Bringing lifestyle into the dry eye discussion (2025)

The Tear Film and Ocular Surface Society (TFOS) addressed the links between lifestyle and eye health – particularly the ocular surface – in the TFOS Lifestyle Report, published in 2023.

“Unintended consequences that threaten ocular surface health can arise as a result of lifestyle choices made by patients,” authors wrote in the TFOS Lifestyle Report Executive Summary: A Lifestyle Epidemic – Ocular Surface Disease.

Authors highlighted the vulnerabilities of the ocular surface from external environments, directly applied products, and the internal environment.

Lack of awareness

Nick Atkins, managing director of Positive Impact, reflected: “Lifestyle encompasses so many things, from a healthy diet, to spending time outdoors versus time spent on screens, whether at work or at home.”

The influence of cosmetics and false eyelashes on ocular surface or dry eye disease has come to the forefront of discussions recently, he said, but added: “Regardless, I don’t think most patients, by which I mean those regularly attending an optometric practice, let alone the public at large, are at all aware of these issues.”

A wider availability of eye-safe cosmetics has started to raise awareness among eye care professionals on the use of cosmetics around the eyes, Atkins suggested.

Positive Impact’s Dry Eye Zone portfolio includes cosmetics designed to avoid the use of ingredients which can exacerbate dry eye conditions.

This includes Eyes Are The Story, a brand of cosmetics designed specifically around the health of the eyes, and Lash Builder, a non-synthetic prostaglandin analogue-containing eye lash serum.

Education is key and involves the whole practice team. Atkins explained: “I think there is a great opportunity for the front of house team to get involved in the process.”

Practices could contact suppliers for training to support them in discussing the products with patients, he suggested.

When talking to patients with dry eye, Atkins shared: “It is important not just to advise on the dry eye options we can obviously influence, such as lid hygiene, eye drops, or oral supplements.”

“This will be completely undermined if the patient is then free to go home and use products on the periocular area, such as retinols, which are known allergens and/or toxic to the ocular surface,” he added.

Providing the patient with advice on ingredients and eye-safe cosmetics, is “just as essential,” Atkins said, as well as sharing information on correct application – such as not using eyeliner on the lid margin.

“Clinicians need to make cosmetic use part of the protocol given to the patient to best manage their dry eye,” he concluded.

Education emphasis

Sam Wymer, sales and marketing director for The Body Doctor, told OT that many patients are aware that lifestyle factors can impact overall eye health, but may not have connected their habits with dry eye disease.

For example, Wymer noted, despite concerns around prolonged screen time, not all patients follow recommendations to take regular screen breaks. Similarly, patients who use makeup may need to be reminded not to sleep in cosmetics or continue using old products.

“Healthcare providers are placing more emphasis on educating patients about the impact of lifestyle factors on dry eye disease. This includes discussions on screen time, environmental conditions, diet, makeup, and hydration,” he said.

Along with solutions for differing severities of dry eye, The Body Doctor offers products to meet lifestyle needs, such as MacuPrime and ReMind supplements, and The Eye Doctor Hypochlorous Eyelid Cleansing Spray.

The company has made practitioner learning and development a priority, Wymer said, through CPD webinars, lectures and events.

He commented: “Optometrists, contact lens opticians, and dispensing opticians, play a crucial role in educating patients about the impact of lifestyle factors on dry eye symptoms and solutions.”

Discussing how patients may be encouraged to consider incorporating dry eye products and treatments into their lifestyles, Wymer said: “A daily routine can be recommended that includes their dry eye treatments, such as heat, cleanse, revive.”

The Eye Doctor Dry Eye Kit has been developed to make it easier for patients to buy all the products they need, including a compress, eyelid wipes, and drops, packaged in a bag for storage and transportation.

Respecting the eye

Scope Eyecare and Healthcare launched a new brand and product in July offering a makeup cleanser that respects the ocular surface.

Providing a background for the development Edel Duffy, head of medical at Scope, told OT: “After speaking with a lot of optometrists, we know people are coming in more complaining of sensitive eyes. This could be due to digital devices, or makeup use, for example.”

Patients are looking to their eye care professionals for recommendations, with Duffy explaining: “You want to pick something that does no harm and that you know has been well tested for the ocular surface.”

It is quite difficult to find a product formulated for sensitive skin, while also remaining “respectful of the ocular surface,” she suggested.

The new Optase Life Sensitive Eye Makeup Remover features patented ionised water which surrounds makeup to help lift it from the skin with less rubbing and without stripping lipids from the skin.

The product has received dermatological testing, as well as tests more traditionally seen in eye care products, including tear film break up time, conjunctival irritation, redness, visual acuity, and general tolerance to the product.

“Although this is not for the ocular surface – it is for the area around the eye – we wanted to make sure it was very respectful of the eye area, of the eye itself, and the ocular surface and tear film,” Duffy explained.

She added: “What is unique about this will be what was done to make sure it respected the ocular surface in dry eye patients with sensitive eyes.”

A discussion of makeup and cleansing routines can form part of a conversation about eye care in practice, especially if it appears a patient may not be cleansing makeup effectively, and has signs indicating dry eye.

Duffy shared: “Once you put them on the slit lamp, if there is makeup on the ocular surface or around the eye, it is a cause of both sensitive eyes and dry eyes.”

In the past, she suggested, practitioners may have found it hard to provide patients with a recommendation, sharing: “It’s hard to stand behind something, to know the science, that it really works and respects the ocular surface.”

Duffy added: “This is the right time to bring the conversation up, because you can give a solution. I think that should empower people to have the conversation.”