When patients come to Lisa Hornick, OD, MBA, FAAO, for their dry eye, they are focused on what they feel: burning, irritation, fluctuating vision, discomfort that builds through the day. Many have already tried artificial tears, prescription medications or other therapies in search of relief.
When these conversations occur, Dr. Hornick often asks another question: “How are you removing your eye makeup?”
FINDING A SOLUTION
That question has become part of her dry eye evaluations at Stanford Ranch Optometry in Rocklin, California, where she is director of dry eye services. Over years of practice, she noticed a pattern, particularly among peri- and postmenopausal women who wear eye makeup daily: few realized that how they removed it could contribute to irritation of the skin and lid margins around the eye.
“I ask patients what they’ve tried, what’s worked, what hasn’t and what their makeup and skincare routine look like,” she says. “If I notice the patient is wearing eye makeup, I’ll ask if they’re removing it every night and how they’re doing it. It becomes a natural conversation instead of adding extra time to the visit.”
There is published peer reviewed evidence for this. In a cross-sectional survey of 207 women who used eye cosmetics, 71.6% reported dry eye symptoms, and severity was significantly higher among those who did not use a cleanser to remove their cosmetics.¹ Eyelid skin is the thinnest on the body, roughly 1 mm, and cosmetics and remover residue can migrate onto the tear film, where they may destabilize the lipid layer.³
Formulation therefore matters. Dr. Hornick wanted something preservative-free and free of retinoids, which have been linked to impaired meibomian gland function when applied around the eye.² She began adding a preservative free periocular skincare regimen consisting of a makeup remover and eye cream that are suitable for sensitive, dry skin around the eyes to the patients’ existing routines, then reviewed what happened over 28 days.
THE EVIDENCE
The analysis was a retrospective chart review at a single practice: 27 women, mean age 53, all with dry eye disease and meibomian gland dysfunction (MGD), all regular eye makeup users.⁴ Every patient stayed on her prescribed care. All 27 used artificial tears, about half had received Intense Pulsed Light (IPL) therapy, and others were on cyclosporine, perfluorohexyloctane, supplements and/or warm compresses.
Periocular erythema gave the clearest signal, present in 17 of 27 patients (63%) at baseline and 7 of 27 (26%) at day 28, with 10 improving and none worsening (p = 0.002). MGD grading improved in 8 of 27 (30%; p = 0.020). Tear break-up time and SPEED scores moved favorably but not significantly. Dr. Hornick graded erythema herself, unmasked, and says so plainly: “This is a first look from one practice, not a controlled trial.”
Tolerability was captured in a companion analysis of the same patients.⁵ No patient reported itching; 23 of 27 (85%) reported neither stinging nor warm or burning sensation. There were no serious adverse events. On a 10-item questionnaire, 26 of 27 agreed the products did not irritate, 25 of 27 intended to keep using them and 70% preferred them to what they had used before. Patients said the cream left their eyelids feeling “more hydrated,” while the remover “made [the] eyes feel better.” 100% of these patients were happy that their ECP recommended these products to them.
MAKING IT A DAILY HABIT
Recommending a product is only half of it, Dr. Hornick says. The other half is explaining why the habit matters. She compares periocular cleansing to brushing teeth, and suggests patients keep the products where they can easily access.
“Patients are using these alongside everything else we’re already doing,” she says. “They’re not replacing prescription therapies. They’re simply adding a gentle, well-tolerated cosmetic option that can sit alongside treatment without getting in the way of it.”
“For patients who wear makeup, we now have preservative-free options formulated specifically for that skin,” she says. “That’s a conversation worth having.”
REFERENCES
- Albdaya NA, Binyousef FH, Alrashid MH, et al. Prevalence of dry eye disease and its association with the frequent usage of eye cosmetics among women. Cureus. 2022;14(7):e27142.
- Ng A, Evans K, North RV, Jones L, Purslow C. Impact of eye cosmetics on the eye, adnexa, and ocular surface. Eye Contact Lens. 2016;42(4):211–220.
- Wang MTM, Craig JP. Investigating the effect of eye cosmetics on the tear film: current insights. Clin Optom (Auckl). 2018; 10:33–40.
- Hornick L, Duffy E, Bhattacharrya S. Clinical benefits of adjunctive periocular skincare in dry eye patients: a retrospective analysis of periocular erythema, tear film stability, MGD and symptom burden. E-poster presented at EUDEC — European Dry Eye Congress, June 2026.
- Hornick L, Duffy E, Bhattacharrya S. Patient satisfaction with adjunctive periocular skincare in dry eye patients: a patient-centered outcomes analysis of tolerability, skin comfort and acceptance. E-poster presented at EUDEC — European Dry Eye Congress, June 2026.
