Maintaining eye health in 4 simple steps

As our most valued sense, vision cannot be taken for granted. By incorporating it into other established regimens—the obvious being oral care—eye care can be made simple and easy. (Image credit: Adobe Stock/puhhha)

Although studies show that people fear going blind more than almost anything else, most don’t practice daily eye care. It seems that patients take ocular health for granted and expect their eyes to function with little to no maintenance. Contrast this to the fact that almost all brush and (perhaps) floss their teeth twice daily—and teeth can be replaced!

To counter this lack of focus on the eyes, I review medications with patients, offer tips to modify their work environments, and suggest the simple daily steps found in the TFOS DEWS II report under Staged Management & Treatment Recommendations for Dry Eye Disease¹:

Hydrate: Artificial tears bring moisture to the ocular surface.

Harmonize: Lid and lash cleansers reduce the bacterial population on lid margins.

Heat: Warm compresses liquify the meibomian and allow it to flow to the ocular surface.

Heal: Nutritional supplements give eyes the building blocks to produce healthy tears.

I start by having patients add lid scrubs and warm compresses twice a day to their oral health regimen. This is an easy way to introduce eye care into an already established ritual (AKA “habit stacking”) without requiring a lot of extra time, thought, or effort. And it helps improve adherence. Once they’ve incorporated these steps, I fine-tune their routine based on what I see during follow-ups. I do this with virtually all patients, whether they have mild, moderate, or severe dry eye disease.

In addition, I provide handouts outlining the steps and recommend products tailored to specific conditions. For instance, I may want patients to use a hypochlorous spray, a foaming cleanser, or a wipe, and I may recommend an electric or a beaded microwavable mask as a compress.

After the initial evaluation, my patients receive a series of emails that reiterate the steps, review the products discussed, and include videos demonstrating correct use. The emails also describe other treatments, like prescription medications and in-office procedures. This way, when they come back for a follow-up, patients have an idea of what might be the next step in their care plan.

Makeup hygiene

For me, it is very important to emphasize proper makeup hygiene. Often patients don’t know how to remove makeup safely and thoroughly or are unaware of the harm caused by cosmetics that get into the tear film. How many of our patients know, for example, that mascara should be thrown out every 3 months?

I also give patients a handout on makeup hygiene that includes my favorite makeup removers and 3 rules: remove make up every night, don’t use waterproof products, and don’t tightline the eyes. These rules are nonnegotiable! If a patient returns to my office with their eyeliner tightlined, I will discuss it with them again. It has taken me some time to gain enough confidence to be this firm and direct. I feel very strongly about the damage patients can do when they break these rules, and I believe they are not getting this information anywhere else. Ultimately, my recommendations are about eye health, not beauty.

Specific recommendations

For most of my recommendations, I suggest specific products. Many of them I sell as a convenience in my office, and patients can reorder them at dryeyerescue.com.

There are many excellent artificial tears available, like Oasis Tears (Oasis Medical), Optase (Optase), Refresh (Allergan), Systane (Alcon), and iVIZIA (Théa). I recommend specific products based on patient lifestyle. If they use contact lenses or work on a computer, I may recommend a particular brand. And I almost always advise them to opt for preservative-free artificial tears.

I’m also very specific when it comes to lid cleansers. For patients with mild dry eye or sensitive skin, I recommend a hypochlorous spray. For those with a lot of scurf in the lashes, I suggest a foaming cleanser and a lid scrub pad. The cleanser and wipes from Zocular are one of my favorites.

It is important that patients use proper cleansers. A product that is too harsh or used too frequently can exacerbate the problem, stripping away needed oils and leaving lid margins red and irritated. Regular follow-up allows me to determine whether I need to back off on part of the regimen.

I also recommend a warm compress mask. My 2 standbys are microwaveable masks, such as those made by Bruder, or the UNclog Mask, a plug-in type that uses infrared light to reach the meibomian glands. I like this mask for patients with rosacea because the light penetrates the skin better, so their lids are not as inflamed after using it.

Nutritional supplements

I recommend that all my patients with dry eye take a nutritional supplement to give their bodies the building blocks required to produce healthy tears. I ask whether they’re taking a fish oil or an omega fatty acid supplement, and I tell them to start HydroEye (ScienceBased Health) once they finish what they have. Some patients claim they get all the needed omegas and nutrients from their diet, but this is rarely the case.

HydroEye’s patented formula is made specifically to support dry eyes. It contains gamma-linolenic acid (GLA), a fatty acid derived from blackcurrant seed oil that is not available in fish oil, flaxseed oil, or most diets. I also let patients know that GLA is a unique fatty acid that helps modulate the body’s inflammatory response.² GLA has been shown to improve dry eye symptoms in variety studies,^3-8 and HydroEye has been specifically validated in a randomized, controlled clinical trial.⁹

Because I am making specific recommendations to provide the best care for my patients, especially with nutritional supplements, I want to ensure they get the right product. Offering HydroEye in the office makes their lives a little bit easier. And I stand by my recommendations, always taking something back and providing a refund if for any reason they are not satisfied.

Conclusion

I believe it is vital to impress upon patients that their eye health needs to be prioritized and made part of their daily hygiene routine. As our most valued sense, vision cannot be taken for granted. By incorporating it into other established regimens—the obvious being oral care—eye care can be made simple and easy. I’ve found that taking advantage of “habit stacking” and adding these simple steps empowers patients to maintain healthy eyes and vision for life. Dry eye care doesn’t need to be complicated; it just needs to be routine.

References

1. Jones L, Downie LE, Korb D, et al. TFOS DEWS II management and therapy report. Ocul Surf. 2017;15(3):575-628. doi:10.1016/j.jtos.2017.05.006

2. Kapoor R, Huang YS. Gamma linolenic acid: an antiinflammatory omega-6 fatty acid. Curr Pharm Biotechnol. 2006;7(6):531-534. doi:10.2174/138920106779116874

3. Barabino S, Rolando M, Camicione P, et al. Systemic linoleic and gamma-linolenic acid therapy in dry eye syndrome with an inflammatory component. Cornea. 2003;22(2):97-101. doi:10.1097/00003226-200303000-00002

4. Macrì A, Giuffrida S, Amico V, Iester M, Traverso CE. Effect of linoleic acid and gamma-linolenic acid on tear production, tear clearance and on the ocular surface after photorefractive keratectomy. Graefes Arch Clin Exp Ophthalmol. 2003;241(7):561-566. doi:10.1007/s00417-003-0685-x

5. Aragona P, Bucolo C, Spinella R, Giuffrida S, Ferreri G. Systemic Omega-6 essential fatty acid treatment and pge1 tear content in Sjögren’s syndrome patients. Invest Ophthalmol Vis Sci. 2005;46(12):4474-4479. doi:10.1167/iovs.04-1394

6. Kokke KH, Morris JA, Lawrenson JG. Oral omega-6 essential fatty acid treatment in contact lens associated dry eye. Cont Lens Anterior Eye. 2008;31(3):141-146. doi:10.1016/j.clae.2007.12.001

7. Pinna A, Piccinini P, Carta F. Effect of oral linoleic and gamma-linolenic acid on meibomian gland dysfunction. Cornea. 2007;26(3):260-264. doi:10.1097/ICO.0b013e318033d79b

8. Brignole-Baudouin F, Baudouin C, Aragona P, et al. A multicentre, double-masked, randomized, controlled trial assessing the effect of oral supplementation of omega-3 and omega-6 fatty acids on a conjunctival inflammatory marker in dry eye patients. Acta Ophthalmol. 2011;89(7):e591-7. doi10.1111/j.1755-3768.2011.02196.x

9. Sheppard JD Jr, Singh R, McClellan AJ, et al. Long-term supplementation with n-6 and n-3 PUFAs improves moderate-to-severe keratoconjunctivitis sicca: a randomized double-blind clinical trial. Cornea. 2013;32(10):1297-1304. doi:10.1097/ICO.0b013e318299549c