Three steps to selecting the
Best Eyelid Cleaning Products
for YOU plus so much more?
Be Empowered through understanding
Hi, I'm Dr Colin Parsloe. I consider myself to be a Professional patient - I work as an Ophthalmologist but live with Dry Eye Disease. I have been studying, treating and teaching on Dry Eye Disease for many years.
After reading this blog you will have an Overview of the options: You can download the PDF where we reviewed products offered by a pharmacy according to price per wipe and put them into the relevant categories.
Between this and choosing a lubricant we are spoilt for choice.
This is good but also bad as it gets very confusing.
We will NOT be discussing options to clean away Demodex mites (Parasites) in the lashes in this post but we have another post that covers this nicely.
What we will cover: we are going to explain that bacteria, fungi and parasites are part of the normal.
Then we will look at briefly look at the 4 main options to clean bacteria from the lashes:
- Household products
- Commercial cleaning solutions
We will consider the commercial cleaning options (Point 2 above), we will highlight the options regarding:
- Wipes - We will consider strength of cleaning chemicals, preservatives, type and size of cloth.
- Bottles of Cleansers
- Gels and
- Medical devices
Principle of cleaning
Anterior Blepharitis is due to the increased number of bacteria or fungi
Bacteria increase usually due to an increase in food supply. This is debris and oils that accumulate due to hormonal changes, underlying medical conditions, a side effect of medication or environmental factors.
Fungi increase mainly in relation to a condition called seborrheic dermatitis
The principle behind cleaning of the lids is to both remove the excess food and to remove some of the actual bacteria.
4 main options
The first step is to consider which of these 4 main options you are going to use.
Household cleaning products
DO NOT use these
Commercially available cleaning agents. These come in various forms such as:
Individually packed wipes
Spray that you direct towards the closed eyelids.
applied to the lashes
4 main options
The Full Essential Dry Eye Course covers all of This in great detail. We will mention the 4 options however the rest of this blog will focus on the commercial cleaning options.
Our PDF detailing findings of a review of an active online pharmacy in Europe that sells Dry Eye Disease products is at the end of this post.
The first is household cleaning products - there is a ton of poor advice on the internet and from some official organisations on how to clean the eyelids. Please do NOT do this - it is unlicensed, unregulated and the methods of mixing and preparing the ingredients is inaccurate and I believe unsafe. There are licensed and regulated medical devices that you can use.
The second are commercially available cleaning agents. These come in various forms such as:
1. Individually packed wipes
4. Medical devices
The third option is a spray that you direct towards the closed eyelids. This is usually a form of preservative such as Hypochlorous acid. It is mild towards the skin however as it is left on it has an antibacterial effect on the excess bacteria. It kills bacteria (bactericidal) a long list of bacteria and has been clinically proven to reduced the bacterial load of the eyelid.
It is a natural product produced by some of your white blood cells (Neutrophils) as they fight infection. It is a safe and non-toxic spray. It is used by numerous disciplines in medicine for a variety of purposes.
It is effective and safer than hydrogen peroxide or bleach and is available over the counter.
I do think that it is an effective add on to treatment. I do not recommend using it in the place of an eyelid wipe. Wipes have much better cleaning properties and Hypochlorous acid needs time to take effect - around 10 - 30 minutes depending on the organisms.
My advice - after cleaning your eyelashes just one use spray directly over the closed eyelids of each eye. Leave it on, no need for wipes. It is known to kill bacteria hidden in biofilms.
The fourth option is using an antibiotic ointment to be rubbed into the lashes to reduce the number of bacteria in the lids. This is usually advised for one to two weeks only then stopped.
It is usually very thick and in the short term may seen to blur the eye and make cleaning the lashes difficult. It can help to rapidly reduce the number of bacteria.
First commercial option - Wipes:
Options include considering
The strength of the cleaning chemicals
Whether it is preserved or not.
Whether it is a leave on formula or a wash off formula
The type of cloth material (most are lint free)
Size of cloth - this can be personal preference
I recommend using one cloth for both eyes as long as you use a clean technique - we illustrate this in our Essential online Dry Eye Disease course.
Some patients cut the cloth into 2 or 4 pieces, I am not a fan of this but I do see the logic as long as you are not allowing the cloth to become contaminated.
When considering cost and are comparing the products you need to be aware of the number of wipes in each pack as this varies from 15 wipes in a pack to 60 wipes in a pack (strictly speaking the 60 wipes are not individually packed)
We have reviewed the cost of wipes and cleansers in our PDF - free to download at the end of this post.
Price per wipe varied between $0.22 to $1.17
Looking at the strength of the cleaning chemicals.
If you have a lot of debris - you need a strong cleaning action
Later when you are on top of the debris collection you may want to move to a product with less cleaning chemicals for longterm maintenance therapy.
If you have very sensitive skin there are products with no cleaning ingredients and are purified water on a cloth.
Looking at preserved vs preservative free
When advising on eyedrops the advice is to go Preservative free. However on eyelid wipes I think that the bacteria killing action of a preservative is a good thing.
It needs to be balanced against the potential damage to the skin. Fortunately the medical device companies are aware of this and they have used a ‘gentler’ preservative that can be left on the eyelid skin prolonging the antibacterial effect of the treatment.
This is also the principle behind the spray that can be used for Anterior Blepharitis.
The main advantage to individually wrapped wipes are that they are convenient to carry around and the main disadvantage is cost. I do find them very difficult to open most of the time. I wash my hands just before using them and this makes it extra tricky.
Anterior Blepharitis treatment can be divided.
Firstly you need a specific treatment approach for active disease with significant bacterial build-up. This is how I often see new patients or sometimes if a patient is having a flare-up.
For example this can occur in patients with Rosacea. When the underlying Rosacea is active then the Meibomian Gland Disease is significantly worse and this can cause an increase in inflammation and debris build up which allows the Anterior Blepharitis to worsen.
Secondly your eyes can be in ‘remission’ and minimal to no build up and maintenance is all that is required.
Second commercial option - cleansers
This option is more cost effective, and this is the use of cleansers. This is a usually a bottle of cleaning agent. They can be in a foaming formulation or a liquid drop. They are usually applied to a cloth. My advice is to purchase some make-up remover pads and use one for both eyes.
Occasionally the cleansers are sold as a ‘compliance pack’ where you buy the bottle and some clean pads.
They tend to last longer but are less transportable.
Third commercial option - Gels
You have two options here, I usually go for the second.
First option - clean your face with soap and water as per normal then apply the gel and leave on.
Second option is when I am using a wash-off formulation cleanser or a preservative fee cleanser, after cleaning the lids with the cleanser that gets washed off, I will apply a small amount of gel to the lids and leave this on for the day. There are some gels with Tea Tree oil - you can not leave these on.
Fourth commercial option - Medical devices
There are other options to clean bacteria from the eyelashes. This usually comes in the form of an in-office or in-clinic therapy.
You can have the base of the lashes cleaned by an eye care specialist. There are various options for them to use. They include:
1. Using a pair of very fine forceps
2. Using a type of vibrating scrubbing brush
3. Using a rotating disc
Do not delay - get the PDF NOW!
Antibacterial Hot compresses - the latest revolution in Dry Eye Disease
We know that Meibomian gland disease is the leading cause of Dry Eye Disease.
The main step to manage this disease is to heat the eyelids. There are a number of products that are available for patients to use. The original products were grain filled bags that were heated, applied to the lids, then removed and put into a cupboard overnight. The next day they are warmed in the microwave and the reapplied to the eyelids.
The problem was that overnight the bacteria multiplied on the hot compresses as they were stored in the cupboard. The patient then applies this contaminated hot compress back onto their eyelids. I believe that cross-contamination and increasing the amount of bacteria (Bacterial load) are significant risks to the patient.
Some manufacturers have ignored this issue completely. Others have advised additional steps including that patients first microwave their hot compresses, then let it cool completely then microwave it again in order to use it. Others advise regular discarding and replacement of the device.
The revolutionary solution, patented by The Body Doctor ltd, was to incorporate an antibacterial element into their hot compresses. They then performed detailed scientific studies to evidence the efficacy of their solution. They have shown that during storage, the non-antibiotic hot compresses allow for continued bacterial growth, and their innovative solution, Sterileyes, actively reduces the bacterial load during storage killing 99.9% of bacteria. Fortunately there are now a number of antibacterial hot compresses available .
The net effect is that Antibacterial hot compresses are simpler and safer to use.
Many people store their hot compress in the bathroom or other moist environments. A hot compress is used around the nose area. As we are all too well aware that there is a very high risk of contamination from coughing or droplets that can lead to contamination of other bacteria onto the hot compresses.
This can potentially cause contamination of the eyes with bacteria that are not commonly found in the eyes but from the throat or nose. We would consider it common sense that you want to use a device that using a device with less bacteria from the nose or other droplets is preferable.
We also have the following scientific evidence to support this idea that using hot compresses with less bacteria is safer than using hot compresses with more bacteria.
An increase in bacteria on the eyelids makes your Dry Eye Disease worse
There is research showing that reducing the bacterial load in subjects with anterior blepharitis or MGD significantly improved the clinical picture of the eyelid margin tissues including the Meibomian glands.
It is argued that in order to treat Meibomian gland disease you need to reduce the bacterial load – indeed Suzuki T propose that systemic (tablets) antibiotics are required for treatment to be successful.
In a published article Zhang et al show that it is clear that in conditions such as dry eye disease there is an increase in the number (Higher culture rate) of bacteria. They conclude that the higher number of bacteria contributes to Dry Eye Disease process.
It has also been shown that ‘the severity of MGD was positively correlated with a higher isolation rate, a greater number of bacterial species, and a higher grade of bacterial severity, which implied that MGD might be correlated with bacterial changes.’ In the same study it supported the use of antibiotics which some of us commonly use in clinical practice.
When looking at the difference in bacteria between healthy people and people with Meibomian Gland Disease, it was found that those suffering from Meibomian gland disease have a higher bacterial load. The bacteria produce specific toxins that can contribute to Dry Eye Disease.
If we divide patients with Meibomian Gland disease based on severity of their disease such as mild, moderate and severe. It has been shown that those with the most severe disease had the highest level of infection of Staphylococcus bacteria.
It is recognised that contamination of hot compresses used as management for Meibomian gland disease may “exacerbate” this condition.
In a paper from Graham et al. there is a table illustrating that there is an increase in bacteria. The lowest bacterial count was in Normal patients and it then increased in the patients with the more severe forms of Dry Eye disease.
It is abundantly clear that the higher the bacterial load in the eye, the more likely it is that their dry eye disease will be more severe. This is also supported by the use of antibiotics to treat this disease and the fact that hot compress manufacturers advise on the importance of reducing the bacterial load prior to using their devices.
Dry eye Disease - This is the most common eye disease in the world. “The reported prevalence rates based on clinical signs in populations over the age of 40 ranged from 38 to 68%” In general it is considered to affect around 20% of the general population however this is higher in woman, Asian populations and is significantly higher in people over the age of 40.
Can Dry Eye Disease cause blindness?
Yes, I believe that this link has been shown in reports such as the DEWS report of 2007, other references to this can be found in certain textbooks and in popular optometry and optician journals.
Certainly in informal discussions between Eye Care Specialists, I believe that we would all agree that there is an increased risk of infection of the cornea in patients with Dry Eye Disease. I think that there are three principle mechanisms at play.
- Firstly that in Dry Eye Disease the tears have a poor quantity and quality. The protective proteins in the tears are disrupted and less effective
- Secondly the physical barrier or the very thick mucus layer on the surface of the eye is degraded. This allows bacteria direct access to the surface of the eye.
- Thirdly, direct damage to the protective surface epithelium will allow bacteria to enter the cornea.
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