AAOpt 2026: The role eyelid hygiene plays in dry eye prevention

Jade Coats, OD, FAAO, discussed how eyelid inflammation affects the treatment options optometrists use for the cornea and ocular surface. According to Coats, the goal is to identify lid disease sooner, in younger patients, and ideally before any preoperative evaluation. “Our goal is to get things identified faster, quicker, sooner, younger, so that we can decrease the amount of inflammation at the level of the ocular surface and decrease the risk that they may face as they get to the age of maybe needing contact lenses, glasses, or surgical intervention,” Coats highlighted.

Coats said eyelid hygiene is often overlooked, although understanding of it has evolved over the past 5 to 10 years. She noted that the TFOS DEWS III report reinforced that dry eye is “multifactorial” and may require addressing several contributors at once.

She stated that more than 60% of patients still arrive for cataract surgery with blepharitis. The goal, Coats said, is to identify lid disease sooner and in younger patients, well before preoperative evaluations.

According to Coats, eyelid disease can cause dry eye, and dry eye can worsen eyelid disease. “Oftentimes addressing one and neglecting the other won’t get to the root of the issue, and so … we are having to address both problems simultaneously to get the results we need,” she stated.

Coats said approaches should vary by patient group. Teenagers need simple regimens they will follow. Men may also apply cosmetic products around the lids and lashes, and she described lid margin education as an opportunity for both men and women before problems develop. She also identified cosmetics as a factor for contact lens wearers and surgical candidates.

Coats recommends clinicians should discuss cosmetics without casting judgment when they see makeup at the waterline or in the tears, so that patients view optometrists as trusted eye care professionals. Looking ahead, she hopes more tools will become available within 5 years to treat eyelid disease and the ocular surface together.