Showing posts with label meibomian gland dysfunction. Show all posts
Showing posts with label meibomian gland dysfunction. Show all posts

Tuesday, November 27, 2018

eye makeup safety tips

As an optometrist, I get up close and personal with a lot of eyes. I see a fair amount of complications related to not-so-great eye makeup habits, so I wanted to share my top 10 eye makeup tips (from an eye health standpoint). 


1. Don't apply makeup inside the lash line.


This tops my list of eye makeup no-nos. "Waterlining" is the practice of applying eyeliner directly on the waterline. The waterline is the thin area between the eyelash line and the eye. Within that area are the openings of your meibomian glands. Meibomian glands secrete oil onto the front surface of the eye to help keep your tear film stable and your eyes moist and comfortable. Applying makeup inside the lash line can block these important glands, which can cause meibomian gland dysfunction (MGD). If the oil is not being secreted onto your tear film properly, your tears evaporate more quickly and your eyes are more dry. Dryness can manifest as a burning sensation, a sandy/gritty feeling, redness, tearing, and discomfort. Meibomian glands can also get infected (this infection is called a hordeolum, commonly referred to as a stye), so keep makeup away from the waterline!

Image via All About Vision

Makeup applied inside the lashline is also more likely to migrate into the eye and contaminate the tear film when compared to application outside the lash line (1). This presence in the tear film can cause irritation (especially for contact lens wearers) and tear film instability, which is a factor in dry eye disease.


Avoid applying eyeliner on the waterline, as demonstrated on the left
Image via Beauty Insiders

Beyond affecting your tear film stability and potentially causing infection, applying makeup inside the lash line can cause the makeup to build up in the eye over time and cause irritation. Below is an example of this. One of my patients came in reporting red and irritated eyes for several weeks. After examining her eyes, it appeared that she was applying a nude eyeliner to the water line, and that same nude eyeliner was found deposited in her lower eyelid tissue (the palpebral conjunctiva). When we discussed the findings, she realized that her symptoms began shortly after she adopted a new makeup technique she found on a YouTube tutorial. 


The arrow is pointing to some of the nude eyeliner particles that have become
embedded in the conjunctival tissue of the lower lid

Something else you shouldn't put on your waterline? Bling. That's right. Apparently, it needs to be said.
Don't do this. Just don't.
Image via Allure

2. Replace mascara and eyeliner every 3 months.


Liquid and cream makeup can be a breeding ground for bacteria. Get in the habit of cleaning out your makeup bag every quarter and replacing your mascara, eyeliner, etc. If you develop an eye infection, throw out your old makeup and start fresh. 


3. Don't sleep in your makeup.


You know this. But it happens. This is a report on a 50 year old woman who admitted to heavy mascara use with inadequate removal for 25+ years. The below photo shows mascara particles embedded in the tissue that lines the upper eyelid. Thoroughly clean your lids and lashes every night! After removing makeup, gently scrub along the lid margin with a premoistened wipe or a q-tip dabbed with a lash/lid cleanser. I recommend using a product that contains diluted tea tree oil, but avoid getting it IN the eye. Tea tree oil is effective against eradicating a mite that lives amongst your lashes (more on that in a previous post). Some of the products I frequently recommend to patients: Blephadex, Cliradex, We Love Eyes. *I have no financial interests in any of these companies- just sharing my recommendations!*

Mascara particles embedded in the conjunctival tissue
Image via Ophthalmology

4. Don't apply mascara in a moving vehicle, or use a sharp object to separate your lashes.


This may seem obvious, but it needs to be said. Mascara wands are a common cause of corneal scratches or abrasions. Keep sharp things away from your eyes!


Corneal abrasion from a mascara wand
Image via Clinical Optometry


5. Avoid using makeup that flakes. 


Glittery eyeliner is an example- the glitter particles can enter your eye and swim around in your tearfilm, irritating the eyes and adhering to contact lenses. 

Fiber mascara is another no-no in my book. The fiber particles often flake off and enter the eye, causing irritation and inflammation. 


This image shows glittery makeup particles within the tear film


6. Stop using a product if your skin/eyes become irritated, red, and swollen. 


It could be an allergic reaction to a new product. It's a good idea to patch test new makeup on your hand or arm before using it on/around your eyes. 

If you experience symptoms of redness, irritation, pain, itching, and/or dryness, discontinue makeup use and see your optometrist. This also applies to eyelash enhancers; there are many out there that cause inflammation and irritation of the eyelid margins. 



7. If you wear contact lenses, opt for daily disposable contacts. 


If there are any makeup particles adhering to your contact lenses, daily disposable contacts allow you to just throw them away at the end of the day. So you're not worrying about makeup deposits accumulating on your lenses day after day. 



8. Keep makeup brushes clean.


Bacteria and dust collect over time, so keep your makeup applicators clean.


9. Avoid eyelash extensions.


Blasphemy, I know. But just hear me out, and do with it what you will. 

Many of the complications I see relating to eyelash extensions stem from neglecting to clean the lash line well. With how expensive eyelash extensions are, I can understand being super cautious about bringing anything near them! Bacteria and dirt can collect and get trapped around the base of the lashes, causing irritation and infection. If you have eyelash extensions, avoid wearing mascara and oil-based makeup on or around the extensions. Use an oil-free cleanser on your lash line daily, gently cleaning the lash line using a bristle brush or spoolie (cotton can snag, so avoid that). Oil-based makeup removers weaken the adhesive and can cause the extensions to fall out prematurely, so use oil-free cleansers (thus, the tea tree oil cleansers I recommended earlier would not be a good option for those with extensions). 

The glue used to adhere eyelash extensions may contain formaldehyde, which can cause an allergic reaction. Ask your aesthetician what ingredients are in the glue he/she uses.

Dislodged or loose extensions, or flakes of glue, can rub against the eyelid and/or the cornea, which causes extreme irritation. If that happens, see an optometrist to remove the offending lash/particle. 

Eyelash extensions can also damage your natural eyelashes and even damage the hair follicle, which can slow down or halt hair growth. 

The best way to avoid these complications is obviously to avoid eyelash extensions. However, if you choose to go that route, here are some tips:

  • Make sure you look into the certifications and experience of your aesthetician
  • Choose a reputable salon that is safe and hygienic
  • Ask about adhesive ingredients beforehand
  • Avoid wearing mascara and oil-based makeup with eyelash extensions
  • Clean lashes daily with an oil-free cleanser
  • See an eye doctor if you develop redness, irritation, etc. 


10. Don't borrow or share makeup.


Sharing makeup introduces more bacteria and increases the likelihood of infection. Sampling makeup at a beauty counter is not a great idea, especially if multiple people sample the same bottle of product. 



CliffsNotes: 1) Don't apply makeup to the waterline, 2) Replace mascara and eyeliner every 3 months, 3) Don't sleep in your makeup, 4) Don't apply mascara in a moving vehicle or use sharp objects to separate lashes, 5) Avoid using makeup that flakes, 6) Stop using a product if your skin/eyes become irritated, red, and swollen, 7) If you wear contact lenses, opt for daily disposable contacts, 8) Keep makeup brushes clean, 9) Avoid eyelash extensions (if you must use them, be safe and keep them clean!), and 10) Don't borrow or share makeup.

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Tuesday, January 31, 2017

meibomian gland dysfunction

image: All About Vision
What are meibomian glands?
Meibomian glands are sebacous (oil) glands located in the upper and lower eyelids. There are more in the upper lid than the lower lid, and they are also larger in the upper lid (1). The glands sit vertically in the eyelids, and their openings are right behind the lash line. The job of the meibomian glands is to make and secrete oil. These secretions make up one of the 3 layers of the tear film, the lipid layer. Blinking helps spread the secretions on the surface of the eye, keeping the tear film stable and preventing it from evaporating too quickly. The function of the glands is regulated by hormones such as androgens, estrogens, and progestins. 

A visibly capped meibomian gland
What is MGD?
Meibomian gland dysfunction, or MGD, is not the most clearly defined condition.  Here's the technical definition:

"Meibomian gland dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian glands,commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion. It may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease." (2)  

Translation? MGD is when the meibomian glands don't work right. The dysfunction is typically either a result of a blockage in the gland or an abnormality in the oil being secreted. A blockage may present as a clear or opaque dome at the opening of the glands (see photo above). MGD can also involve changes in the quality and quantity of secretions. When pressure is applied to normal glands, they should secret a small amount of clear oil. In the case of MGD, the secretion is thicker and more yellow-white in color. I liken it to when you leave a tube of toothpaste open for a while, and you get some crusty, solidified gunk at the opening that you have to squeeze out to get to the usable toothpaste. 


What are the signs and symptoms of MGD?
Some common symptoms include dryness, a sandy/gritty feeling, a burning sensation, eye and lid irritation, contact lens intolerance, eyelids sticking together in the morning, and even blurry vision. These symptoms are also symptoms of similar but distinct conditions, so a thorough examination of the eyelids, tear film, and front surface of the eye by an eye doctor is warranted to help identify what the source of the issue is. 

Common associated signs of MGD are thickened eyelid margins, frothy tears, and a low tear break-up time (the time it takes for the tear film to break up due to evaporation). In fact, dysfunction of the meibomian glands is one of the main causes of evaporative dry eye disease. Not only does it cause dryness, but insufficient lipids may cause increased bacterial growth on the lid margins, which can cause a number of secondary lid issues (2).


What is MGD associated with?
  • Age: MGD increases in prevalence with age (3).
  • Contact lens wear: Studies suggest a decrease in functional meibomian glands with contact lens wear (4, 5).
  • Ethnicity: MGD appears to have a much higher prevalence among Asian populations (2). 
  • Systemic factors: menopause, rosacea, Sjogren's syndrome, etc. 

How is it treated?
There are various treatment options available, depending on the severity and associated symptoms/signs.  Here is a list of treatments I typically recommend for MGD, going from least complex (for milder cases) to most complex. 

1) BLINK! Blinking stimulates the secretion of meibum, and helps spread it across the surface of the eye. Studies show you blink less when reading, and you blink 60% less when at the computer (6).  So take frequent breaks, and make a conscious effort to blink completely during those breaks.
2) Warm compresses with lid massage. Taking a page out of a colleague's book, it's the flossing of the eye world- it's something you SHOULD do daily to prevent disease, but not a lot of people do it religiously. 
  • Use a warm washcloth (or a boiled egg or warmed dry rice wrapped in a cloth- somethng that stays warms for a few minutes) and rest it over your eyelids with your eyes closed. Do so for at least 5-10 minutes. Gently massage your eyelids, rolling your fingers vertically down your upper lid and up your lower lid (towards your lashes). This helps get the oils flowing normally, and also helps remove any solidified gunk at the opening of the glands.
  • I recommend doing this twice daily when symptoms are present, or when MGD is first diagnosed. Beyond that, once daily is great for maintenance.
  • Follow up with a lid cleanser, gently scrubbing along the lash line to remove debris, makeup, and bacteria that may clog or infect the oil glands. A cleanser containing diluted tea tree oil is particularly beneficial if Demodex is present. 
Lipiflow is an in-office procedure that accomplishes the same thing, though more effectively.  The device heats the internal surface of the lids and simultaneously applies pressure to the external lid to express the glands, all in about 12 minutes. 

3) Omega-3 fatty acids. Omega-3s help improve the quality of the oil produced by the meibomian glands, and they have anti-inflammatory effects. A great source of omega-3s is fatty fish, like salmon and tuna. Another option is fish or flax seed oil supplements. It's always a good idea to consult with your doctor before starting any supplement.

4) Artificial tears can also help beef up the contents of the tear film.  Lipid-based artificial tears are best in the case of MGD because they help replenish the lipid layer of the tear film, and not just the aqueous layer. Some lipid-based drops: Systane Balance, Soothe XP, Retaine MGD, and Refresh Optive Advanced. 

5) Prescription medications.  Depending on the other presenting conditions, some patients with MGD may require the use of antibiotics. Topical azithromycin or low-dose, long-term use of oral doxycycline are thought to alter the eyelid bacteria and also provide anti-inflammatory effects (7, 8). Still others with severe MGD may need to have the inflammation controlled through the short-term use of a topical steroid drop or the long-term use of a dry-eye drop. 


CliffsNotes: MGD can alter the makeup of the tear film, leading to eye irritation, inflammation, and dry eye. So see your eye doctor STAT to nip it in the bud!

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