Episode Transcript
Speaker 0 00:00:00 Welcome to the dry eye coach podcast series. Click on dry eye. Your insider passed to the most exclusive dry topic. The series will raise awareness about the current and future state of ocular surface disease. The podcast will focus on a variety of topics.
Speaker 1 00:00:15 In today's episode, we have the pleasure of speaking of with our very own dry eye coach, uh, Dr. Tracy doll, who practices at sunset eye clinic in, in Oregon. Welcome Tracy.
Speaker 0 00:00:27 Thank you for having me Wal I'm so excited to be able to do this interview with you today.
Speaker 1 00:00:32 So what I wanna do for this episode is talk to you about lashes. What is this CRA with lashes going on these days? And I know you have a lot to say, so you pick what your favorites, so we'll go from there.
Speaker 0 00:00:44 Okay. Um, the newest trend and probably the fastest growing trend in all of makeup is the obsession with growing the length of eyelashes to great lengths in order to properly divert airflow away from the eye. The eyelashes should actually be about one third, the width of the eye. So have you ever seen a Giraff IRAs have incredibly long eyelashes because they have gigantic eyeballs, right? So it tends to go for all mammalian species, including humans, that that is the proper health length for eyelashes. When you mess with this alteration, you kind of make that grow too long. You actually could end up getting debris and allergens and wind going straight to the front surface of your eye, which is what we do not want for patients. So this complete obsession going lashes long is not actually a healthy one.
Speaker 1 00:01:37 I gotta be honest. I've never seen a giraffe eye, but I'll Google it after this.
Speaker 0 00:01:41 <laugh> you wanna see another weird one? Ostrich is they're also a little, um,
Speaker 1 00:01:45 Disturbing. Oh, okay. Well I'm pretty sure the, this zoom thing and this, this FaceTime thing, it's gotta have a little impact there. Any comments on that?
Speaker 0 00:01:55 Well, for a while, the only part of the face that we were actually seeing was physically the structure of the eyes, but it's turning out that, um, the basic concept of having people look at themselves consistently, while they're at work, this is something that's new that we haven't ever encountered in history before. So I used to lecture for a living and I would even not know how I looked. So the fact that you're having a conversation with other people, and you're suddenly seeing yourself for the first time and how you, um, phrase things, how you appear. This is actually pushing people to more and more, um, both for cosmetic surgeries and actual, um, makeup to enhance the appearance. There was a study out of Australia that interviewed people. And I think it was about 300 to 400 individuals. And they asked them, what are you looking at during your zoom meetings, whether that was for recreation or work and a quarter of the respondents, do you know where they were looking the entire time
Speaker 1 00:02:51 Themselves?
Speaker 0 00:02:52 Yeah, only at themselves. They were, they were not looking at, they were not paying attention to anything else, not the content of the meeting. They were very obsessed with how they appear to other people on the screen. So this desire to look better on camera is kinda moving everybody into wanting to do more cosmetic and cosmetic enhancements. Um, the lashes being one of the fastest growing trends. So what other questions do you have for me on eyelashes?
Speaker 1 00:03:19 So, you know, where do I start? You know, what do I tell my, my female patients?
Speaker 0 00:03:24 So you, you get asked a lot like, well, how is, is it safe to grow eyelashes? Is there anything that can make my eyelashes grow longer? What we wanted to encourage our patients to do is not to go for lash link, but more for healthy, thick lashes. So when we're looking at prostaglandin analogs, um, the prescriptive version was actually helpful by the fact that it would educate patients on the potential side effects. So we know that by law pharmaceuticals actually have to list the potential of what a side, what side effects the ingredients can have. And the meta Prost actually causes, uh, the eyelash follicle to increase the last length and actually had extra pigmentation during the antigen phase. So that sounds great. And that sounds wonderful. And I first experienced these side effects from Aros wall working, um, in the veterans administration, we would get these veterans with incredibly beautiful long eyelashes or sometimes really Stuy eyelashes, cuz they would actually take scissors and cut them off because they'd be hitting their glasses.
Speaker 0 00:04:22 But as you know, that prostaglandin analogs don't come without the potential for side effects. So have you seen the classic side effects of prostaglandin analogs? You're gonna get red eyes, irritated eyes, the potential for pigmentation of lid margin and with the drop form also alterations in the coloration of the Iris. So these side effects are not without the ability to happen. Even with the topically applied proline analogs that are just meant to be painted along the lashes. Anyone that's considering taking these needs to be carefully monitored for side effects, just like you would just like you would be monitoring a glaucoma patient because if that patient does get hyperemia, if it, they are getting alterations in that they may not want cosmetically. They may not be, um, realizing it. So anytime I get a doctor who's thinking about jumping on either the prescriptive version of it or a synthetic version, I really, really highly recommend that they monitor these patients because it seems like either you love it or you don't. Yeah, I did a little, um, research project during the pandemic when all of us were kind of stuck home, I interviewed about 200 users and it, they split down the middle. It was kind of a love, hate relationship either they tolerated it and did really well. Or the other half really had substantial side effects. It was a little bit over 40% of patients who discontinued using are respondents that discontinued using these prostaglandin analogs. The main reason being side effects, second one being cost. Yeah. So,
Speaker 1 00:05:54 So
Speaker 0 00:05:55 If you've got a patient that wants this, I actually push them more towards lash conditioners instead. Okay. So more amino peptide base that supports the leg growth of lashes and make the lash thick and healthier instead of longer because ultimately what people are looking for is that darkening effect or that gives that the, um, eyelash margin a little bit more of a pop to it. So thicker not longer is better.
Speaker 1 00:06:21 So tell me about growth serums
Speaker 0 00:06:23 Mm-hmm <affirmative> so that's what we're talking about with growth serums.
Speaker 1 00:06:26 Oh, okay.
Speaker 0 00:06:27 Okay. So we don't wanna force, we don't wanna force extra long growth. We wanna, we want to encourage healthy growth of eyelashes. You also wanna ascertain why the patient may have short, not healthy lashes to begin with. So if the eyelids are inflamed, if there's blepharitis going on, if there are eyelids skin conditions like eyelid eczema, all of those will actually contribute to unhealthy eyelash growth. So the great majority of my patients know I'm treating for ocular surface dryness. Once we get those eyelids cleaned up and calmed down over time, those lashes actually start to get healthier and grow longer. It's a pretty, pretty frequent comment that I get from my patients that tell me that they're surprised about how good their lashes look and they were just trying to get rid of the redness in their eyes.
Speaker 1 00:07:14 So what's a tent, what's a lift. I mean, there's so many different lash things going on. Help me.
Speaker 0 00:07:19 Right. So a tint is what it sounds like. So tint, you know, like color, like tinting your hair and I've gotta be honest with you. The ingredients for a lash tint are chemically identical to what you'd be using in hair dye. So any patient that's considering doing this needs to make sure that they get patch tested first, or if they have an allergy to hair dye, that's definitely a no go. Uh, the truth is that the lid seal is not completely airtight or water type. So anything that's gonna be applied to the lash margin has the ability to get into the eye. So the idea of tinting the lashes is to, you know, do more of like a permanent mascara and get those lashes nice and dark. It just has to be done very carefully. Um, I tell patients to avoid the DIY. This is not something that you do it yourself at home with.
Speaker 0 00:08:06 Um, you definitely wanna go to a licensed esthetician who has, who becomes highly recommended, um, by somebody that you know, who has done it, not just like set somebody's cousin Suzi in the basement. This has to be a licensed individual who has, um, who has a good reputation and certificates on the wall. Okay. Um, alas lift is slightly different because that's actually perming solution. That's applied to the eyelashes. So now we've got hair dye and perming solution applied to the eyelashes too. That is to meant to kind of lift the eyelashes up and curl them away from the eye. Uh, in this case, you're gonna get the lashes that are kind of glued or, or put to a sticky rod. So they're gonna curl up. And then that perming Solutions's upset there and allowed to sit. Um, in that case, you're gonna gonna get a lot of hydrogen peroxide involved with the situation, um, because that's what is in that's what's perming solution.
Speaker 0 00:09:03 So, uh, thalates in it. So if anyone has an allergy to perming solution, definitely not gonna be a candidate for this one. And unfortunately, once that perming solution gets into the lashes, it's gonna take the lifelong of that lash to get it out. So if a patient has a hyper reaction to this, you're talking about having to chronically treat that patient for a couple of months with anti-inflammatories until the allergen goes away. So I've had to employ things like amniotic membranes, topical steroids, anti-allergy drops to, to help patients to recover from that. And once again, they do sell, do it yourself kit to do this. This is something to absolutely discourage patients from doing so healthy lash growth with healthy I cosmetics is better than the chemical treatments.
Speaker 1 00:09:51 Well, since we're amongst friends here, you and me, you help me understand. I've had patients come in, their eyes are irritated. Their eyelashes are like, seems like two inches long and you, I know they're fake. Yeah. Can you help me understand what is the process? So they go in, they want take eyelash extension, okay. There's Glu there's glue or something. How long does that last? How often are they supposed to change? Em, help me understand this process.
Speaker 0 00:10:16 So kinda went through the chemical processes. We went through the prosta. Um, the next thing that people like to do is to artificially elongate by attaching a single synthetic, or it could be a real lash to their existing lash. This is a two to four hour procedure, depending on how thick they want these lashes to appear. So it's literally, um, an aesthetician taking an individual lash, dipping it in glue, sticking it to the current lash, taking another individual lash, sticking it in a glue pot, then sticking it directly to the lash. This is very intensely. This is very, very time intensive. The main issue with the glues where people have allergic reactions and problems is because the glues contain latex and for Medhi. So very, very strong preservatives that can be very O irritating to the ocular surface. And then because of the normal eyelash growth cycle, patients are gonna have to, or clients are gonna have to go back and have this repeated in about two to three weeks.
Speaker 0 00:11:16 So this is a very time intensive, very expensive process that needs to be kept up and done over and over again. Um, problems that are inherent with this is people try to elongate the lifespan of those fall slashes and that can sometimes affect the lid hygiene. So patients will sometimes think of these like genes, like, Hey, I don't wash 'em they'll last longer. It's pretty much exactly the opposite of what happens. So you'll a lot of times see patients with a lot of BLE, um, a lot of makeup stuck to it because believe it or not, you think that you put these fake lashes on that. Patients wouldn't wanna do anything to them. They already have it. It looking long. That's not actually the case. A lot of patients are actually layering mascara over the top and other types of makeup at the lid margin and on the eyelids. So this is not just a one type of, um, cosmetic enhancement and done. This is layering it
Speaker 1 00:12:10 Intensive or amongst friend here. So I could ask any question I want. So they have things on their eyelid, these extensions mm-hmm, <affirmative> tell them how should they clean that or do they leave it alone?
Speaker 0 00:12:22 Right. Right. So you absolutely have to do lid hygiene, but you're gonna wanna do. But if you take up, you take a patient's eyelashes away, the addiction to this is stronger, then almost, uh, chemical addiction to, to drugs. People cannot give up their lashes. They almost rather give up their phone. There's been a couple of studies where people they've proven this, people would rather give up their cell phones and give up their makeup. Um, so it's not about taking away it's giving alternatives. So if the patient wants to keep their lashes and keep them healthy, they need to clean them. But with something that's not gonna break down those blue bonds. So HypoChlor acid is a good choice. And, um, also there are soaps that are out there that are compatible and most of your lash lounges, most of your lash, um, places that do this regularly will have those as options where there are soaps, gentle soaps that will not destroy the on. Um, because if you take away patients lashes, they probably won't come back to you because again, their love affair with long eyelashes is stronger than their love for you. Unfortunately <laugh>. So if you wanna keep 'em healthy and going, I also recommend partial fills are lighter fills. If you've got somebody who's addicted to it and won't give it up. So, you know, just do the outside edges, shorter, more natural lengths, less glue, less chemicals near the eye.
Speaker 1 00:13:45 So do you do, is this an opportunity to collaborate with estheticians? Do you go out there? Do you talk to them, say, Hey, you know, I'm a resource. If you have a problem with one of your patients, feel free to send them to me. What do you do there? Are
Speaker 0 00:13:58 You, I actually do. I, um, I definitely, I have some beauty insiders that I work with. One of them, um, works at one of our local aesthetician schools. So she talks about this now and she teaches with it. Um, I've tried to get in, in a couple of the more professional places. They haven't been as interested cuz sometimes they're scared of me thinking I wanna take away from what they do, but moer along the lines, it's just enhancing what they do. Um, I've gone in, um, undercover with a couple of friends just to see what you know, common practices are, uh, with just to see what's actually being done. So, but yeah, having a conversation or, you know, just giving your card and say, Hey, if you ever any issues, you can refer a patient to me. I will, you know, I can help you out with, um, if something goes wrong, if somebody has an allergic reaction, especially if you've got somebody that went someplace where they just did a terrible job and you, you start to recognize when the lashes are clumped up. They're they're not where they should be. They're scratching the cornea. They're too low. They're too heavy. Um, I've learned to take them off. So have you ever had to take those off for clinically? No. No,
Speaker 1 00:14:59 No, thanks.
Speaker 0 00:15:00 It's so I told you that, um, you don't want something that's gonna destroy the bonds. Um, what will absolutely destroy the Glu? The glue bonds is oil. Okay. So we'll slather on, um, the Hoba oil. Um, I keep a jar in my little in my office. Make sure it doesn't expire. You just slather the lids with that and then stick a hot compress on mm-hmm <affirmative> and keep for about 20 minutes. Then it's just going in and it's just breaking it apart. You can buy glue solvents that the professional estheticians use. Cuz let tell you need anything on Amazon again. That's why DIY is the problem. Um, but you can use that too. If you've got somebody with something that's really, really recalcitrant, you can order that to take it off too. If you don't wanna send the patient back to whoever did that procedure in the first place.
Speaker 1 00:15:46 Well, I was gonna say I'd love to culture. One of those lashes, one of those last it's gotta be interesting.
Speaker 0 00:15:54 It's gotta be interesting. That would be a really fun project to do. So, um, somebody out there you're into research, there's a good project for you.
Speaker 1 00:16:01 Yeah. You, I like to do research. Why don't you do it?
Speaker 0 00:16:03 <laugh> well, what I will do, um, is educate the patients on swap outs. So I like things that are removable. So if I can encourage patients to go back to, um, standard false lashes, those come off. So that's not something they're sleeping with. That's not something that stuck to their eye all the time and then they can go as glam as they want at night. But I tell them to go into more natural length during the day. Um, and oftentimes it's about having a conversation with patients and I'll say, you know, do you wanna look special? Because if you're glammed up all the time, if you have to go without these, no one's gonna think you look special anymore. So why don't you save the ultra glam for special occasions or for going for going out at night, go for more natural lengths during the day, I also will tell them about eye friendly, different cosmetic lines, which I've compiled a list of trying to get them to swap out. Because what I'll find is you cannot get patients to quit beauty, but you can give them healthier alternatives. So again, those that heavy addiction and that desire to, um, you know, beauty wins, frankly, the best thing you can do is get swap outs. Cause if you just tell, stop wearing makeup, they're not gonna listen to you. <laugh> they'll never come back.
Speaker 1 00:17:10 Yeah, that's a uphill battle, but you know, I think I, you just signed yourself up for a, a little section on the website to talk about, you know, what are some of these products and you know, some of our colleagues they've, they've, they've helped develop some great products, both optometrists, there's some ophthalmologists that did it as well, but it's not just saying, you know, I eye doctor tested, you know, they look at the ingredients to make sure that they're, they're, uh, good ingredients for the, for the surface and safe. So in the last minute or so that we have, what are some other exciting things or things that we should know about when it comes to, uh, lashes that I haven't asked you about yet?
Speaker 0 00:17:47 Okay. So I will tell you really quickly that the tier film mono ocular surface society is currently compiling in the lifestyle report recommendations and that should be coming out within the next year or so. So be watching for that report, cause it's gonna talk about what is healthy and what isn't, um, for the ocular, for the ocular surface, but at a minimum, if you're thinking about what to do with the lashes, it should be supporting growth rather than forcing it and using healthier, um, cosmetics around the eye, shorter length, thick lashes, and healthier glues that do not contain from Mel height are good way to start. So just a couple healthier swap outs. Um, if I could say, go with, um, non for Mey glue for fake lashes, try to stay away from anything that's ultra enhancing. And if you're gonna try anything new that you've never tried before the weekend before is a bad time to do it. So I recommend that if you're gonna, if patients are wanting to try things that you have them get patched tested with the glues or the tents or the, um, the dyes somewhere like under their eyebrow, because if you do that first, they're not gonna have a huge reaction. That's gonna, you know, basically ruin their event if their eyes well shut. So there's some quick recommendations I have
Speaker 1 00:19:01 No, Hey, I totally appreciate cause these are all questions that I, that I've had. And I know, uh, uh, there's a lot of our colleagues, uh, that would have the same, uh, questions as me. So appreciate your expertise on the, the role of, uh, aesthetics and lashes and what we can do to help address our patients to, to, to improve and, and help create a healthy ocular surface. So thank you so much there, Tracy.
Speaker 0 00:19:26 All right. Well, thanks Freddy. Ring me. I guess I'll get to turn the tables and ask you some questions next time.
Speaker 1 00:19:31 Anytime.
