Technology and innovation has improved many aspects of health care and eye care, including ocular aesthetics. The options at optometrists’ disposal to treat periorbital skin changes are increasingly more effective, more affordable, and more available than ever before.
Let’s take a look at these physiologic changes, what causes them, and how they can be managed.
Related: Embracing aesthetics in optometry
Causes of eyelid and periorbital skin damage
Time, sun, and other environmental factors, including gravity itself, are the mortal enemies of youthful, tight skin. The anatomy of the skin can be simplistically compared to the cornea (see Figure 1).
The epidermis is the relatively thin, superficial skin layer most directly exposed to the environment, similar to the corneal epithelium. The middle skin layer, the dermis, comprises the bulk of the skin’s thickness just as the stroma does in the cornea, while the skin’s subcutaneous tissue (i.e., hypodermis) loosely correlates with the cornea’s endothelium.
Collagen, the main component of connective tissue, comprises about one-third of the total protein content of the body. In the skin, Type I collagen, and to a lesser degree Type III, are present in the dermis and subcutaneous tissue and are responsible skin tautness.1,2
Elastin, on the other hand, is another connective tissue protein present in the body that has rubber-like in consistency. Elastin fibrils slide over one another and recoil, providing elasticity.
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.