Dr. Tina Khanam has more experience with dry eye disease than most. As an alum of the prestigious Moorfields Eye Hospital and the head of a leading British research team, she’s battled it for years. Dr. Khanam took time out to discuss her insights into this often-idiopathic disorder and her hopes for the future of DES treatment.
Dry eye disease (DED) presents in a variety of ways, affecting a wide range of patients, ranging from mild sufferers to those with severe dysfunction. But one doctor is bringing a refreshing approach to this enigmatic condition. Though there’s no silver bullet for DED, Dr. Tina Khanam, a British consultant ophthalmologist with Centre for Sight UK, Spire Healthcare Group, and My-iClinic, argues that human behavior often plays a pivotal role in both onset and progression. Thus, for many patients, the symptoms of dry eye can be greatly mitigated by implementing a few simple lifestyle changes.
Dr. Khanam takes a holistic view of DED, recognizing the importance of genetics and outside factors like pollution. But for her, the role of patient lifestyle choices remains the focus.
“Dry eye is a multifactorial condition, so it can be difficult to sort out. But if patients have lots of tools under their belt, they can manage it or comanage it with their physician and surgeon,” she said. To that end, she seeks to educate patients on anterior segment health and preventable DED risk factors.
As proof of concept, a few of her tips offered below have helped countless clients improve their quality of life.
Screen timeout
While the exponential jump in screen consumption has become the hobbyhorse of professionals—from teachers to sociologists, its detrimental effects on the human eye are incontrovertible.
Dr. Khanam suggests that the prolonged fixed gaze associated with heavy screen use significantly contributes to dry eyes. “What we tend to do when we use monitors is stare at the monitor and not blink for a long while,” said Dr. Khanam.
Her advice to patients is straightforward: “You need to take regular breaks while using monitors. Exercise your eyes and make sure you’re blinking regularly and fully—
not halfway. Your monitor’s not going anywhere.”
One tip for computer designers and software engineers? Apps that remind users to blink!
Makeup malfeasance
From arsenic eye-shadow to radium face cream, human beings have historically made questionable beauty choices. It should, therefore, come as no surprise to find makeup another major culprit in the growing incidence of dry eye syndrome.
As Dr. Khanam explained, “Half the population is female, many of whom are putting toxic cosmetic products on their eyelids. Raising awareness on that front is really important. What are you putting on your eye and around your eye? What can potentially go into your eye?”
Dr. Khanam acknowledges that swearing off makeup is a non-starter for many, herself included. “I really love eyeliner products,” she said. When consulting with patients, she instead opts for more modest recommendations, like going organic or preservative-free. Despite the elevated cost, such minimalist, eco-friendly products are readily embraced by a large segment of modern beauty consumers.
Underscoring this, Dr. Khanam cites the growing number of green cosmetics startups as proof. She stresses, however, that consumers need to do more than avoid unpronounceable ingredients—pH awareness is critical.
“The active ingredient in eyeliner is usually charcoal, which is alkaline. And alkaline injury is the worst kind of injury to the surface of the eye. It can kill off a lot of cells very, very quickly.” For a pH-balanced alternative, she suggests cocoa.
Finally, Dr. Khanam emphasizes the need for more ophthalmologic-focused testing. “I think ophthalmologists should really lead this. They should be in the conversation with the industry so that products are ophthalmology tested. Just like you have skin products, which are dermatology tested,” she continued.
Hygienic habits
Noting the incidence of dry eye among contact wearers, Dr. Khanam bemoans the consistent misuse of soft lenses. “Some people wear contact lenses far too long and they don’t look after the lens hygiene well. It’s really important to educate patients. For example, none of the ophthalmologists I know advise monthlies or fortnightlies. We recommend daily disposables, eight hours or less. Never shower or swim with them on,” she stressed.
Any contact wearer who’s suffered an ocular infection has learned these lessons the hard way. There remains, however, an information disconnect when it comes to ophthalmic hygiene. While many patients know to switch their contacts regularly or not share mascara, lid hygiene is still a foreign concept.
To dispel that ignorance, Dr. Khanam educates dry eye patients on measures to prevent meibomian gland dysfunction. “Look after your eyelids and the oil that you produce in the eyelid. Use a warm compress or eye beads and get heat on the eyelid. Also, massage your eyelids: top lid down, bottom lid up. Really squeeze out those pores and make sure they’re not blocked. That’s the best thing you can do,” she shared.
New hopes
Dr. Khanam acknowledges that DED—much like IBS, migraine or fibromyalgia—remains an elusive problem. “Some patients look like they’re okay in terms of the anatomy, but physiologically they’re really suffering.” By the same token, she feels optimistic about new approaches to preventing dry eye or alleviating its symptoms.
She cited the advent of autologous serum eyedrops, a treatment born out of the use of blood to ameliorate severe DED among patients in the developing world. “Just like you take a drop of blood to check your blood sugar, if you put it on your eye, you treat your dry eyes.”
Dr. Khanam also pointed to the comparatively recent adoption of Ikervis for DED of suspected autoimmune etiology after the drug’s successful use in veterinary medicine.
We asked Dr. Khanam about her hopes for the future of DED treatment. “My goal would be to reach out to as many dry eye patients as I can and to really say that we have great tools under our belts now to help these patients,” she enthused. “It’s really important to get to grips with educating the patient as well as making the shared decision of how we can manage this together. It’s a chronic condition and, you know, we’re in it for the long haul with our patients.”
Editor’s Note: A version of this article was first published in CAKE Magazine Issue 20.
