Beauty and the Beasts: How Cosmetics Can Harm the Eye

Patients spend more than $18 billion a year on the beauty industry in the United States. Blepharoplasty was the fourth most common cosmetic surgery in 2018, and the number one and number two nonsurgical procedures were injections of neurotoxins and fillers, respectively.

Optometrists have an incredible opportunity to talk with patients about avoiding cosmetic offenders and bad habits and explain the benefits of injections and nonsurgical and surgical procedures. We absolutely have the skill set not only to be a part of these conversations, but to lead them.

As with any good conversation, it starts with asking the right questions.

EDUCATE YOUR PATIENTS

But how do we have this kind of conversation without making it awkward or insulting? An easy entry point is to discuss your findings throughout your examination. As you assess the periocular skin, talk to your patient about how common skin cancer is in your region. Only 1% of the human body’s skin is in the periocular area, yet 5% to 10% of skin cancer is located there. Why is that?

One study examined that question.¹ In the study, patients were asked to apply sunscreen as they normally would, and UV pictures were acquired to document their application habits. What was missing on every patient? The periocular region. Teach patients about properly applying sunscreen and wearing sunglasses that block UV-A and UV-B light.

As you check patients for dermatochalasis, droopy lids, or lash touch, ask them if their eyelids have been bothering them recently. That conversation can lead to a recommendation for radiofrequency (RF) treatments or blepharoplasty.

As you continue through the slit-lamp exam and evaluate the lids and lashes, take the opportunity to discuss healthy habits. Notice if patients are wearing eyelash extensions, and, if so, ask how they clean them. “I’m curious how you take care of these; can you walk me through how you do it?” If they have long eyelashes, ask if they are natural (lucky them!) or if they use a lash enhancement serum such as the FDA-approved bimatoprost ophthalmic solution 0.03% (Latisse, Allergan). Make sure patients who use a serum are applying it appropriately, and discuss the possible side effects.

What about patients who have junk in their tear film, have so much mascara caked on that it’s clogging the meibomian glands, or use their eyeliner inside the waterline? If you notice this, speak up; otherwise, your patients might not realize they’re harming their eyes.

Advising patients to stop wearing makeup will likely have no effect. For a more fruitful conversation, discuss the importance of removing eye makeup every night and explain how products containing tea tree oil or hypochlorous acid can be beneficial for hygiene. Tell patients to apply eyeliner on the dry side of the lid, not on the inside of the waterline where the delicate meibomian glands can be harmed.

WHAT TO AVOID

Typically in these types of discussions, patients will ask what ingredients or products to use; if they don’t, then forge ahead with more questions. I say to patients, “Many patients have found this information about what ingredients in cosmetics to avoid useful; is that something you would like to discuss further?”

You don’t have to be an expert on brands; instead, teach your patients the ingredients to avoid (see Cosmetic Offenders). The FDA hasn’t changed the Cosmetic Act since 1938. Proposed legislation was recently introduced to modernize the laws; however, the beauty industry reacted, and it was not signed into law. So consumer protections aren’t there, and our patients are on their own.

Store shelves are filled with products labeled with meaningless hype. Some of the most expensive brands on the market contain bad cosmetic offenders. Our patients are unknowingly mixing a toxic soup, and their ocular surface is suffering as a result. Have information readily at hand for them. Good resources include the Dry Eye Divas (www.dryeyediva.com), the Never List at Beautycounter.com, and apps such as Think Dirty and EWG’s Healthy Living.

If it makes sense in your clinic, carry some products that you like. It can be convenient for patients if you already have what they need or are looking for. I offer sunscreen, mascara, and antiaging products for purchase, along with many dry eye products.

OPTOMETRIC PROCEDURES

What services can we offer patients who seek rejuvenation, or for millennials who want “prejuventation”? Optometrists can offer many procedures that have dual benefits. One is intense pulsed light (IPL) therapy (Figure 1). Patients with dry eye disease or telangiectasia on the eyelids are candidates for IPL. This technology has been used for decades and is known as the photofacial. We can help patients with their disease and improve skin texture and appearance with this powerful tool, delivering a one-two punch.

RF therapy is a noninvasive way to tighten skin. It can target periorbital fine lines and wrinkles and help with lateral hooding and dermatochalasis. It has helped many of my patients who weren’t yet ready for blepharoplasty or were put off by the idea of surgery. It’s a great in-office procedure with no downtime for the patient.

Neurotoxins can help delete those pesky frown lines, crow’s feet, and forehead lines (Figure 2). When used correctly, they can give beautiful results. When done incorrectly, however, ptosis and worsening of dry eye disease can result. Patients know that their optometrists are knowledgeable about the periocular anatomy; therefore, in my clinic, my patients want me to perform their injections.

Fillers can restore volume, and many times they can help patients with ectropion who experience loss of the scaffolding of their cheek that was holding their eyelids in place. The tear trough is an area that often concerns patients. Using fillers in this area is especially tricky due to the important anatomy and thin skin. These procedures should be performed only by well-trained injectors (ie, optometrists, oculoplastic surgeons, ophthalmologists, facial surgeons, and dermatologists).

Armed with the correct knowledge, beauty doesn’t have to be such a beast. We can help patients have fairytale endings and get their desired look without sacrificing their ocular health.