The products you use around your eyes play an important part in your eye health. Similar to brushing your teeth daily, eye hygiene and removal of make-up is essential. We all react to products on our skin differently and for those of us who are more sensitive, hypo-allergenic products are preferable. For those with dry eyes or contact lens wearers, it is particularly important to develop healthy habits with eye hygiene.
Eye make-up products; whether they are applied to our eyelashes or around our eyes, affect different anatomical parts of the eye. Below are some tips for different eye make-up application.
-Eyeliner. When using eyeliner, be mindful that application on the waterline (inner eyelid) can block the meibomian glands (see image 1) and contaminate the eye 1. A study done in the Faculty of Science at Waterloo found that within 5 minutes, 15-30% more make-up particles were found in the tear film when eyeliner was applied to the waterline, compared to application outside of this 1. Our meibomian glands secrete the lipid layer of our tears which stop our tears from evaporating and thus it is important that these glands are open and functioning. Shortly after application of eyeliner, there are demonstrated changes to the tear film and its stability 2.
Eyeliner application if used, should avoid the waterline to reduce its effect on our tears.
Image 1. Layers of tears.
-Eyeshadow. This is applied further from the glands and inner structures of the eyes, however certain types of eye shadows that smear easily, may also end up in your tear film. Studies show that this product in addition to mascara, can cause the greatest discomfort amongst many cosmetic products 3. Contact lens wearers should also be mindful that eyeshadow may deposit on their contact lenses and this should be avoided 3.
-Mascara. This is a common make-up item that needs to be changed regularly. Our skin has normal bacteria such as Staphylococcus Aureus and some people may have a build-up of bacteria on their eyelashes termed ‘anterior blepharitis’. A maximum of 3-month use of a mascara wand before replacement is important to reduce harbouring bacteria 4. When your optometrist performs a slit lamp microscopy exam, they look at your lashes for signs of blepharitis. If this is present, you may need an additional eyelid cleaner such as an antibacterial foam, which is used to scrub your lids and lashes at least once per day. Research has demonstrated that mascara can also cause pigmentation inside the eye at the lacrimal sac (part of the duct to the lacrimal system which contains anatomical structures used for tear production and drainage) 5.
-Anti-ageing eye creams. These creams are often applied around the eyes. Research shows that the retinoids present in these eye creams can negatively affect meibomian gland function (the glands which secrete the oil in our tears), and potentially contribute to dry eye disease 2. Studies investigating the effect of systemic isotretinoin on animal models demonstrated signs of blepharitis and meibomian gland ductal epithelium thickening, as well as decreased mature gland acini, which contribute to the lipid (oily) layer of our tears 2. There was also reduction in the number and size of meibomian gland acini (see image 2) 2. Human studies of those taking systemic isotretinoin for acne also demonstrated dry eye symptoms, blepharitis and Meibomian gland dysfunction. The lacrimal gland, which secretes the aqueous tears, also releases isotretinoin. “The potential impact of the usage of anti-aging facial and eye creams and gels on developing meibomian gland dysfunction and dry eye syndrome is great” 2.
Image 2. A single meibomian gland has clustered acini that secrete meibum. (Knop et al, 2011.)
• Pigmented products used over many years, may accumulate in the conjunctivae and the lacrimal system 2,6. The conjunctiva is a mucous membrane forming most of the surface of the eye – the white part of the eye you see in the mirror.
• Cosmetic products may also cause contact lens spoliation 2.
Removal of make-up before going to sleep is essential. Water alone cannot effectively remove cosmetic products, whereas surfactants in cosmetic removal products dissolve and alter the solubility of oils and waxes found in make-up 2. Note that water-proof mascara is removed best by oils, so investing in an oil-based make-up remover is beneficial 2. Oil-free make-up removal products have different surfactant concentrations which are good at removing cosmetics, however may solubilize the sebum in the eyelids and irritate the skin around your eyes 2. Your optometrist has eye-lid wipes and antibacterial foams that may also be used for make-up removal, particularly for those with dry/sensitive eyes.
The Tear Film & Ocular Surface Society Dry Eye Workshop (DEWS 2) latest report notes that exposure to cosmetic products, many of which contain toxic products, can elicit dry eye symptoms 7. For those with very sensitive eyes and/ or moderate to severe dry eyes, your optometrist may recommend avoiding eye make-up.
**Take home messages **
• The best way to ensure no additional irritation of the eyes, dry eyes and deposits on your contact lenses is to avoid eye make-up.
• When make-up is applied, avoid the inner part of the eye, particularly the waterline, as this can affect your tears and cause irritation.
• Retinoids present in anti-ageing creams and gels can contribute to dry eye and meibomian gland dysfunction.
• Ensure you have a good make-up remover that you use before going to sleep.
• Ensure all make-up products are changed regularly and that make-up brushes are washed regularly too.
• Your optometrist examines the health of your eye with a slit lamp microscope and can detect signs of cosmetic products depositing on the eye, tear film and/or your contact lenses.
1. Alison Ng, Katharine Evans, Rachel V. North, Christine Purslow. Migration of Cosmetic Products into the Tear Film. Eye & Contact Lens: Science & Clinical Practice, 2015; DOI: 10.1097/ICL.0000000000000124
2. Alison Ng, Katharine Evans, Rachel V. North, Christine Purslow. Impact of Eye Cosmetics on the Eye, Adnexa, and Ocular Surface. Eye & Contact Lens: Science & Clinical Practice, 2016. 42(4): 211-220. DOI: 10.1097/ICL.0000000000000181
3. Gao Y & Kanengiser BE. Categorical evaluation of the ocular irritancy of cosmetic and consumer products by human ocular instillation procedures. J Cosmet Sci 2004; 55: 317– 325.
4. Pack LD et al. (2008). Microbial contamination associated with mascara use. Optometry. Oct;79(10):587-93. doi: 10.1016/j.optm.2008.02.011.
5. Clifford, Luke & Jeffrey, M & Maclean, H. (2011). Lacrimal sac pigmentation due to mascara. Eye (London, England). 25. 397-8. 10.1038/eye.2010.209.
6. Ciolino, Joseph & M Mills, David & R Meyer, Dale. (2009). Ocular Manifestations of Long-Term Mascara Use. Ophthalmic plastic and reconstructive surgery. 25. 339-41. 10.1097/IOP.0b013e3181ab443e.
7. Gomes, J et al. (2017_. TFOS DEWS II iatrogenic report. Ocul Surf. Jul;15(3):511-538. doi: 10.1016/j.jtos.2017.05.004.
I’m sure most of us can relate to having experienced some sort of seasonal allergy when Spring and Summer comes around. For some it’s a mild case of hayfever, whereas for others, it can be a struggle getting through those months. Besides the constant runny nose and sneezing, seasonal allergies also have a large effect on our eyes – from watery eyes to allergic conjunctivitis.
Did you know Gerry & Johnson Optometrists are involved in clinical in-practice and international research projects?
Kate is busy working on her PhD, researching the optics of OrthoK and eye muscle coordination, which is due to be completed in July. All of the data for this research was collected from the practice, with our special PhD participants being involved in the key data collection phase from 2014 to 2016.
Kate and Paul are also working on an international research collaboration which will measure signs of UV damage and their effect on reading focus across a number of countries.
Kate & Paul returned back from a trip to Las Vegas in January to give presentations & learn about the latest treatments with contact lenses at the Global Specialty Lens Symposium Conference.
Paul (pictured above) is directing a new set of contact lens studies investigating new designs, for which we have been recruiting QUT School of Optometry students, who get to learn about contact lenses while participating in research. One day in February, we had 10 participants in the practice until 8pm that night trialing three different types of soft lenses for fit and comfort differences. We fed them pizza to show our appreciation!
Did you know that contact lenses are not just used for vision correction? There are many special applications of contact lenses – some of them are quite surprising!
I recently saw a patient with a badly scarred and blind eye. He was uncomfortable with the way the eye looks especially in photos so was wondering whether there was anything he could do to improve the cosmesis! We’ve all seen the wacky cosmetic coloured contact lenses (cat’s eyes anyone?) but what if you just want a ‘normal’ looking eye? Well, prosthetic contact lenses are the answer. I decided to fit my patient with a hand painted soft prosthetic contact lens with a black pupil – it is painted as an exact match to his uninjured eye! The result is quite impressive! Check out the before and after photos (consent obtained to share images)
Contact lenses are also commonly used as bandages or barriers for people who suffer from recurrent corneal problems or if their eyelashes grow in the wrong direction. The contact lens protects the surface of the eye and prevents scratches, abrasions and even opportunistic infections.
In February 2015 Paul and I volunteered a week at the Vietnam National Institute of Ophthalmology in Hanoi, teaching OrthoK fitting to the staff of the Refractive Department. The VNIO is a specialty eye hospital, employing about 500 staff and seeing around 2000 patients per day. I was also there in March 2014 teaching the fundamentals of rigid contact lens fitting, and was greeted with squeezy hugs from Minh Anh (Hanoi’s only qualified optometrist) and Dr Huong (Hanoi’s nicest and most cuddly ophthalmologist) whom I’d worked closely with in 2014 and had kept in touch with since. If you’re wondering why there’s only one qualified optometrist in Hanoi, and indeed only a total of three in a country of 90 million people, read on.
Hanoi had just entered a cold snap as we have arrived, so Minh Anh and Dr Huong brought scarves and extra layers for us today, because they’re so lovely. After three months of relentless 30+ degree heat in Brisbane, though, Paul and I were really enjoying mid-teens temperatures even though the locals were all rugged up! Each morning Paul or I gave lectures to the staff, and then were treated to a tasty lunch at a local street eatery, usually washed down with cinnamon tea. We would then see patients in the afternoon.
On this initial day, our first three patients are all 8 years of age, and all around -5.00. This is generally considered a high level of myopia (shortsightedness), meaning that anything further away than 20cm from their nose is blurred. The younger you are when you become myopic, generally the faster you progress (1) so parents looking to do something to slow down this worsening are wise for two reasons: higher levels of myopia are strongly associated with higher levels of eye diseases like glaucoma, macular degeneration and retinal detachment in adulthood (2) and because very high spectacle prescriptions have been shown to affect quality of life.(3)
Twin sisters came first – little M only got her last pair of glasses at the end of 2014 and has progressed two more steps of myopia in two months. Her mother said M’s first pair of glasses were only a year ago, and were less than half of the current strength. Her twin sister P has a similar story. After measurement including corneal topography, or mapping of the eye surface to select the best fitting lens, M&P then sat in the waiting room with trial OrthoK lenses on their eyes.
M was reclining in her Dad’s arms with her eyes closed enjoying a toasty winter’s day cuddle. Their mother discussed OrthoK with me through Minh Anh, reassured her daughters and took photos of the two overseas experts discussing trial lens selection with their eye doctors. Mum said she was only -1.00 and her husband is -4.00 – both girls have surpassed their parents’ myopia by only age 8.
Our third patient, a little boy of the same age who soon becomes nicknamed ‘Little Champ’, was lead out of the room with his eyes closed for a similar waiting room nap. We then brought M&P back in to check their lens fitting. M had a reduction in her myopia of nearly half in her 30 minute nap; P a little less. They were shown lens handling along with their mum and dad, and we planned to see them back in the morning. Paul and I gave M&P a koala toy to take home with them which they both seem quite taken with, although their unruffle-able demeanour wouldn’t give it away – they were entirely quiet and calm throughout having eye drops and contact lenses popped onto their eyes.
Around the world there is an increase in children of all ethnicities becoming myopic (4), and the reasons are multifactorial. Minimal time spent outside and high educational demands are key factors. I had an interesting conversation with one of the VNIO ophthalmologists at a dinner held in our honour later in the week. He said his children were myopic, and were getting worse, when they lived in an apartment with no significant outside view. Since they had moved to a higher apartment and could see further from the windows, their eyes had stopped worsening! While there’s probably a bit more to it such as the children getting older, where generally progression will slow down (1), there’s some truth to this observation!
Optometry isn’t a regulated profession in Vietnam, meaning that anyone can set up an optical shop with an automatic refraction machine (which takes an average reading of a spectacle prescription) and call themselves an optometrist or optician. Across the road from VNIO, the street is lined with these optical shops. Unfortunately for a lot of these myopic kids, this means that their glasses aren’t accurate, and whether they are over- or under-corrected, both can lead to worsening of myopia.(5,6)
Little Champ returned and his lenses look good for proceeding to an overnight trial. Mum was then instructed on lens handling and was struggling a bit, which gave Little Champ the giggles – no sight of tears or even a frowny face! While Dr Huong finished lens care discussions with his mum, Little Champ was folding up a paper plane out of a tissue I gave him earlier and flying it towards his toy koala. We saw him the next morning too.
Our three 5D myopic kids have done brilliantly after their first night in OrthoK. Twin girls M&P both crack smiles when their lenses are taken off, experiencing clearer vision with over half of their myopia being reduced in one night. Little Champ arrives at 9am and peeks in through the glass windowed door, looking a bit squinty as is normal on the first morning when the lenses are worn in for fitting assessment. He stands up in front of the microscope, rather than sitting down, because it’s at the perfect level for his 3 and a half feet of height. He’s been lucky enough to undergo even more overnight myopia reduction than our twin girls, and happily departs with all three due for follow up in another week
- Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith III EL, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci 2012;89:27-32.
- Flitcroft DI. The complex interactions of reintal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res 2012;31:622-60.
- Rose K, Harper R, Tromans C, Waterman C, Goldberg D, Haggerty C, Tullo A. Quality of life in myopia. Br J Ophthalmol 2000;84:1031-4.
- Dolgin E. The myopia boom. Nature 2015;519:276-8.
- Chung K, Mohidin N, O’Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vis Res 2002;42:2555-9.
- Gwiazda JE, Hyman L, Norton TT, Hussein ME, Marsh-Tootle W, Manny R, Wang Y, Everett D; COMET Group. Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children. Invest Ophthalmol Vis Sci. 2004 Jul;45:2143-51.