A Closer Look at Aesthetics in the EyeCare Space

Uncovering the aesthetic benefits of various devices, eye beauty trends, and products
Aesthetic optometry has created quite a buzz in the optometric community. We understand ocular aesthetics best for its roots in managing dry eye disease (DED), but over the past few years, we have witnessed a growing area of “eye beauty” awareness, perhaps thanks to the Zoom era, where patients have become hyper-focused on the appearance of their eyes.
Ocular aesthetics used to fall in the realm of cosmetic eye surgery, but that has changed, and the definition of aesthetic optometry has evolved to include the enhanced appearance of the eye and the skin around the eye. Thus, optometrists should be at the center of any discussion involving aesthetic optometry, as we are well-versed and educated in the anatomy of the eyelid skin and how it interacts with the eye itself, especially in relation to the ocular surface. As our understanding of the delicate ocular surface grows, we can’t help but realize the positive aesthetic effects of dry eye treatments, leaving us curious for more.

Ocular aesthetics can be divided into three categories: devices, products, and safe eye beauty trends. A comprehensive ocular aesthetics clinic comes together best when treatment can be offered in all three areas. As optometrists, we are well acquainted with the ocular surface benefits of these areas, so this article highlights their aesthetic benefits.
 

DEVICES

Intense Pulsed Light Therapy
In-office procedures such as intense pulsed light (IPL) therapy’s aesthetic benefits include: reduction of hyperpigmentation and skin telangiectasias; promotion of skin tightening and collagen synthesis; treatment of acne; and hair removal. IPL also reduces Demodex load on the eyelids, which enhances the appearance of erythematous and edematous eyelids.1,2 Its limitation is darkly pigmented skin. Although many instruments are used for aesthetic purposes off-label, the OptiLight (Lumenis) is the only IPL device that is FDA approved for treatment of DED.

Low Level Light Therapy
Low level light therapy (LLLT) is an atraumatic, athermal method of photobiomodulation using light-emitting diodes (LED) at certain wavelengths to influence cellular metabolism.2 Most notably, LLLT’s aesthetic benefits lie in improving collagen synthesis, hydration, and skin pigmentation, as well as reducing erythema, inflammation, and rosacea of the skin.3 Various wavelengths (aka colors) of light can be applied for specific applications due to the light’s penetration through the skin’s different layers. Amber light, for example, is mostly used for its aesthetic benefits,4 whereas blue light is absorbed by bacteria’s cell membranes for the treatment of blepharitis. LLLT can be beneficial when paired with other modes of photobiomodulation, such as IPL.

Radiofrequency
Radiofrequency (RF) is primarily used in eye care to reduce fine wrinkles around the eyelid skin by targeting water molecules. RF produces high frequency electric currents that penetrate to the skin’s dermal layers and create tissue resistance, which generates heat to provide collagen synthesis, and therefore, a reduction in fine lines and wrinkles. Heat exposure is thought to support fibroblast activity and skin rejuvenation.5 Due to its heating mechanism, RF is becoming a known treatment for MGD. Tighter skin of the eyelid may lead to a tighter/full blinking mechanism, which then leads to a healthier ocular surface. Its aesthetic benefits include collagen synthesis, reduced fine lines and wrinkles, and a plump appearance to the skin. It cannot be used in patients with pacemakers.

There is obvious overlap in the outcomes of LLLT and RF, although the mechanisms in the application of these devices differ slightly. We are still learning from our dry eye applications which treatments work best and in which combination. As eye care practitioners, we understand that combining the effects of these devices can improve the ocular surface and confer aesthetic benefits, such as improved symptoms and signs of MGD and Sjögren syndrome–related DED when combining IPL and LLLT.2,6,7

AESTHETIC PRODUCTS
OnabotulinumtoxinA (Botox, Allergan/AbbVie) has been used in aesthetics for decades and is more recently gaining attention for its application to relax lateral canthal rhytids (aka crows’ feet). However, if not applied appropriately, it has the potential to cause dry eye symptoms due to lagophthalmos, poor blink mechanism, and/or ectropion, as a result of reduced tonicity of medial pretarsal fibers, reduction in outflow of tears, or malpositioning of the eyelids.8

EYE BEAUTY PRODUCTS
Eye safe beauty has made its mark in the dry eye community, largely owing to ingredients that are potentially aggravating to the ocular surface. Eye safe beauty also has aesthetic roots that lie in DED treatment. This is well detailed in a recently published report titled, “A Lifestyle Epidemic: Ocular Surface Disease,” which is part of the Tear Film & Ocular Surface Society Workshop.9

Safer eye beauty products created with the ocular surface in mind are now available to our patients, including eyelid cleansing and makeup removal options. Eyelash and eyebrow growth serums are also gaining popularity as a safer way to enhance the appearance of our eyes, although a thorough review of ingredients is necessary to avoid harsh preservatives that can lead to ocular surface and adnexal inflammation.

Additionally, these products can be sold in-office and contribute to building a comprehensive aesthetic clinic.

It is crucial that we consider the biochemical composition and interactions of the ingredients in the whole product, rather than isolating individual ingredients. Due to the complexity of how certain molecules interact with each other and in different environments, best practices lie in guiding patients towards cleaner products, rather than identifying and avoiding individual ingredients.

Eye Beauty Trends
Trends in the beauty industry related to eyes have also gained attention over the past 5 years, such as eyeliner tightlining; loose glitter eye shadows; eyelash extensions; and tinting, dyeing, and lifting the eyelashes and eyebrows. Many eye care practitioners are of the belief that patients will engage in these habits regardless of our advice, and instead of isolating patients from adequate care, we should offer these services in our offices to better monitor any complications. In many instances, this contributes to building the aesthetic portion of the practice, in addition to promoting healthy beauty habits and education.

Skin Care
Skin care is often the first type of aesthetic treatment we think of before we visit an aesthetician. Skin care and ocular health are tied intimately by toxic ingredients that might be found in skin care products and can migrate toward the ocular surface. One such example is eye creams that contain retinoid derivatives, which can affect meibomian gland health.8 Medical grade sunscreen and facial cleansers are also available for eye care practitioners to offer for purchase in-office and round out their aesthetic offerings.

1. Fishman HA, Periman LM, Shah AA. Real-time video microscopy of in vitro Demodex death by intense pulsed light. Photobiomodul Photomed Laser Surg. 2020;38(8):472-476.
2. Stonecipher K, Abell TG, Chotiner B, Chotiner E, Potvin R. Combined low level light therapy and intense pulsed light therapy for the treatment of meibomian gland dysfunction. Clin Ophthalmol. 2019;13:993-999.
3. Menezes PFC, Urbaczek AC, Matta RFD, Bagnato VS. Photobiomodulation using amber light and infrared laser to control the pigmentation and flaccidity from skin. J Aesthet Reconstr Surg. 2020;6(2):8
4. Thomas C. Understanding photobiomodulation therapy. Modern Optometry. 2021;3(5):24-26.
5. Elsaie ML. Cutaneous remodeling and photorejuvenation using radiofrequency devices. Indian J Dermatol. 2009;54(3):201-205.
6. Solomos L, Bouthour W, Malclès A, Thumann G, Massa H. Meibomian gland dysfunction: intense pulsed light therapy in combination with low-level light therapy as rescue treatment. Medicina (Kaunas). 2021;57(6):619
7. Di Marino M, Conigliaro P, Aiello F, et al. Combined low-level light therapy and intense pulsed light therapy for the treatment of dry eye in patients with Sjögren’s syndrome. J Ophthalmol. 2021;2021:2023246.
8. Ozgur OK, Murariu D, Parsa AA, Parsa FD. Dry eye syndrome due to botulinum toxin type-A injection: guideline for prevention. Hawaii J Med Public Health. 2012;71(5):120-123.
9. Sullivan DA, daCosta AX, Del Duca E, et al. TFOS lifestyle: impact of cosmetics on the ocular surface. Ocul Surf. 2023;29:77-130.