Eyelids, Exfoliation + Expressions

Consumers today care about their facial appearance more than ever.

In a 2018 American Society for Dermatologic Surgery survey, 72% of respondents reported that they are bothered by the lines and wrinkles around their eyes.

In 2018, dermatologists performed 3.7 million wrinkle-relaxing injections and fillers procedures (out of 12.5 million total procedures), and plastic surgeons performed 10 million similar procedures (out of 15.9 million total procedures), according to 2018 National Plastic Surgery Statistics. The same report logged 709,000 microdermabrasion procedures and 206,000 eyelid surgeries.

Many of these patients are not aware that clean eyelids and lashes plus a healthy ocular surface prior to surgery can enhance the desired outcome. They also may not know that the above aesthetic procedures can sometimes exacerbate their preexisting irritated eyelids and dry eye symptoms.

If a survey was conducted on the percentage of Americans who are bothered by their red, irritated, dry, and tired eyes, the percentage would probably be quite high. Yet most people are not aware of the following:

1. Annual eye exams and daily eyelids/lashes hygiene routines are necessary, not optional, for eye health and comfort;
2. Poor eyelids/lashes hygiene can lead to chronic blepharitis and demodex infestations, which contribute to increased dry eye symptoms and meibomian gland dysfunction and progress to the disease state if left untreated;
3. More ocular surface disease (OSD)-focused optometric practices are offering effective and minimally invasive eyelids microblepharoexfoliation (MBE) and clogged meibomian gland expression services.

Patients are not aware of the explosion of OSD and dry eye disease (DED) treatment options. So, I have adopted both the dental and dermatological model and language to explain to our patients and to ECPs what the eyelids exfoliation and expression procedures and benefits are.

According to the most recent American Dental Association Oral Health and Well-Being Survey, 95% of survey participants agreed regular dental visits keep them healthy; 85% felt that they need to visit the dentist twice per year; and 77% said that they plan to visit the dentist within the next year.

It is common knowledge that daily teeth brushing, flossing, and mouthwash rinsing can reduce and prevent cavities and gum disease. Similarly, many people are aware that regular facials and microdermabrasion procedures improve and rejuvenate their facial skin health and appearance.

I have had success in how I educate about the following eyelids exfoliation and expression services:

1. In-Office Microblepharoexfoliation Procedure: Table 1, similar to deep teeth cleaning every six months
2. At-Home Eyelids/Lashes Cleanser: Table 2, similar to daily teeth brushing and flossing
3. At-Home Hypochlorous Acid (HoCl) Leave-On Spray: Table 3, similar to daily dental mouthwash rinse
4. In-Office Meibomian Gland Expression (MGX) Procedures: Table 4, similar to combined effect of microdermabrasion facials and unclogging blackheads

The “BSL Protocol” below is in addition to other pharmacological and nonpharmacological DED concurrent therapies when applicable (TFOS DEWS II Report):

MBE + IPL + MGX

1. MBE: Reduce chronic blepharitis and demodex infestations
2. IPL: Reduce eyelid and peri-ocular surface inflammation with intense pulsed light (IPL) treatment
3. MGX: Rejuvenate + express blocked meibomian glands

Effective eyelids exfoliation and expression procedures have helped many of our patients feel more confident, regain control of their contact lens and cosmetics use, and improve their ocular aesthetic procedure outcomes. —BRIDGITTE SHEN LEE, O.D.

All chart information compiled by Bridgitte Shen Lee, O.D., FBCLA, FAAO

BRIDGITTE SHEN LEE, O.D., FBCLA, FAAO, earned her degree from University of Houston College of Optometry in 1998. She is the founder of the Vision Optique practice in Houston and iTravelCE, which organizes CE programs in Asia. She writes and lectures on the topics of digital eye health, dry eye disease, anti-aging eye care, healthcare social media, and ocular aesthetics.