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    Uncover patient lifestyle habits that lead to OSD


    • Makeup application habits should be discussed with patients. Applying eyeliner to the waterline, a trend known as “tightlining,” may block the terminal ductule of the meibomian gland.

    • BAK is known to be toxic to epithelial cells, causing surface epithelial cell damage and punctate epithelial keratitis, which interferes with surface wettability.5 Cell culture experiments indicate toxicity to the meibomian glands as well.4 Makeup removers have high concentrations of this preservative, putting the ocular surface at risk of desiccating stress, night after night.

    Even though your patient refreshes her Botox injections to the crow’s feet area every six to eight months, she’s still paranoid of wrinkles. Her nightly routine includes the application of an anti-aging moisturizer near the eyelashes and orbital area. She believes that this anti-aging formula with Retinyl derivatives will help to delay the signs of aging.

    What she doesn't know is that these very same ingredients are damaging to the meibomian glands,6 and the parabens preserving the pot of expensive moisturizer also have a negative impact on the meibomian glands.7

    Related: How ODs can do better with dry eye


    • Botox is a trend on the rise, even in young patient groups. The neurotoxin decreases peri-ocular wrinkles by weakening the orbicularis oculi muscle.8 Check baseline meibomian gland function and structure, using meibomian gland expression and transillumination or meibography for these patients and monitor for change over time. These patients are at risk for incomplete blinking and evaporative DED.

    • Treatments such as warm compresses, cyclosporine,9 and LipiFlow10 may indeed benefit, but if these OSD-exacerbating beauty regimens continue, such treatments may need to be repeated frequently. It is important for the patient to understand that this is not a failure of the technology but rather a call to change the daily habits that are contributing to the problem.

    • Retinyl derivatives are a known cause of meibomian gland damage and evaporative DED.8 They are commonly found in anti-aging facial lotions and under-eye serums.

    Your patient wakes up in the morning and notices that her eyes are red and feel irritated. She steps into the shower, and the shampoo she uses comes in contact with her eyelids. The chemicals further irritate her eyes. Once out of the shower, she applies a daily moisturizer, with the paraben-preserving and retin-A anti-aging aspects of these creams negatively affecting her meibomian glands.

    She begins her workday before the sun rises, with eyes glued to the iPhone upon opening, then straight to the laptop and air-conditioned meetings. Coffee and Red Bull are her beverages of choice because plain water does not help keep her eyes open. Frequent business travel not only adds to her SkyMiles account but to her stock in Visine (which is tachyphylactic and loaded with BAK) because she needs to hide the red eyes from clients.

    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