Adjunctive periocular skincare reduces erythema in dry eye

Adding a preservative-free periocular skincare regimen to standard dry eye disease (DED) management produced a statistically significant reduction in periocular erythema and meibomian gland dysfunction (MGD) severity over 28 days, alongside high patient-reported satisfaction and tolerability.¹ Presented by lead author Lisa Hornick, OD, MBA, FAAO, in a poster at the 2026 Optometry’s Meeting of the American Optometric Association, held from June 17-20, in Phoenix, Arizona, the retrospective analysis highlights periocular skin health as an underaddressed component of standard DED regimens despite its daily contact with the ocular surface.

Eyelid skin is less than 1 mm thick with a weaker barrier and fewer sebaceous glands than facial skin, making it prone to dehydration and cosmetic-related damage.¹ Eye cosmetics and make-up remover residue can migrate onto the tear film and ocular surface, disrupting the lipid layer and triggering inflammation; DED prevalence has been reported at 71.6% among cosmetic users compared with 32.1% in the general population, with eye-makeup users carrying a 2.2-times higher dry-eye risk. Preservative-containing make-up removers, particularly those with benzalkonium chloride or polyhexamethylene biguanide, have shown corneal-epithelial cytotoxicity in live/dead cell models, while preservative-free formulations maintain viability comparable to saline.¹

“Adjunctive preservative-free periocular skincare with Optase Life products delivers measurable, statistically significant reductions in periocular erythema and MGD grade—with excellent safety—supporting routine consideration,” Hornick told Optometry Times, adding that practicing ODs should ask cosmetic-using patients with dry eye about their make-up removal practices and periocular skin symptoms. “Adjunctive preservative-free periocular skincare achieves high patient-reported acceptance, comfort, and tolerability, making it a patient-preferred component of comprehensive DED care.”

Study design and primary clinical outcomes for adjunctive periocular skincare

The retrospective chart review evaluated 27 female DED patients (mean age 53 years) treated at a single optometric practice, assessed at baseline and 28-day follow-up.¹ All patients had diagnosed DED and MGD and were existing eye-cosmetic users. Adjunctive periocular skincare consisted of a sensitive eye make-up remover (preservative-free, ionized-water-based) and a sensitive eye daily renewal cream (preservative-free, barrier-supportive; Optase Life; Scope Eyecare), added alongside each patient’s existing concomitant DED therapies, which included intense pulsed light, cyclosporine, perfluorohexyloctane, artificial tears, warm compresses, hypochlorous acid spray, and omega-3 supplementation as clinically indicated.

The primary end point, periocular erythema, showed a statistically significant reduction from 63% prevalence at baseline to 26% at day 28, a 37% absolute reduction (McNemar P = .004), with 10 of 27 patients improved and none worsened.¹ MGD grading also improved significantly (P = .020), with 30% of patients (4 of 27) showing improvement and the proportion of patients with no MGD findings increasing from 0% at baseline to 4% at day 28, alongside a shift away from grade 1+ and elimination of grade 2+ findings.

Numerical improvements in tear break-up time (TBUT) and SPEED symptom scores did not reach statistical significance: TBUT improved from a mean of 4.48 seconds to 5.22 seconds (+0.74 seconds, 56% of patients improved; P = .180), and SPEED scores decreased from a mean of 14.7 to 13.7 (30% of patients achieved a 3-point or greater reduction; P = .313).¹ Corneal or conjunctival staining improved in 40% of patients with evaluable baseline staining (6 of 15).

Patient-reported satisfaction and tolerability of preservative-free periocular regimen

Tolerability was favorable, with no serious adverse events reported across the cohort.¹ Local tolerability assessments showed stinging in 15% of patients (4 of 27), warmth or burning in 15% (4 of 27), and no reported itching. One patient discontinued treatment due to an undesirable effect; no serious adverse events were associated with this discontinuation.

Patient-reported satisfaction was high across measured domains (n = 27): 96% reported the regimen as nonirritating, 93% indicated intent to continue use, and 70% reported preferring the regimen to their prior periocular care.¹ Individual satisfaction items ranged from 81% to 96% agreement, including skin feeling less dry (96%), eyelids feeling soothed (96%), skin feeling refreshed (96%), and willingness to recommend to others (96%). Patient comments captured in the poster described the eye make-up remover as effective without stinging and the renewal cream as improving hydration and comfort.

“Cosmetic use on the periocular skin can affect ocular surface disease; it is important that we educate patients about this and recommend safe products that will not worsen their condition,” Hornick said.

The study authors noted several limitations, including its retrospective, single-center design with a small, all-female cohort limiting generalizability, the absence of a control arm, and the use of multimodal concomitant DED therapies that limit attribution of the observed improvements to the periocular skincare regimen specifically.¹ Prospective, randomized, controlled studies with longer follow-up and standardized patient-reported outcome measures were identified as warranted to confirm the contribution of adjunctive periocular skincare to overall DED management.

References

1. Hornick L, Duffy E, Bhattacharrya S. Clinical benefits of adjunctive periocular skincare in dry eye patients: a retrospective analysis of periocular erythema, MGD, tear film stability, symptom burden & patient-reported outcomes. Poster presented at: AOA Annual Meeting; June 2026; Phoenix, AZ. Poster #40.

2. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-283. doi:10.1016/j.jtos.2017.05.008