Many cosmetic products and eye beauty trends can cause ocular surface complications, leading some cosmetics consumers to become patients for routine or urgent eye care.1 The convergence of social media, reality TV, and selfie culture fuels a growing obsession with long eyelashes and dramatic eye makeup.2 However, consumers are generally unaware of the many harmful ingredients found in their own beauty products (Table 1).3

It is important that eye care practitioners know how to identify, communicate about, and manage common ocular surface disease complications related to eye beauty trends1 (Table 2), and to recommend noninvasive in-office procedures and safe products to patients. Doing so will, in turn, expand your ocular surface disease management services.4 I’ll explain how below.


I practice in Houston, Texas, where many women regularly wear eye makeup and use lash extensions or falsies. Discussions of meibomian gland dysfunction (MGD) and dry eye disease (DED) are part of my routine eye exams. It is natural for me to ask about cosmetic habits at the slit lamp if I observe any of the clinical signs that can lead to ocular surface disease. After the slit-lamp exam, I review the patient’s meibomian gland image. Often, the structure appearance matches the patient’s reported symptoms and observed clinical signs.

Symptomatic Versus Asymptomatic

Symptomatic patients are invited to return for a separate DED exam and are asked not to wear any makeup or use artificial tears on the day of the exam. Patients are given an educational sheet on MGD and DED, and are asked to read “Homework Before Your Dry Eye Exam” on our website.

For patients who are not symptomatic but show clinical signs, we provide education on the importance of healthy eye beauty habits (See Five Healthy Eye Beauty Habits).

Five Healthy Eye Beauty Habits

1. Obtain baseline ocular surface exam findings before getting eyelash extensions.

2. Always remove makeup and wash your face and eyelids before going to bed.

3. Do not tightline or apply eyeliner over your waterline.

4. Avoid waterproof makeup if possible; do not use on a daily basis.

5. Do not use over-the-counter “take the red out” eye drops without first treating the underlying cause of your red eyes.

  • Source: Shen Lee B. Ocular aesthetics: Eyeing beauty. Eyecare Business. 2019;33: 34-36.

Staged Management and Treatment of DED

It is important to follow the evidence- based protocol established by the Tear Film & Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) when we treat DED. Most patients can be managed effectively with Steps 1 and 2 of the four steps for staged management of DED (Table 3).5

Simplify Your Treatment Procedures

The three initial routine eye exam tips below have helped increase our success with having patients return for DED exams while also following the recommended treatments.

Educate patients on why they need to return to your office and what to expect at the next visit.

Prescribe a new preservative-free artificial tear to improve prior authorization (PA) success. PA success is improved when you document patients trying a different over-the-counter tear twice daily for at least 2 weeks.

Add meibomian gland image screening to your exam. Reviewing meibomian gland images with the patient helps to improve the patient’s understanding of MGD and DED.

There are several prescription drug options for DED. Although it is time-consuming to deal with health insurance regulations and coverage procedures, it is necessary to learn the PA process to help patients obtain their prescribed drops. Here are some suggestions for successfully obtaining prescription drugs:

  • Educate patients on the process and fill out necessary paperwork in the office.
  • Train a team member to be in charge of all medical prescription PA processes and associated communication with patients.
  • Schedule regular meetings with pharmaceutical representatives, as they can provide invaluable support with training staff and supplying samples and coupons.

I have steadily added diagnostic and treatment technology, studied evidence-based research, and shared clinical success in the in-office treatment of DED in the past decade. Our in-office procedural treatment protocol has been successful in helping our patients.5


When you take the time to educate patients on their beauty habits and the potential for harm from their cosmetic products,6 they are appreciative and interested in finding safe solutions.1 Building an ocular aesthetics–focused dry eye clinic takes time, but it is achievable (see Pearls for Building an Eye Beauty Store in Your Practice). Focusing on creating happy patients often leads to a happy practice!

Pearls for Building an Eye Beauty Store in Your Practice

  • Improve understanding and increase compliance through education and communication; engage in social media.
  • Sell recommended products through both an in-store beauty counter and online store.
  • Ask for referrals from patients, beauty services, and other health care providers.
  • 1. Shen Lee B, Kabat AG, Bacharach J, Karpecki P, Luchs J. Managing dry eye disease and facilitating realistic patient expectations: a review and appraisal of current therapies. Clin Ophthalm. 2020;14:119-126.
  • 2. Shen Lee, B. Ocular aesthetics: lash obsessions. Eyecare Business. September 2018.
  • 3. O’Dell L, Sullivan AG, Periman LM. Uncover patient lifestyle habits that lead to OSD. Optometry Times. October 2016.
  • 4. Shen Lee B. Ocular aesthetics: eyelids, exfoliation, expressions. Eyecare Business. April 2020.
  • 5. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628.
  • 6. Gomes JAP, Azar DT, Baudouin C, et al. TFOS DEWS II Iatrogenic Report. Ocul Surf. 2017;15(3):511-538.