I asked Dr. Michele Pendrak to share what she has observed and learned about Retinol by seeing hundreds of patients. Here is what she shared:
According to research published on PubMed, since retinol can damage eyes, you should be cautious of any serum containing retinol as an ingredient.¹
Unfortunately, retinol can be a foe to your eyes.
At this point, my patients usually start shooting eye daggers at me. But before you break out your pitchforks, allow me to explain! Because today there are more healthy, clean alternatives to help you achieve that youthful glow than ever before.
What are retinoids?
So first let’s talk about what retinoids are. Retinoids are a group of compounds that are Vitamin A derivatives.
There are 6 types of retinoids:
1)retinol (the natural form of Vitamin A)
2)tretinoin (synthetic, prescription only, and also branded as Retin-A cream)
3)Adapalene (branded as Differin gel
4)tazarotene
5)aliretinoin
6)bexarotene.
All of the above have become popular in the skin care industry mainly because when used topically they increase cell turnover and can increase collagen and elastin.
Increased cell turnover comes with many benefits including unclogged pores and anti-aging effects.
The most commonly used types of retinoid creams for skin care are retinol and tretinoin. Retinol has to be converted by our skin enzymes into retinoic acid, which slows down its effects. Therefore it can take about 6 months of using it to notice retinol’s cumulative benefits, but this also makes it a gentler product with fewer side effects.
Tretinoin does not need to be converted and therefore acts faster, with results in 6 to 8 weeks. For this reason, it is a stronger medication. The general rule with medications is stronger = greater side effects, and the same is true here.
Why are retinoids bad for my eyes?
What are the side effects of retinol? 2 words:
1) drying
2) scarring.
Even if you are not using a retinol eye cream, or if you feel that you are keeping your retinol cream away from your eyes, you never know how much of that cream can migrate towards your eyes. And this brings a number of concerns.
We have three layers to our tear film. The top layer is oil, which acts as a moisture seal to prevent evaporation. We get this oil from the approximately 25 meibomian glands that run vertically along each of our upper and lower eyelids. 86% of dry eye falls under the category of evaporative dry eye ¹ - meaning we don’t have enough oil. It is currently estimated that approximately 49 million Americans have dry eye - compare this to the fact that 3 million have glaucoma².
Many of my patients with evaporative dry eyes have fluctuating filmy, hazy, and blurry vision.
Dry eye symptoms can also include red, burning, scratchy, stinging, and watery eyes (yes I know that last one is counterintuitive!). If left untreated, it can even lead to corneal scarring and nerve damage.
As time goes by, we are realizing just how susceptible the oil glands are to damage from certain products and medications.
And - you guessed it - the retinoids are at the top of the list of offenders that are known to cause damage to the meibomian glands.
Retinoids work for acne by shrinking oil glands, but they can also decrease oil production everywhere. That includes the delicate oil glands in our eyelids.
In general, with the meibomian glands, follow the rule “if you don’t use it you lose it”- meaning if our bodies get signals not to use the glands, then they start to shrink and atrophy or drop out.
This atrophy is darn near impossible to reverse. Studies have found retinoic acid “alters meibomian gland epithelial cell gene expression, reduces the activity of cell survival mediators, inhibits proliferation, and induces meibocyte cell death.”³ In other words - it kills our meibomian glands.
Over the years I have consistently seen patients come into my office with atrophied meibomian glands who also have a history of retinoid use.
Once you've seen a parade of meibomian glands completely atrophied by-products such as retinoids day in and day out, you can't go back!
Patient Example:
Recently I saw a 61-year-old with a history of retinol cream use whose dry eye I finally have under control after 4 years of treatment (we got interrupted by the COVID-19 pandemic of course). When I started treating her in 2018, she always came back for dry eye follow-ups showing little to no improvement despite aggressive treatments. Finally, I noticed her gorgeous skin and asked what her skincare regimen was. Lo and behold, she was using retinol creams. It was around this time that we also obtained a meibographer - a camera that does infrared imaging of the meibomian or oil glands in the eyelids. And suddenly it all became clear.
Her glands were partially atrophied, possibly from years of retinol use, so she wasn’t giving me much to work with. This scarring is very common with retinoid use and makes treating the glands very difficult. I am fortunate that I have an in-house surgeon who performs meibomian gland probing, because less than 3% of eye doctors in the country do this⁴, and it is one of the few procedures that is documented to help regenerate atrophied glands. The images of her meibomian glands are below.
The picture is meibography, or infrared imaging of his meibomian glands. You’ll notice that her “OD” which is her right has worse shortening of the white columns (the meibomian glands) on the right side of the picture. Her “OS” or left eye has a more significant shortening throughout the length of the lid.
Also, despite all of our best efforts, if she was going home and putting a cream on or around her eyes that was drying her out, she was basically undoing all of our hard work!
Consider that retinol is also stored in the lacrimal gland, the gland that secretes the middle watery layer of our tear film, and Retinol has been isolated in rabbit and human tears ⁵. It therefore should come as no surprise that we have seen cases of lacrimal gland atrophy ⁶ in people with a history of retinoid use.
Learning from my experience:
After this patient, I added a section to my Dry Eye Intake Questionnaire about anti-aging products and procedures where I specifically asked about things like retinol use upfront. This patient taught me that I needed to ask about retinol use before we started treatment. I needed to give my patients an opportunity to understand where their dry eye may be coming from, counsel them on healthy alternatives, and understand what treatment challenges we may be facing.
So is a skin cream worth all of that? And if we can’t use retinol, what can we do instead?
If retinol was the only anti-acne or anti-aging treatment out there, I could see where occasionally someone feeling invincible would take their chances. However, there are so many other alternatives. In my clinic, we offer powerful light-based treatments that are quickly becoming the gold standard for treating dry eye. These treatments, such as Low Level Light Therapy and Intense Pulsed Light Therapy , just so happen to offer amazing aesthetic benefits as well. Gone are the days when we had to choose between treating our skin or taking care of our eyes.
And thankfully it is easier than ever to find clean products that are good for our skin and our eyes. Companies such as Luxe Beauty, who in particular make great anti-aging serums with hyaluronic acid and peptides, and an antioxidant serums. I tell my patients to be diligent when choosing anti-aging serums and antioxidant serums and research the ingredients to make sure there is no retinol.
And it makes me so happy to see that so many people (like you!) are pushing back, doing their research, and seeking out healthy alternatives to retinol.
References
1- https://pubmed.ncbi.nlm.nih.gov/22378109/
2- USA General Population 2018 Cross Sectional Study and Census.gov Population Clock
3- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694789/
5- https://pubmed.ncbi.nlm.nih.gov/2950849/
6- https://pubmed.ncbi.nlm.nih.gov/33470346/
Dr. Michele Pendrak is an optometrist who specializes in the ocular surface disease. She is currently at Siepser Eyecare in Wayne, PA, where she recently oversaw the clinic’s opening of the area’s first and only Dry Eye Center of Excellence. Her specialty has led her to have an interest in clean makeup and personal care products, a topic she often lectures on.
Disclaimer: Content in this blog and on our website is not a substitute for professional medical or healthcare advice, diagnosis, treatment, dietary, or safety advice and may not be used for such purposes. Always seek the advice of your physician or other qualified experts with any questions you may have regarding a medical question, condition, or safety concern. Reliance on information presented on this site is at your own risk.
