By Ally Stoeger, OD
Meibomian gland dysfunction is a hot subject, and providing the best possible care for these patients can set your practice apart. There are lots of great articles on this topic, but very few of them advise asking a question I find incredibly useful: “How do you remove your makeup?”
The answers will stun you! Women often remove their makeup with Vaseline, thick “cold cream” or baby oil. To make it worse, they almost never follow that makeup removal regimen with washing their lids with a soapy facial cleanser. I believe Vaseline, cold cream or oily substances migrate to the inner rim of the lid and cause, or exacerbate, meibomian gland dysfunction.
Even makeup removers marketed to be “non-oily” are slick and slippery. I am convinced makeup removers migrate into the inner rim of eyelids and form sludge composed of makeup and makeup remover. Women see that the makeup remover they use has removed makeup visible on the skin around their eyes. But what they don’t know is that these oily or slick substances are coating up their meibomian gland orifices.
I suggest that instead of using makeup removers or other oily products to remove their makeup, that they instead use a mild, non-creamy facial cleanser. Simply tell these patients to close their eyes and gently wash their eyelids with their fingertips. If heavier makeup is worn, the patient may need to wash and rinse twice. And if makeup is very heavy and a makeup remover Is actually necessary, the patient should make sure they wash their eyelids with their eyes closed, using a gentle facial cleanser after they have used the makeup remover.
Another group that runs into eyelid washing procedure problems are people who use exfoliating face washes or acne treatment washes. These products cannot be used around the eyes, and as a result, some of the people most at risk for meibomian gland dysfunction are never really washing their eyelids. These patients should be informed that they should use a mild facial cleanser (maybe one of the new eyecare tea tree oil cleansers) and then use their acne or exfoliating product on the rest of their face after that.
Probably the strangest answer I ever got from a patient when I asked her about makeup removal was that she used alcohol. I asked her why? She said because it is a “natural product.”
And then there was the patient whose dermatologist had given her a prescription for oral steroids. She came to see me, and I asked her: “How do you remove your makeup?” With proper makeup removal her problem cleared up completely–no steroids needed.
Interestingly, I have almost never found makeup to be a problem. But I have frequently diagnosed “Makeup Remover Blepharitis.”
How do you discuss with patients the importance of proper facial cleansing, including thoroughly removing eye makeup, in preventing meibomian gland dysfunction? Any tips to have a conversation about this without patients becoming defensive?
Ally Stoeger, OD, was a founding and managing partner of a multi-doctor practice and has recently opened a new practice in Gainesville, Va. Contact: ally@realpracticetoday.com. You also can follow Dr. Stoeger on Facebook at http://www.facebook.com/gheyedr.
