While therapeutic interventions no doubt improve the symptoms of dry eye disease (DED), optometrists should also be sure to educate patients about the lifestyle changes patients can make to achieve symptomatic relief. This is because such changes can also benefit ocular surface health, say those interviewed. This education:

Make dietary changes
Ophthalmologist Melissa Toyos, who practices at the Toyos Clinic, which has six locations, including one in New York City, recommends educating patients about the benefits of a low-inflammation diet.

“Dry eyes can be the canary in the coal mine for systemic inflammation and autoimmune diseases,” she explains to patients. “Lowering inflammation systemically via diet — vegan for three months, then largely Mediterranean — can improve the signs and symptoms of dry eye.”

Practice daily ocular hygiene
Pamela E. Theriot, OD, of Lusk Eye Specialists, in Shreveport, La., says she educates patients on the importance of daily lid hygiene, which is comprised of an artificial tear, a lid scrub, spray, wipe or cleanser, a warm compress mask, and a nutraceutical.

Specifically, she says to patients, “in addition to the treatment(s) you are using, these items are shown to help you maintain a clean, healthy, and lubricated ocular surface, which will help keep symptoms at bay.”

Cecelia Koetting, OD, FAAO, a clinical instructor at the University of Colorado School of Medicine, and Optometric Management’s former “Dry Eye” columnist, agrees and adds to educate patients about the importance of using products that are designated as safe for the eye. Some ingredients, such as benzalkonium chloride, can hurt ocular surface health, she notes.

“Just like we don’t use toothpaste on our face, or face wash to clean our teeth, there are specific cleansers designed for the very sensitive area around our eyes and our eyelids and lashes,” she tells patients.

In understanding that lash extensions are currently all the rage, she says she further educates patients that while no lash extensions or false lashes are safe or come without risk, the use of individual lash extensions that attach to the natural lashes, vs. those that attach to the skin itself, tend to cause less irritation, although the glue used for both can be toxic and patients can have an allergic reaction to it. In both cases, she advises patients to clean the false eyelashes with both okra-based foams and hypochlorous acid spray, removing nightly those lashes that are adhered directly to the skin.

Pause, break, blink
Both Drs. Theriot and Kimberly K. Friedman, OD, of Moorestown Eye Associates, in Moorestown, NJ, say they encourage their patients to take intentional, hard, full and complete blinks to increase their daily blink rate, as doing so stimulates the meibomian glands to produce meibum and protects the lipid layer of the tear by preventing or slowing tear evaporation.

Dr. Friedman adds that she recommends patients associate this with a specific continuous activity, such as when checking their email, so they remember to do it.

Put environmental protections in place
All three optometrists also suggest their DED patients wear wraparound sunglasses to protect themselves from the elements, to angle car vents away from their face (so as not to dry out their ocular surface), and to sleep without a fan for the same reason as angling the car vents. OM