. O’Dell, OD, FAAO, is the director of Dry Eye Center of PA and Wheatlyn Eye Care in Manchester, PA. Dr. O’Dell lectures ...
    Amy Gallant Sullivan
    Amy Gallant Sullivan, is cofounder and executive director of TFOS (www.tearfilm.org), a world leader in eye health education that’s ...


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    Optometry Times A/V