Beauty is in the eye of the beholder. Beauty is skin deep. It's what's inside that counts. These phrases gets tossed around, yet people all over the world are investing billions into the cosmetic industry now more than ever. Men and women paint our faces and in particular our eyes to create the smokey, butterfly lashes that magazines and TV tells us we need in order to be 'current'. But what is happening to the tissue underneath that paint - what happens after the smoke fades away? I can tell you from my years of clinical experience and research that the eyes aren't very forgiving and what you're not seeing is the decline and deterioration of one of the most important organs in your body. Your EYES!
So after years of piling pencil liner, mascara, shadow, concealer to and around your eyes, despite your best efforts to remove all of it from the area with cleansers and patented lotions and potions, the eyelid is unfortunately ends up carrying the burden of harboring microscopic bits of make-up debris and builds a breeding ground for bacterial growth which results in an aggressive inflammatory cascade that is so sneaky that the symptoms fail to present themselves until the disease is in full swing. That disease is LID DISEASE - it encompasses blepharitis, meibomian gland dysfunction, lid wiper epitheliopathy and more generally dry eye disease.
When is the last time you visited your dentist or dental hygienist for a teeth cleaning? Do you brush your teeth everyday? This concept of oral hygiene is well accepted and widely known that the consequences of not cleaning your teeth can lead to gingivitis and several other oral issues. The eyelid, both upper and lower, are complex structures that have hair follicles, 2 types of differentiated skin and several glands all that are responsible for keeping your cornea nourished, clear and comfortable; the windshield wiper of your eye so to speak. Yet despite the importance of this structure in keeping your vision clear and protecting the eye from infection and damage, we plaster foreign material that is in some cases toxic to this sensitive tissue and still expect it to last a lifetime? Well what actually happens is the eye lid skin and glands (known as meibomian glands) go through a process called keratinization and atrophy. Basically the devitalized skin crusts and grows irregularly over the gland openings as well as within the glands themselves, eventually leading to gland death in the long term. These glands are responsible for adding the much needed oil your tears need to prevent evaporation of the tears, buffer the friction between cornea and eyelid as well as balance inflammation at the surface of the eye. When this surface isn't properly cleared of debris, the keratinization process is started leading to breakdown of this gentle balance that keeps our eyes comfortable and clear. Some studies have shown that as much as 60% of adults have incomplete eyelid closure when blinking, a process that is meant to assist proper clearance of debris and epithelium from the lid surface.
Washing your face and eye area is important to minimize the small particles of makeup debris that can and will transfer into the eye, however the lid margin is an area that without clinical instruments is near impossible to clear with causing damage. In fact, without specific vital dyes, similar to the ones your dentist uses to highlight plaque on your teeth, damaged tissue is actually very difficult to see even under a microscope. Don't be fooled when you look at your lids under a magnifying mirror and think all the make-up is gone or if you cannot see any dead skin build up.
A new innovative area in eye care is emerging to manage this preventable problem. Dry Eye Disease is reported in scientific literature in as much as 1 in 3 adults in North America. The problem with that number is many cases of Dry Eye Disease can be prevented by clinical periocular hygiene. At eyeLABS Center for Ocular Surface Disease, various techniques have been developed and adapted to clean and clear this area with clinical precision and effectiveness. A comprehensive clinical periocular cleaning is the most effective way to keep this structure healthy and hygienic to date and is a non-surgical treatment for this surface. As clinical director at eyeLABS, our patients have benefited from hundreds of clinical hours spent refining our non-surgical periocular techniques as well as developing new ones making our center a first of its kind facility with specialty services in periocular hygeine and treatments. Lid margin debridement/scaling is a technique used to clear keratinized tissue after being highlighted with specific ophthalmic dyes at the eyelid surface. Obstructed glands can be cleared which give the oils a clear path to the tear film using various expression instruments with gentle pressure being applied. In many cases, thermal pulsation is used if the obstruction is too hardened for routine expression to clear. This 12-minute procedure is the only FDA approved therapy for non-surgical treatment of evaporative dry eye and eyeLABS was the first optometric center in the country to acquire this technology. Eyelash follicles and roots are known areas where bacteria and mites (Demodex) make a home and can accumulate. This can lead to inflammation at the eyelash base which worsens the nearby tissue inflammation and damage. Loss of eyelashes can be a sign of bacterial or mite infestation. Up to 80% of blepharitis patients have clinically documented Demodex infestation, depite good at home hygiene. BlephEx is a new treatment method that allows clinical removal and cleaning of this area.
Clinical periocular hygiene is a growing area of non-surgical treatments for the eyelid and periocular region which is a proven effective means of keeping the delicate skin of the inner and outer eyelid healthy and vital to preventing lid disease and maintain good comfortable ocular health. Wear and tear to this area can and does happen without makeup application as well. Incomplete blinking, contact lens wear, environmental debris, certain medications and health problems (diabetes, thyroid, arthritis) all increase the burden to this area. Men are just as vulnerable as women to this problem.
Like every new area of medicine, many doctors don't even know it exists and may prescribe artifical tears, antibiotic drops, lid scrubs or other at home warm compresses and baby shampoo however none of these at home solutions are able to clinically treat this area. Like brushing your teeth daily (or twice daily), professional grade hygiene is required for proper oral health. The most effective therapy is a combination of good home hygiene and regular clinical periocular hygiene. The next time you book a facial to 'clear your pores', consider doing your eyes a favour and booking a comprehensive clinical cleaning for your eyes. They'll thank you for it!
In good health,
Dr. Richard Maharaj OD, FAAO