Caring for the skin around the eyes

In everyday practical work, the dermatologist and dermatocosmetologist often have to deal with various cosmetic deficiencies and dermatoses on the skin around the eyes. Knowledge of a number of anatomical and physiological features of the periorbital region can help in explaining the pathogenesis and features of the course of these conditions and diseases.

In the orbital region is directly the eye and its auxiliary apparatus, which provides protection and movement of the eye. The auxiliary apparatus includes eyelids, tear apparatus and muscles of the eye. Eyelids (palpebrae - lat., Blepharon - Greek.) Represent a kind of "sliding screens", the functional purpose of which is to protect the eyeballs. The upper eyelid is larger than the lower one, and its upper border is represented by an eyebrow. When the eye opens, the lower eyelid falls only under the influence of its own gravity, and the upper eyelid rises actively due to the contraction of the muscle lifting the upper eyelid.

For the skin of the eyelids, fewer rows of cells in the epidermis are characteristic. So, the number of rows of cells of the spinous layer is 2-3, while in other parts of the skin - from 3 to 8-15. The granular layer is absent. The smaller thickness of the stratum corneum is also noted, it is about 9 μm.

There are a few small fuzzy hair and small odnodolchatye sebaceous glands in a small amount, and a small accumulation of sebaceous glands is present in the corners of the eyes and along the edge of the eyelids. It is known that the surface of the skin of the eyelids has a more alkaline index than in other areas of the skin. Data on the greater permeability of the stratum corneum for medicinal and toxic substances have been accumulated. The listed features of the structure of the epidermis and its stratum corneum indicate the imperfection of the barrier properties of the skin, on the one hand, and its high permeability, on the other. So, in practical work, care should be taken when prescribing funds in high concentrations, as well as topical glucocorticosteroids. In addition, for the skin of the eyelids, all procedures that violate its barrier properties, in particular, brashing, etc., are highly undesirable. In carrying out procedures that change the pH of the skin surface (for example, peelings), it is recommended to focus on individual tolerability. Features of the structure of the skin of the eyelids necessitate the use of special, adapted for this area means for daily care (cleansing and moisturizing).

In addition, the distinctive feature of the composition of the skin of the eyelids is its tendency to increased hydration. There is an abnormal tendency to water retention in various pathological processes accompanied by acute inflammation, such as simple and allergic dermatitis, herpes, streptococcal impetigo, etc. It is in this localization that swelling is often present. This feature professionals usually take into account when diagnosing these dermatoses. Edema of the eyelids, especially the lower ones, can also be associated with impaired lymph flow. So, with a deforming type of aging, the lymph drainage becomes worse because of the impaired tonus of the circular muscle of the eye. Persistent edema of the eyelids associated with lymphostasis can occur in a particular form of rosacea (rosacea with persistent solid swelling, or Morbigan's disease). Disturbance of outflow in lymphatic vessels can take place at various tumor and metastatic processes in the orbital region and in other anatomically close localizations (eg, lacrimal cancers, etc.). In this case, persistent lymphostasis is quickly complicated by secondary fibrosis, and then a characteristic density of tissues appears in the lesion.

At the edges of the eyelids there are hair follicles of the eyelashes, deeply embedded in the connective tissue. Eyelashes are bristly hair, their shift occurs every 100-150 days. In clinical practice, specialists deal with so-called "barley". This disease belongs to the group of staphylococcal pyoderma and is a purulent-necrotic inflammation of the hair follicle of the eyelash. An analogue of this process in the skin is a furuncle. Subcutaneous fatty tissue in the skin of the eyelids is absent. That is why the aforementioned inflammatory process is more localized, in comparison with the furuncle.

Directly under the skin are bundles of circular muscle of the eye. The rigid base of the eyelids is the tarsal plate of the semilunar form, formed by a dense connective tissue, and not cartilage, as is sometimes mistakenly considered. The Tarzal plate covers the special branched sebaceous glands (meibomies). These glands open outside the hair follicles behind the eyelashes and secrete a lipid-rich secret that, when mixed with a tear fluid, creates a special emulsion on the surface of the eye. An analogue of such an emulsion on the skin is a water-lipid mantle, the purpose is to prevent the evaporation of tear fluid from the surface of the eye and maintain the barrier properties of the corneal epithelium. With a number of eye diseases, in particular with ophthalmic-rosacea, the composition of the described emulsion is disrupted, so it is recommended to use artificial tears. As is known, the anterior epithelium of the cornea is multilayer, flat nonkeratinizing, it contains numerous nerve endings that provide high sensitivity of the cornea, has a high capacity for regeneration, updated every 7 days. It is this term that explains the duration of external use of most drugs in ophthalmology. Directly into the dermis and the tarsal plate, the fascia of the eyelid is interwoven - the tendon of the muscle, which raises or lowers the eyelid.

Cosmetic deficiencies in the periorbital area include wrinkling of the skin, overhanging of the upper eyelid and the so-called "hernia" of the lower eyelid. These phenomena are typical for age-related skin changes. In particular, with a constant contraction of the facial muscles of the eye circumference and with constant contraction of the fibroblasts of the overlying dermis, typical oblique lines are formed in the projection of "crow's feet" on the skin in the region of the outer corners of the eyes. These changes are one of the first signs of premature skin aging. These phenomena are exacerbated by hypertension of the muscles of the eye circle, which is characteristic for persons with visual impairment (myopia, astigmatism, etc.). In this regard, it is not accidental to recommend specialists - timely adequate correction of visual impairments, wearing sunglasses when staying in the sun, etc. In the future, with a decrease in turgor and a breach of skin elasticity, another sign of age-related skin changes is formed - wrinkles of the eyelids and overhanging of the upper eyelid. The appearance of characteristic changes in the lower eyelids is due to the hypotonicity of the circular eye muscle, which can occur with a deforming type of aging.

A special complaint of patients may be pigmentation under the eyes or around the eyes. Differential diagnosis of this phenomenon should take into account the individual anatomical features of the periorbital zone, atopic dermatitis, as well as cutaneous manifestations of a number of endocrine dysfunctions (eg, Addison's disease). Individual anatomical features include a thin stratum corneum in the epithelium of the skin of the eyelids, especially the lower one, as well as venous stasis in the surface of the dermis, giving a slightly bluish skin tone. This was reinforced by fatigue, a short sleep, anemia. For the childhood and adult phase of atopic dermatitis, pigmentation on the eyelids, especially the lower ones, is typical, combined with a characteristic deep fold on the lower eyelid (Denny-Morgan symptom). Periorbital pigmentation can also occur with melasma (chloasma), along with typical localization in the centrofacial part.

In cases of periorbital erythema, a specialist should be aware of allergic dermatitis of the eyelids, atopic dermatitis, toxicermy, dermatomyositis. For allergic dermatitis is characterized by pruritus, the presence, in addition to erythema, vesicles and papules, fuzzy boundaries of the lesions, going beyond the skin of the eyelids. A certain allergic anamnesis is found out, as a rule, patients indicate the use of external cosmetics for care or decorative cosmetics. With an exacerbation of atopic dermatitis, there is erythema, scaling of the eyelid skin, well visible in the folds of Denny-Morgan. When a patient is questioned, a characteristic "atopic" anamnesis is revealed, other signs of atopy (rhinitis, asthma), and when viewed - typical rashes on the trunk and extremities, atopic cheilitis. Dermatomyositis is characterized by an increase in symptoms associated with muscle weakness (it is difficult to raise your hands, there are difficulties in climbing the stairs, etc.). On the skin there can be various nonspecific rashes. In particular, persistent erythema (recurrent, bright red or purple-lilac) accompanied by periorbital edema is observed in the eyelid region.

In addition to these diseases, seborrheic dermatitis, perioral (steroid) dermatitis, simple dermatitis, rosacea, milium, pyoderma, xantelasms of the eyelids, fibropapillomatous developmental malformation, as well as various neoplasms can be attributed to the most common dermatoses of the skin around the eyes with which patients refer to a cosmetologist.

In the case of diagnosis of neoplasms on the skin of the eyelid, a consultation of the oncologist-dermatologist and ophthalmologist-oncologist is necessary in order to adequately diagnose and resolve the issue of tactics for further management. It should be very carefully removed neoplasms located on the ciliary edge of the eyelids, as further formation of the scar can lead to a change in the direction of growth of the eyelashes. A consequence of this is a permanent trauma of the corneal epithelium. The most common neoplasms of the eyelids include siringams and fibromas (they are often called papillomas).

Finally, the thinning of the eyebrows and eyelashes can also have an important diagnostic value. This phenomenon is noted in focal alopecia, secondary syphilis, atopic dermatitis. In focal alopecia often there are characteristic foci on the scalp, there may be damage to the eyebrows and eyelashes (including one-sided). Hair within the foci is absent, and on the periphery with the progressing stage of the process, a specially modified hair is revealed in the form of an "exclamation mark". Small alopecia areata with secondary recurrent syphilis are more often observed on the scalp, less often in the beard, mustache, pubic region, eyebrows and eyelashes. Considered as a sign associated with the defeat of the nervous system. Hair loss in the form of small foci in the eyebrow is called "omnibus" (A. Fonmier) or "tramway" (P.S. Grigoriev) syphilide, ie, a symptom that allows diagnosing syphilis even in a tram in the opposite patient. The defeat of the eyelashes is characterized by a partial loss of their lashes and a consistent fusion, so that the eyelashes vary in unequal length: near the normal lashes one can see short ones. These eyelashes are called "stepped" (a sign of Pinkus). In severe atopic dermatitis (child or adult) in some patients, in addition to the characteristic changes in the skin of the eyelids, erythema and edema of the face, cheilitis, note the thinning of the outer third of the eyebrows.

Thus, a number of anatomical and physiological features of the skin around the eyes determine the diagnosis of various cosmetic defects and skin diseases, as well as dictate the choice of a specialist cosmetic manipulations. It is necessary to emphasize once again the importance of the most gentle approach to choosing procedures, as well as the need for an integrated and analytical approach in assessing the skin condition of the periorbital area.

Eye Care at home

Skin care at home is made up of morning and evening manipulations. Careful cleansing is necessary with the use of cosmetic milk, cream, foams, and tonic, non-alcohol-based, tonic, eyelid liquids specially designed to care for this area. Recommended adequate hydration and photo protection. Moisturizing eye creams are applied twice a day and are applied by superficial dotted movements over the upper eyelid from the inner corner of the eye to the outer corner, while the remedy should not be applied below the natural fold of the upper eyelid. In the lower eyelid, the cream is applied from the outer corner of the eye to the inner corner, not closer than 5 mm from the edge of the eyelid. Special eye creams can be used to reduce edema, remove "dark circles under the eyes", smooth fine wrinkles (with the effect of "Botox"). The choice of a specific agent for skin care for the eyelids is decided individually, after the diagnosis of a particular condition.

General requirements for cosmetic products for the eyelids:

• the eye cream should not be sticky and greasy so as not to cause swelling and pasty;
• eyelid cosmetics should contain active ingredients in small concentrations, since the skin of this area is characterized by a thin stratum corneum and an active rate of proliferation; The cosmetic preparation should not have the expressed irritating effect at hit on a conjunctiva;
• cosmetics for the eyelids should have confirmation of the passage of dermatological and ophthalmological control.

To reduce the swelling of the eyelids at home, you can recommend a mask of fresh grated potatoes, chopped parsley, lotion with astringent solutions. Freshly prepared mask is applied to the cleansed eyelid skin for 15-20 minutes. Then the mask is washed off with cool water or infusions of herbs.

At home, it is advisable to perform gymnastic exercises for the eyelids, strengthening the oculomotor and facial muscles, improving the blood supply of the periorbital area and helping to prevent overwork of the eyes. Exercises are performed in a sitting position with straightened back and raised head. Movement is carried out by the eyes, and each time it is necessary to focus the view on the selected point This will improve the ability to focus.

Gymnastic exercises for the eyelids (according to LA Kunichev, 1985)

1. Rotation of the eyeballs in the direction up-down, up and down. Close eyes. Repeat the exercise 3 times.
2. Look up, forward, down and forward. Repeat the exercise 3 times. Close eyes.
3. Look left to right Repeat 3 times. Close eyes.
4. Look left, forward, right, forward. Repeat 3 times. Close eyes.
5. Look diagonally up, then down: first to the upper right corner, and then to the bottom left corner. Repeat 3 times Close your eyes. Change direction: the upper left corner, the lower right corner. Repeat 3 times and close your eyes.
6. Slowly make 3 circular motions eyeballs to the right. Close eyes. Then do the same exercise in the direction of movement of the eyeball to the left and close your eyes again.
7. Look at the tip of the nose, and then at some distant point. Repeat the exercise 5 times and close your eyes.
8. Look at the tip of one of the fingers, located at a distance of 30 cm, then to any point in the distance. Repeat the exercise 5 times and close your eyes.
9. For a long time, without blinking, consider the selected object in detail.
10. Close your eyes and squeeze your eyelids tightly, then make some quick blinking movements. Repeat 3 times and close your eyes.

Care of the skin around the eyes in the conditions of a beauty salon  

It is important to emphasize that all manipulations are carried out along the lines of the least stretching of the skin - from the inner corner of the eye to the outer one in the upper eyelid, and in the opposite direction through the lower eyelid.

All procedures begin with cleansing the skin of the eyelids. The question of the use of peelings in the field of eyelids is solved individually. Glycopilings (25 and 50% solutions of glycolic acid) are shown. Applying mechanical peeling cream is not recommended. When choosing masks for age, preference should be given to moisturizing masks on a cream and gel basis, collagen sheets or "glasses", alginate fillings. Nowadays, patches, napkins and patches with collagen and retinol are widely used.

The range of physiotherapeutic procedures for the skin around the eyes is very limited. Not shown are exfoliation, disinfestation and vaporization, cryomassage with liquid nitrogen and carbonic acid snow, vacuum massage, and direct exposure to ultraviolet is not recommended. '

Use darsonvalization of the skin of the eyelids to improve blood flow and lymph drainage, trophic and muscle tone strengthening. Indications are the pastosity of the eyelids, fine wrinkles. Contraindications: dry and sensitive skin, rosacea and individual intolerance of the method. Darsonvalization of the eyelids is made by cylindrical or mushroom-like electrodes that are moved through closed eyelids in circular motions. The duration of the procedure is from 1 to 3-5 minutes per eyelid, the course is 5-7 sessions, every other day. With correctly chosen parameters of exposure, the patient feels a slight tingling sensation and heat. In the field of the eyelids, it is preferable to carry out the procedure for the cream, since darsonvalization has a drying effect.

For. Prevention of wilting of the skin around the eyes is applied the method of myostimulation. The procedure is conducted every other day, for a course of 10-15 sessions. Preventive courses are shown 2 times a year. Patients under the age of 35-40 years are not recommended to prescribe this procedure.

Microcurrent therapy is widely used to reduce the manifestations of pastosity, puffiness around the eyes due to lymph drainage effect (lymph drainage). Microcurrent lifting is also used, especially with deforming type of aging.

To eliminate mimic wrinkles, localized in the area of the nadir ("folds of anger"), horizontal wrinkles on the forehead and "crow's feet" around the eyes, injecting techniques are successfully used. The preparations are used, manufactured on the basis of botulinum toxin, extracted from botulinum causative agent - Clostridium Botulinum type A, - "Botox" and "Disport". In addition to some differences in activity, the drugs "Botox" and "Disport" have completely the same side effects. This may be a temporary paralysis of other muscles at incorrectly chosen points of administration. Most often this is expressed in the formation of the so-called "Mephistopheles" eyebrows, ptosis of the eyelids. "Botox" and "Disport" are combined with almost any cosmetic procedures. It is not recommended deep laser skin resurfacing and dermabrasion. There is no single point of view on the use of mesotherapy in the area of the eyelids

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