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You have been diagnosed with blepharitis, and your eye doctor recommended baby shampoo. Your eyelids are still swollen, red and irritated.

 Is there a better choice than baby shampoo for eyelid hygiene?

Baby Shampoo Not Good Enough

Baby shampoo has long been recommended to clean the eyelids due to its gentle surfactant properties and affordability. Eye doctors doubt its efficacy, and people almost always neglect the doctor’s “as directed” recommendations. So, let’s look at what is considered productive (and realistic). Suppose we only want to recommend general wellness to the non-disease-bearing patient. In that case, it may be enough—it has to be better than nothing! For people with eyelid disease, baby shampoo fails to reduce the microbial load, and more aggressive hygiene is needed.

Research studies have compared baby shampoo to any of the dedicated eyelid cleansers ( see below). Clinical improvements in blepharitis occurred with both treatments. However, only the dedicated eyelid cleanser effectively reduced ocular surface inflammation and was the preferred therapy. Learn more, click here

What are the better eyelid cleansers for blepharitis?

Since surfactant cleansers can dry the skin, oil-based cleansers may be a reasonable alternative for some patients. Mineral oil is well tolerated and an excellent skin moisturizer capable of removing make-up and lash debris. (Personal Testimonial: I have been using a mineral oil-based emollient to remove eye make-up for 15 years!) The antimicrobial effects of coconut oil have been well documented. Its extracts are found in each of the lid scrubs. Dilute tea tree oil shampoo can also be used but cause irritation and is not recommended for children or pregnant women. Reducing the eyelids’ bacterial overgrowth; abandon the baby shampoo and recommend one of these more effective products.

There are several products available as foam or pre-moistened wipes. Despite the significant overlap in their formulations, they all have a few key ingredients that differentiate them from the others and baby shampoo. In the presence of blepharitis, frothy tears, small marginal infiltrates, etc., consider one of the following treatment plans:

  • SteriLid contains linalool, which is thought to condition the skin and maintain oils that have antimicrobial properties. Tea tree oil and sodium perborate, a preservative, both may further reduce the bacterial load.
  • OCuSOFT Lid Scrub products are marketed as Original for mild to moderate disease or Plus for moderate to severe disease. These products contain 1,2-hexanediol and 1,2-octanediol, which can penetrate bacterial cell membranes, induce cellular leakage, and provide antibacterial properties.
  • Systane Lid Wipes contain benzyl alcohol, which is traditionally used as a preservative. However, it may function to reduce bacterial counts when applied to the lid.
  • Cliredex- contains tea tree oil  Cliradex is considered a premium solution in managing blepharitis, MGD, Demodex, dry eye, and rosacea. As is, Tea Tree Oil could be harsh, especially on the face.
  • Avenova – (formerly i-lid Cleanser) by NovaBay Pharma is a lid and lash cleanser available by prescription only. It was developed as a skin and wound cleanser, approved by the FDA to remove bacteria. It also has anti-viral and anti-toxin properties. Avenova contains isotonic saline and pure .01% hypochlorous acid (Neutrox). Avenova does not contain soaps or detergents.
  • Hydrate Lid and Lash Cleanser is a hypoallergenic diluted hypochlorous acid formula. It is alcohol and fragrance-free and contains no parabens, sulfates, or preservatives.

What is Blepharitis?

Blepharitis is an inflammatory condition of the eyelids leading to red, irritated, itchy, and dandruff-like scales that form on the eyelashes. It is a common eye disorder caused by bacteria or a skin condition, such as dandruff of the scalp or acne rosacea. 

Blepharitis can be presented as asymptomatic or symptomatic. The diagnosis is made via the number of meibomian gland expressions, quality of meibomian gland secretion, and loss of gland structure and function.

As the disease progresses, symptoms worsen, and lid margin signs may include inspissated meibomian glands, telangiectasia, and thickened eyelid margins. At this point, MGD-related posterior blepharitis is said to be present. The end result is a decrease in the quality of the tear film’s lipid layer resulting in evaporative dry eye disease.

How To Manage Blepharitis

With so many presentations of blepharitis, there is a need to identify and classify the condition to allow for a clinically straightforward diagnostic and treatment algorithm.

 Understand the prevalence and who is affected

The second step in addressing blepharitis is to appreciate why it matters and who is affected. The ocular comfort and quality of vision for people affected. We understand that ocular surface disease, including dry eye disease, ocular allergy, and both anterior and posterior blepharitis, plays a role. Why do some people get blepharitis and others do not? According to a 2009 survey, 37 percent and 47 percent of patients, respectively, present with some form of blepharitis. MGD ( clogged meibomian oil glands) is a form of posterior blepharitis – the most common cause of evaporative dry eye disease.

Despite its prevalence, blepharitis is still often overlooked, misdiagnosed, and therefore suboptimally treated, which is why it is so vital for people to be aware of the condition.

According to a research study, people seeking an eye exam because of ocular discomfort or irritation, the prevalence of posterior blepharitis was 24 percent, dry eye disease 21 percent, and anterior blepharitis 12 percent.15

Nonetheless, symptomatic people are typically the easiest to identify and treat with available treatment options.

What’s all the craze about Demodex?

What about our surgical patients? With the rise of our cataract population, we need to be concerned about the increased risk of endophthalmitis due to bacteria’s lid flora. According to the Endophthalmitis Vitrectomy Study, 70 percent of isolates were gram-positive, coagulase-negative organisms (primarily Staphylococcus epidermidis), 24 percent were other gram-positive organisms, and 6 percent were gram-negative organisms.16

A diagnostic algorithm for all forms of blepharitis includes a comprehensive eye evaluation and thorough history. Age and associated skin disorders (dermatitis, rosacea, and acne vulgaris) must be considered.

Anterior blepharitis has morning lid stickiness or crusting, burning, and acute/chronic symptoms. These are clues to the diagnosis and the signs of lid erythema, edema and debris. MGD and posterior blepharitis, symptoms will include burning, stinging, and fluctuating vision due to an insufficient lipid layer of the tears.

To look at the number of secreting glands and quality of secretion, we use meiboscopy (transilluminator), meibography (Lipiview II, TearScience), and diagnostic manual expression, using a Q-tip, fingertip, or Meibomian Gland Evaluator (TearScience).

For chronic conditions, the eyelid margin cultures may be indicated for patients who have recurrent anterior blepharitis or who are not responding to therapy. The microscopic evaluation of epilated eyelashes may show Demodex mites. Mites are implicated in some cases of chronic blepharoconjunctivitis.

Before initiating treatment, eye doctors must remember that both conditions may present concurrently; however, once correctly identified, treatment can be instituted. We must not forget that we can’t find it if we aren’t looking for it.

 How can Theralife Help?

Blepharitis is an integral part of chronic dry eye treatment. Recovery must also include treating dry eyes and MGD to stop the recurring inflammation. 

To learn more, click here.

References

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  3. American Academy of Ophthalmology Cornea/External Disease PPP Panel, Hoskins Center for Quality Eye Care. Blepharitis PPP – 2013. Available at: http://www.aao.org/preferred-practice-pattern/blepharitis-ppp–2013#references.
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