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A patient comes in with red, irritated eyes. Their eyelids are swollen. Maybe they have recurring styes, or perhaps they have tried several contact lenses and insist that every one of them feels dry.
For an eye care professional, the natural response is to start thinking about treatment. But Amy Gallant Sullivan, executive director and co-founder of the Tear Film & Ocular Surface Society (TFOS), suggests starting somewhere much simpler.
“What do you wash your face with?”
It was a question Sullivan returned to throughout her conversation with Dr. Jennifer Lyerly on the Defocus Media Podcast. As skincare routines become more complicated, the products patients use every day may be an overlooked part of the dry eye conversation.
Topics Covered :
Dry Eye Is Increasingly a Lifestyle Conversation
Dry eye was once commonly associated with aging, particularly menopausal women. That picture no longer reflects what clinicians are seeing.
Teenagers are showing up with irritated eyes. Young adults are struggling with contact lens comfort. Men and women across generations are dealing with redness, inflammation and eyelid problems.At the same time, skincare has changed dramatically. Patients may use cleansers, acne treatments, serums, retinols, makeup removers, eyelash growth products and multiple creams without ever considering them relevant to an eye exam.
They are also unlikely to volunteer that information.
As Lyerly pointed out, patients generally do not consider a face wash, retinol cream or lash serum a “medication.” Asking what medications they take may therefore completely miss an important part of their daily routine.That changes the conversation in the exam room. Instead of only asking what a patient is taking, clinicians may need to ask what they are putting on their face.
The Problem With Some Familiar Recommendations
Baby shampoo remains one of the most recognizable recommendations for eyelid hygiene, but Sullivan argues that its reputation deserves reconsideration.
A product being designed for babies does not mean it was designed for the ocular surface. Some formulations can contain fragrance, formaldehyde donors and other ingredients that may irritate the delicate skin surrounding the eyes. Lyerly also noted that baby shampoo may strip oils without delivering the antibacterial benefit many patients and clinicians assume it provides.
Oil-based products create a different concern. Petroleum jelly, coconut oil and similar products may seem appealing because they feel moisturizing and can loosen makeup. But around the eyelids, Lyerly and Sullivan discussed the possibility of trapping makeup residue, bacteria and oils against the skin while potentially contributing to meibomian gland obstruction.
Micellar water also received scrutiny. Despite the name, Sullivan noted that it is not simply water. Formulations may contain fragrances, corn derivatives and other ingredients that were developed with facial skin—not necessarily the ocular surface—in mind.
When “Natural” Does Not Mean Eye-Friendly
The skincare aisle is filled with products promoted as natural, clean or gentle. Those descriptions can be reassuring to consumers, but they do not automatically make a product appropriate around the eyes.
Tea tree oil is one example. It may have a role in clinician-directed Demodex management, but Sullivan emphasized the distinction between a targeted, short-term treatment and something applied around the eyelids every day.
The conversation also raised concerns about prolonged exposure to ingredients such as salicylic acid, retinols, certain essential oils and heavily fragranced products.
For clinicians who do not have time to decode every ingredient list, there may be simpler clues. Does the cleanser foam heavily? Is it strongly scented? Is it formulated with aggressive acne or anti-aging ingredients? Is the patient applying it directly around the eyelids?
Those questions can quickly lead the conversation in the right direction.
Skincare May Be Hiding Behind Contact Lens Intolerance
Perhaps one of the more interesting implications involves younger contact lens patients.
Lyerly described young patients and staff members who struggled to tolerate contact lenses because every option felt too dry. When a healthy first-time wearer cannot tolerate modern contact lens materials, it may be worth looking beyond the lens.
Young patients are entering the skincare world earlier than previous generations. The discussion pointed to children using retinols, acne treatments, eye makeup and other products long before most clinicians would traditionally think to ask about skincare.That makes unexplained contact lens intolerance a reason to dig deeper.
A teenager asking for contact lenses may need more than an evaluation of prescription, fit and tear film. A few questions about their morning and nighttime routines could reveal exposures that otherwise never make it into the chart.
A New Question for the Dry Eye Exam
None of this means optometrists need to become cosmetic chemists.
Sullivan’s approach is considerably more practical: make skincare part of the history.
Ask what patients wash their face with. Ask what goes around their eyes. Pay particular attention to patients with recurring redness, swollen lids, styes, unexplained irritation or contact lens intolerance.
For clinicians looking for a more structured resource, Sullivan pointed to the “Top 10 Nasties” available through Eyes Are The Story, which identifies ingredients of concern for people with sensitive eyes. TFOS also provides more extensive scientific resources on ocular surface disease and lifestyle factors.
The larger shift may simply be recognizing that dry eye care does not begin and end at the slit lamp.
Patients spend only a few minutes in the exam chair. The products they apply to their skin may sit around their eyes for hours every day. As skincare routines grow more complicated—and begin at younger ages—that daily exposure deserves a place in the clinical conversation.
Sometimes the most revealing question in a dry eye evaluation may also be one of the easiest to ask:
“What do you wash your face with?”
