The Aesthetic Impact of OSD

Ocular surface disease (OSD) affects more than just vision and eye health—it also has noticeable aesthetic consequences. In addition to physical discomfort associated with dryness, burning, itching, and irritation, OSD can alter patients’ appearance with visible redness, swelling, and more. These visible changes can affect self-confidence, contributing to mental and psychological distress and, ultimately, overall quality of life.

As more patients seek solutions to address both ocular discomfort and concerns about their appearance, the need for comprehensive care continues to grow. Effectively managing both the root cause and obvious effects of OSD requires practitioners to have a thorough understanding of symptoms and treatment options.

COMMON AESTHETIC CONCERNS OF OSD

OSD refers to conditions that affect and damage the surface layers of the eye. The most common is dry eye disease (DED), a chronic and progressive multifactorial condition that affects tens of millions of Americans.¹ Additional examples include meibomian gland dysfunction (MGD), the leading cause of DED;² blepharitis, or inflammation of the eyelids; and ocular rosacea, among others.

The aesthetic concerns I observe most often in my patients include red eyes, swollen or puffy eyelids, crusty lashes, watery eyes, visible blood vessels (telangiectasia), chalazia, fine lines, wrinkles, and lid laxity. When patients present with these symptoms, we go through the process of properly identifying, diagnosing, and developing a customized treatment plan.

THE POWER OF DIAGNOSTIC IMAGING

Diagnostic imaging is a powerful tool for patient education and empowerment. During the initial visit, we capture real-time images with the Oculus Keratograph 5M Dry Eye Analyzer (Oculus) and the Firefly slit lamp microscope (MediWorks) to illustrate exactly what’s happening with the patient’s eyes. For example, we can show a patient their conjunctival injection or redness and its position on a grading scale. Meibography images allow us to assess the structure of their meibomian glands and compare them to a healthy baseline. We can also demonstrate how quickly their tears evaporate and explain how this leads to friction, irritation, redness, and inflammation.

With the help of diagnostic imaging, patients don’t just hear about the problem; they see it, which helps them understand the symptoms they’re experiencing. Once we review their images with them, we create their treatment strategy.

CUSTOMIZING THE PATIENT TREATMENT PLAN

Many ocular surface conditions can be improved using in-office procedures, and many advanced treatment technologies inherently have aesthetic benefits. As we discuss options, patients often appreciate these added perks, making these treatments even more appealing.

Intense pulsed light (IPL) therapy delivers controlled pulses of intense light around the eyes, reducing inflammation and addressing vascular abnormalities associated with MGD.³ The OptiLight (Lumenis) is the only FDA-approved IPL device for managing DED due to MGD.⁴ This technology stimulates the meibomian glands to restore their structure and function⁵ and is customizable and comfortable for patients, making it a cornerstone treatment in our practice.

Radio frequency (RF) is another effective solution for patients with MGD. In our practice, we use OptiLight and OptiPlus (Lumenis) as a one-two punch. IPL works well on surface aesthetics, reducing redness and inflammation and targeting rosacea. It also helps to improve the tone and texture of the skin. OptiPlus uses dual-frequency RF to heat multiple skin layers, melt gland blockages, enhance blood circulation, and stabilize the tear film.^6-8 It also stimulates collagen production and reduces the appearance of wrinkles, puffiness, and redness around the eyes.⁹ We often describe RF treatment to patients as feeling like a relaxing hot stone massage.

Low-level light therapy (LLLT) delivered via devices such as the InfinityPro (MDelite) and the Equinox (Essilor Instruments) uses different wavelengths of light to provide antiinflammatory and bio-stimulatory effects on the lacrimal and meibomian glands. It improves tear production, conjunctival health, and meibomian gland function.¹⁰ LLLT also enhances skin texture and reduces redness, so it’s a great option for managing dry eye symptoms and cosmetic concerns.

Dynamic Muscle Stimulation technology (DMSt) is a newer solution that targets the mechanical aspect of dry eye and other ocular surface symptoms, such as lower lid laxity and impaired blinking. OptiLift (Lumenis) uses DMSt to activate facial muscles with electrical impulses, tightening and toning the periorbital muscle¹¹ and enhancing overall facial firmness to minimize sagging.

Another new technology is fractional skin rejuvenation delivered via the Tixel 2 (Novoxel), which uses titanium tips to transfer thermal energy to the skin’s surface through brief contact. The heating stimulates collagen production, improves fine lines and wrinkles, and helps with skin elasticity around the eyes.¹² It can also help with dark circles and puffiness.

Other in-office solutions we offer include the TearScience LipiFlow Thermal Pulsation System (Johnson & Johnson Vision), a thermal pulsation device that applies controlled heat and pressure to the eyelids; BlephEx (BlephEx), which exfoliates and cleanses the eyelid at the lash line; Rinsada (Rinsada), a high-flow lid irrigation system that cleanses the ocular surface using a specialized lid retractor; and OptiVize (BlephEx), which employs cutting-edge vaporization technology to directly target biofilm within the eyelid and meibomian glands.

While our practice specializes in office-based treatments, we acknowledge the role pharmaceuticals can play in treating some patients. For those seeking a combination approach, we customize their treatment plans to balance in-office procedures with the appropriate pharmaceutical support.

RESTORING CONFIDENCE THROUGH TREATMENT

Behind every successful treatment is a patient whose quality of life has been transformed.

The Power of Personalization

In one case, a prominent YouTuber came to us after struggling with chronic red eyes for a decade. He was told the issue was due to aging, allergies, or the environment and was advised to use OTC treatments. He wasn’t satisfied with this management plan and sought out my clinic. We immediately put him on a personalized treatment plan with a combination of office-based solutions. He saw immediate relief, and as someone who appears on camera regularly, the improvement in the appearance of his eyes was especially significant. He was so pleased with the results that he shared his journey with his followers on YouTube, which has serendipitously led to new patient referrals for us.

The Doctor Becomes the Patient

One aesthetic burden many patients with OSD face is the presentation of a stye that progresses into a chalazion. I experienced this firsthand last July. My young son loves touching everything, especially things he shouldn’t, and then reaching for my face. Combine that with disrupted sleep and stress, and I developed a chalazion that wouldn’t go away (Figure, A). I explored conventional at-home and pharmaceutical options, such as warm compresses, omega-3s, lid hygiene, a topical medication, and an oral medication, which helped but didn’t fully resolve it. However, after three sessions with OptiLight and OptiPlus, it was gone (Figure, B)! I’ve used this same protocol to help countless patients quickly regain comfort and confidence.

EMBRACE INNOVATION, ELEVATE PATIENT CARE

OSD and aesthetic concerns are connected; addressing one benefits the other. When patients see noticeable improvements in comfort and appearance, they become more engaged in their treatment plans, leading to long-term success. The latest advances in office-based treatments provide dry eye specialists with an opportunity to meet evolving patient needs and provide the best possible care without the need for referrals. In the end, it’s about helping patients see and feel their best.