Beauty Behaviors and Ocular Health
The primary role of the eyelids and lashes is to protect the eyes, but their aesthetic effects cannot be underestimated. For many patients, improving the aesthetic appearance of their eyelids and lashes is just as important as addressing medical concerns. As such, it is important for eye care providers to proactively maintain and/or improve both eye health and aesthetic appearance for optimal patient satisfaction. This article reviews five common eyelid conditions to watch out for when examining patients.
NO. 1: DERMATOCHALASIS AND PTOSIS
Dermatochalasis and ptosis can interfere with a person’s ability to open their eyes fully, leading to eye strain, difficulty reading, and even headaches. Cosmetically, drooping eyelids can alter facial expressions and make people appear tired or older.
Management
While some patients assume surgery is the only treatment option (blepharoplasty or ptosis repair can restore the position and function of the upper eyelid), they may be interested in a temporary, nonsurgical solution. Oxymetazoline hydrochloride ophthalmic solution 0.1% (Upneeq, RVL Pharmaceuticals), an alpha-adrenergic receptor agonist that selectively targets Müller muscle to elevate the upper eyelid, is FDA-approved for once daily dosing.1 Other conservative treatments, including eyelid exercises, tape, and special eyelid crutches, provide temporary relief.
NO. 2: BLEPHARITIS AND DEMODEX
Both blepharitis and Demodex often lead to chronic discomfort, eye irritation, redness, eyelid edema, thinning or loss of lashes, and the formation of crusty debris along the lash line. These signs and symptoms not only affect a person’s appearance, but also exacerbate ocular surface conditions.
Management
Patients with blepharitis and/or Demodex can benefit from in-office eyelid cleaning treatments such as BlephEx (BlephEx), ZEST (Zest Optical), and NuLids Pro (NuLids). Intense pulsed light therapy has also been shown to decrease the Demodex load.2 At-home eyelid hygiene is crucial and can be done with eyelid scrubs, wipes, and cleansers. An effective prescription option for Demodex blepharitis is lotilaner ophthalmic solution 0.25% (Xdemvy, Tarsus Pharmaceuticals), which is a topical drop that acts as an antiparasitic agent to eradicate Demodex mites. It is FDA-approved for twice daily dosing for 6 weeks.3
NO. 3: MEIBOMIAN GLAND DYSFUNCTION
Whether mild or severe, meibomian gland dysfunction can significantly affect vision and eye comfort. Cosmetically, patients with this condition may experience red eyes or have the sensation of heavier or tired eyes due to inflammation of the eyelid margins.
Management
In-office thermal treatments include the LipiFlow Thermal Pulsation System (Johnson & Johnson Vision), MiBo Thermoflo (MiBo Medical Group), the Tear Care System (Sight Sciences), Systane iLux 2 (Alcon), and radiofrequency. At-home therapy includes warm compresses, eyelid massage, nutritional supplementation, and prescription eye drops. Phase 2 data from the ERSA study suggests topical lotilaner 0.25% can improve meibomian gland secretion scores by increasing the number of meibomian glands yielding liquid secretion.4
NO. 4: OCULAR ROSACEA
Ocular rosacea is a chronic inflammatory condition that affects the entire periocular region, often causing eyelid erythema, edema, and meibomian gland dysfunction. These symptoms affect a patient’s physical appearance and the health of their ocular surface.
Management
Management of this chronic condition involves a combination of treatments aimed at reducing inflammation, controlling symptoms, and preventing flareups. Intense pulsed light therapy, oral doxycycline, and oral or topical ivermectin have been found to be helpful. Altering diet and lifestyle factors that may aggravate rosacea symptoms may also be beneficial.
NO. 5: FLOPPY EYELID SYNDROME AND LID LAXITY
These conditions alter the architecture of the eyelids and result in lids that are loose, easily everted, and do not close completely. This laxity can negatively affect the ocular surface and contribute to dry eye symptoms. Aesthetically, these conditions give the appearance of sagging lids that cause a patient to have an overall aged and fatigued facial appearance.
Management
Floppy eyelid syndrome is associated with obstructive sleep apnea, which should be assessed to prevent serious systemic diseases. A new noninvasive treatment option designed to address lower eyelid laxity is OptiLIFT (Lumenis). This device uses the company’s Dynamic Muscle Stimulation technology, which targets the muscles around the eyes to help strengthen them to reduce the appearance of sagging eyelids and improve blink dynamics. The device also incorporates radiofrequency to stimulate collagen production, further improving skin elasticity and overall eyelid aesthetics.
Other treatment options for loose eyelids include eyelid surgery and management of dry eye symptoms through eyelid taping, nighttime goggles, and lubrication.
THE AESTHETIC EFFECT
Sometimes, people seek out aesthetic procedures and products to enhance the appearance of their eyes without realizing these treatments could cause long-term harm to their eyelid health and overall eye function.5 Educating patients on how various aesthetic procedures and products can affect the health of their eyelids and lashes is crucial. For example, eyelash serums, makeup, lash extensions, lifts, and tints can weaken natural lashes, irritate the eyelid margins, cause infections, and disrupt the ocular surface.6 Additionally, certain skincare and makeup ingredients may worsen dryness, irritation, and inflammation or trigger allergic reactions around the eyes.
I prioritize recommending eye-friendly products that also provide aesthetic benefits in my clinic. A few practice favorites for me include Optase Life Sensitive Makeup Remover (Optase); Double Duty Precision Liquid Eye Liner (Twenty/Twenty Beauty), Visionary Eye Shadow Stick (Twenty/Twenty Beauty), and Get Growing Lash & Brow Serum (Twenty/Twenty Beauty); and mascara and powder eyeshadow from Eyes Are The Story. I also share simple and effective makeup tips with patients, such as removing eye makeup before bed and avoiding use of eyeliner on the waterline to prevent ocular surface issues. This may seem like common sense to eye care providers, but patients often don’t know what they don’t know, making it important to share this vital information to ensure their eye health is protected. Educating patients on these practices empowers them to make informed choices that protect their eye health and appearance. I often lead these discussions in the exam lane, but I also rely on my staff to help reinforce this important education. To further support patients, I hand out an informative brochure that outlines my tips and product recommendations.
Patients want to look and feel good, and the eyes are typically the first thing people notice. When eyelid and lash health are compromised, it can affect not only vision, but also physical appearance, self-esteem, and confidence. By prioritizing eye health alongside ocular aesthetics, we can help patients achieve the balance of feeling great and looking their best. Healthy lids and lashes are the foundation for clear, comfortable, beautiful eyes. As eye care providers, we have a unique opportunity to improve our patients’ eyelid health and physical appearance.
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