Eyeworld

108 | EYEWORLD | DECEMBER 2020 C ORNEA by Maxine Lipner Senior Contributing Writer It's not enough for patients to avoid the eye area when applying these products. "They're not putting it anywhere near the orbital rim because you don't get pimples there," Dr. Periman said, adding that there was either a migration effect or downregulation of meibum in the neighbor- hood in response to these drying medications. Trendy cosmetics can also cause dryness. Instagram is full of cosmetic tutorials, Dr. Periman noted. "I cringe when I see these," she said. One such technique involves applying eyeliner directly on the lid margin, known as tightlining. "That can effectively block your meibum flow," she said. Some teens may also do eyelash perming, she continued. With this, a plastic bolster is used and solution is placed on the base of the eyelashes to permanently crimp them. This in- terferes with the eye's natural defense in which the lashes are in a certain position to maximize the deflection of wind, allergens, and debris. Eyelash growth serums are proinflammatory, Dr. Periman continued, and make the meibomian glands sick. How the latest trends may be affecting the ocular surface in teens W hen teens come into the clinic, it's important to consider that they might have dry eye or mei- bomian gland disease. Investiga- tors in a recent study found that among minors coming in for eye exams, 15% were experiencing dry eye discomfort and 9% had signs of meibomian gland dropout, accord- ing to lead investigator Anna Tichenor, PhD. 1 "We were expecting that their meibomian glands would be healthy and everything would look great," Dr. Tichenor said. The fact that so many were reporting discomfort was surprising, Dr. Tichenor added, but noted that the meibo- mian gland dropout rate was not statistically significant. The study included 225 individuals 8–17 years old. Among older individuals (14–17 years old), dropout rates rose to 11%, Dr. Tichenor reported, speculating that it could be due to digital device use. "We started to hear potential links with digital devices and dry eye," she said. Though the research did not find a significant associa- tion with device use and dry eye, it's possible that the dry eye was not yet severe enough and a link may have been seen in slightly older patients, Dr. Tichenor said. When it comes to dropout, it's unclear whether some amount may be normal. Approximately 30 of the subjects said they used mascara, but no correlation was found. "I think that's because there was such a small number of them who used makeup," Dr. Tichenor said. Other studies have identified dry eye among younger patients, too. Laura Periman, MD, cited a study that showed the majority of young patients have at least a mild degree of meibo- mian gland atrophy, with moderate and severe disease also present in some. 2 In Dr. Periman's view, significant dry eye risk factors for teens are screen time and use of acne care products. "These things are known ocular surface offenders," she said. One study showed that those who used isotretinoin/eryth- romycin had a decreased tear film breakup time and lower ocular surface disease index scores, Dr. Periman noted. 3 Fifty-one percent of eyes also had punctate epitheliopathy. About the doctors Cynthia Matossian, MD Matossian Eye Associates Doylestown, Pennsylvania Laura Periman, MD Director of Dry Eye Services and Clinical Research Oracle Eye Institute Seattle, Washington Anna Tichenor, PhD Assistant Professor Indiana School of Optometry Bloomington, Indiana References 1. Tichenor AA, et al. Tear film and meibomian gland character- istics in adolescents. Cornea. 2019;38:1475–1482. 2. Gupta PK, et al. Prevalence of meibomian gland atrophy in a pediatric population. Cornea. 2018;37:426–430. 3. Aslan Bayhan S, et al. Effects of topical acne treatment on the ocular surface in patients with acne vulgaris. Cont Lens Anterior Eye. 2016;39:431–434. Relevant disclosures Matossian: None Periman: None Tichenor: None continued on page 110 This 20-year-old college student with meibomian gland dropout and lid seal insufficiency had dry eye complaints. The student reported long computer hours, poor sleep, poor nutrition, excessive contact lens wear, and use of multiple over-the-counter and prescription acne treatment products. Source: Laura Periman, MD

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