When eyelids are irritated (including “mucus fishing” - as well as allergies, such as to our best friend - pets!)
As a dry eye specialist, I can’t diagnose or treat over the Internet, but anytime a patient reports a significant reaction on the eyelids, my first question is what are you putting on them? That’s because some chemicals (lid cleanser and makeup products in particular, as well as preservatives and even antibiotics) can cause this reaction. My next advice is to stop it. As lid skin is the thinnest skin of your body, it is often the “canary in the mine” that will show sensitivity ahead of most other areas, so even soap, shampoo and perfume (as well as soap and softener you wash clothes and bedding with) can add aggravation. A good exam is also required, as irritation of the lids (commonly called blepharitis) can arise from many causes best left to the diagnosis and treatment of dry eye specialists (see my prior post on blepharitis and germs).
A common source of irritation relates to allergies. Allergies tend to be magnified when you have dry eyes, as tears normally wash and support the ocular surface - poor tears means less washing and less support. Inflammation is a driver of dry eyes and is a byproduct of allergies - so the two often go together. Dogs, cats and any furry animal has a tendency to carry pollens, dusts and dust mites a bit like a duster would - and like that duster, having it near you can infuse some of that into the air around you. Running air purifiers and regular pet grooming can help mitigate some of the allergy issues. Sadly, the antihistamine products used to treat allergies can also have a drying effect on your water producing glands (nose, mouth and eyes) - so just "covering up" the allergies with medication is often not the best answer. Working with an allergist will likely help. We all love our 4 legged friends and having to cope with dry eyes and allergies related to them can be heartbreaking if it results in our having to part with them. Hopefully you can find a way around this that works for you and your dog, cat, gerbil, hamster, rabbit or other furry friend.
A common treatment of lid irritation is to buy over-the-counter or prescriptive ointments to apply to the lids. Ointments can contain lanolin (related to sheep’s wool - a common allergen) as well as antibiotics (if prescriptive) and are largely mineral oils (which are not organic/human based oils) so they are not nutritive, contain no antibodies and generally don’t “behave” like normal tear oils - so while I know some patients with severe MGD and secondary evaporative dry eye disease or with certain kinds of germ-related blepharitis need this kind of ointment help, one of the goals of getting your oil glands working (as can be facilitated with IPL & and heated expression of oil gland clogging using a variety of techniques including my off-label RF treatments) is to get away from the ointments. Ointments will “seal” your surface from dry air (which is an intended result) but also from some of the good oils you begin to make (an unintended result that can potentially limit treatment effectiveness). As your own oils improve, you might be advised to wean off the over the counter and prescriptive ointments. As usual, every case is different and as usual, your best option is to heed the advice of your dry eye specialist.
A special case of eyelid (and eyeball) irritation is the condition known to eye specialists, as “mucus fishing.” Dry eyes are often plagued by excessive mucus production and accumulation. This relates to several issues:
- When there is poor oil, as is most often the case in dry eyes (& there have been long posts on MGD, including my interview by Dr. Ziegler), then there is rapid evaporation of the water that is normally held in place by the thinner oils that would otherwise float on top. As water leaves, it leaves behind the proteins (mucus) and salts that don’t evaporate. This commonly causes increasing irritation and inflammation. The mucus forms strands and “gunk” relating to the added proteins of inflammation. Allergies and blepharitis (eyelid irritation often associated with the overgrowth of eyelid germs) can add fuel to the fire
- Once strands and sticky “goo” accumulates, many patients feel compelled to extract the goo by using finger tips, QTips or other things (edge of a tissue, etc). This has the term “Mucus Fishing” attached to it, as long strings can be serially “caught” and pulled out. The irony is that the more you fish, the more irritation (partly from friction, partly from further triggering of reflex tears that are salty and can have lots more proteins but no oils and sometimes by introducing germs from these “fishing objects” -fingers, etc) that trigger germ and inflammation-related immune responses. Other causes of “Goop” can include chronic infections that can cause inflammation (such as some cases of “pink eye”), but also could relate to blocked tear ducts (in which case germs can live in the “plumbing” that otherwise allows tears to leave the eye’s surface and travel to the nose).
The answer is to stop mucus fishing (if that’s what is going on) and see a good dry eye specialist to properly diagnose and treat the root causes of your dry eye disease (often related to MGD). Unfortunately in my experience there are no over the counter artificial tears that will fix this.