The aging process reduces collagen production and changes the composition of the collagen that remains, yielding a loss of skin tightness.1,2
As a result:2
• The dermis thins to reveal blood vessels, and melanin levels may increase (which appear as dark circles around the eyes when those vessels dilate)
• The skin sags, and pockets of edema can form, producing “bags” under the eyes (i.e., malar edema)
• Fine lines (e.g. crow’s feet) develop
Damage from the sun’s ultraviolet rays reduces elastin synthesis, which when combined with other environmental and gravitational changes yields loss of skin elasticity (e.g., dermatochalasis) and the formation of deep wrinkles (i.e., rhytids).1,2
What, if anything, can be done?
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Preventive advice for patients
As the old saying goes, “An ounce of prevention is worth a pound of cure.”
Yet sometimes the preventive advice ODs could offer is so obvious that it is easy to overlook. To minimize damage to the periorbital tissue, including the risk of malignancy, ODs should proactively recommend our patients use:
• Sunscreen and other skincare products with sun protection factor (SPF) protection (even on the eyelids) to slow the development of rhytids and dermatochalasis
• Ultraviolet coatings on all clear and sunglass spectacle lenses
• Sunglasses with large eye sizes and/or wraparound designs to maximize protective coverage whenever outdoors
• Polarized sun lenses to reduce squinting and the development of “crows’ feet”
Obviously, even if patients follow these recommendations, clinical signs of damage to the lids and periorbital skin tissue will eventually still develop.
Numerous in-office therapies and procedures can now be offered to improve the function of the lids and periorbital skin tissue as well as to enhance their aesthetic appearance.
Recommendations, especially for reducing dark circles and bags around the eyes, include:3,4
• Applying cold compresses in the morning
• Suggesting patients ingest caffeine (a vasoconstrictor) in the morning (in moderation because excess caffeine can dehydrate tissue)
• Staying well-rested (seven to nine hours of sleep per night)
• Maintaining proper hydration
• Limiting salt intake
• Avoiding excess alcohol consumption, especially late in the evening
• Treating underlying allergies which can contribute to malar edema
Potentially using over-the-counter creams and lotions containing retinol and/or other appropriate ingredients to remove makeup and to reduce fine lines, rhytids, and malar edema
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(Note: There are a multitude of options, but do your research and recommend only those products you are confident have a clinically proven effect; several product lines, such as We Love Eyes and Ocusoft’s Zoria products, can be made available for direct in-office sale)
Several therapeutic procedures are also available for patients.
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1. Howard D. Structural Changes Associated with Aging Skin. International Derman Institute. Available at: www.dermalinstitute.com/us/library/11_article_Structural_Changes_Associa.... Accessed 9/3/19.
2. Cleveland Clinic. Skin. Available at: https://my.clevelandclinic.org/health/articles/10978-skin. Accessed 9/3/19.
3. Fries WC. Solutions for Dark Circles and Puffy Eyes. WebMD. Available at: https://www.webmd.com/beauty/features/eyes-puffy-circles#. Accessed 9/3/19.
4. Lyerly J. Your Eye Doctor’s Guide to Reducing Dark Under Eye Circles. Eyedolatry. Available at: https://www.eyedolatryblog.com/2015/02/your-eye-doctors-guide-to-getting.... Accessed 9/3/19.
5. Weiss RA. Noninvasive radio frequency for skin tightening and body contouring. Semin Cutan Med Surg. 2013 Mar;32(1):9-17.
6. Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg. 2015 Jan 1;33(1):41-46.
7. Albietz JM, Schmid KL. Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction. Clin Exp Optom. 2018 Jan;101(1):23-33.
8. Gupta PK, Vora GK, Matossian C, Kim M, Stinnett S. Outcomes of intense pulsed light therapy for treatment of evaporative dry eye disease. Can J Ophthalmol. 2016 Aug;51(4):249-253.
9. Jaccoma EH, Litherland C, Jaccoma A, Ahmed A. A pilot study comparing the efficacy of the Pellevé System to LipiFlow for the treatment of dry eye due to meibomian gland dysfunction. J Dry Eye Ocular Surf Dis. 2018 Mar;1(1): e11-e21.
10. Cleveland Clinic. How Ultrasound Skin Tightening Can Firm, Lift Your Face.Available at: www. https://health.clevelandclinic.org/how-ultrasound-skin-tightening-can-fi.... Accessed 9/3/19.
11. Becker A. In the Eye of the Beholder: Aesthetic Procedures for the Periocular Area. Rev Optometry. Available at: https://www.reviewofoptometry.com/article/in-the-eye-of-the-beholder-aes.... Accessed 9/3/19.