Dry Eye Dx and Tx

Washing Eyelid Trouble Away

BY KATHERINE M. MASTROTA, MS, OD, FAAO

I love eyelids. I think about them all the time. I spend a good part of my day examining eyelids and lid margins, photographing them and looking at the skin, glands, and eyelashes that are associated with them. I look around them and under them. I stain them, flip them, pull on them, and squeeze them. Frankly, I am obsessed with them.

The Importance of Lid Hygiene

I am not alone in my passion and fascination for the eyelids. I agree with Professor Jose Benitez-del-Castillo, director of the Ocular Surface and Inflammation Unit at the Hospital Clinico San Carlos, Madrid, Spain, when he says, “The healthy human eyelid is a remarkable but all too frequently neglected structure.” He suggests that eyelid hygiene should be incorporated into a broader concept of eyelid health in which eyelid cleansing is but a part of a more complete program of care that includes screening, risk assessment, and patient education (Benitezdel-Castillo, 2012).

The benefits of eyelid hygiene/managing blepharitis are likely multifold. Reducing debris, allergens, and bacterial colonization on the eyelids reduces the risk for conjunctivitis and is thought to lower the chance of endophthalmitis after cataract surgery (Mamalis et al, 2002) or from filtering blebs (Mac and Soltau, 2003), and can offer symptomatic relief of the deleterious effects of ocular surface disease and meibomian gland dysfunction (Lindsley et al, 2012).

Eyelid Cleansing Options

When it comes to eyelid hygiene, most patients prefer commercially prepared products as opposed to homemade solutions or therapies (Key, 1996). Products are available in pre-moistened towelettes or pads, solutions, gels, and foams.

OcuSoft’s line of eyelid cleaning products has been available since 1987. The company now manufactures OcuSoft Baby, the first and only product designed for infants and children. The TheraTears SteriLid (Advanced Vision Research) family of products, developed by ocular surface pioneer Jeffrey Gilbard, MD, also remains popular. The antimicrobial properties of the OcuSoft and SteriLid products make them ideal for managing infectious blepharitis and for use in pre-surgical prophylaxis. Additionally, OcuSoft Plus has demonstrated acaricidal (mite-killing) properties, important when addressing blepharitis thought to be caused by an overpopulation of the mite Demodex folliculorum. Distributed by BioTissue, new Cliradex lid wipes contain key constituents of tea tree oil, which has also been found to have acaricidal properties (Gao et al, 2005).

Also new, Systane lid wipes (Alcon) are marketed to remove lid debris and makeup similarly to EyeScrubs from Novartis. European contributions include Blephaclean lid wipes/Blephasol lid cleaning solution with hyaluronic acid (Spectrum Thea), demonstrated to provide symptomatic relief from blepharitis and to improve the status of the eyelid margin and meibomian glands (Guillon et al, 2012a and b).

There are also “generic” eyelid cleaning pads available at Walgreens and numerous products from other small companies that are available online.

Educating Patients on Lid Care

The “dental analogy” or “skin analogy” works nicely when discussing eyelid care with patients. Appropriate attention and daily cleansing are mandatory for healthy teeth and gums as well as for soft, blemish-free skin. It’s not hard to translate this to lid care.

I encourage you to customize a lid hygiene sheet for your practice and/or stock products for patient convenience. You send patients off with a lens cleaner for their glasses…shouldn’t you suggest one for their eyelids? CLS

For references, please visit www.clspectrum.com/references.asp and click on document #208.

Dr. Mastrota is secretary of the Ocular Surface Society of Optometry and center director at the New York office of Omni Eye Services. She is a stock shareholder of TearLab Corporation and a consultant or advisor to OcuSoft, B+L, Allergan, Alcon, Sarcode Bioscience, and Nicox. Contact her at katherinemastrota@msn.com.