Regular eyelid hygiene is a key to managing blepharitis and meibomian gland dysfunction (MGD), a condition where the meibomian glands do not secrete enough oil into the tears due to a blockage or inspissation of gland secretions. Because ophthalmic professionals often instruct patients in hygiene regimens, we play an integral role in the treatment and maintenance of the lids. This article will discuss how ophthalmic professionals can provide essential teaching steps associated with at-home lid hygiene.
Understand the mechanics of the lid
Ophthalmic professionals should display a working knowledge of the lids. In brief: The eyelid is made up of several layers. The skin of the eyelid, which is the thinnest on the body, contains sebaceous and sweat glands, as well as fine hairs. Meibomian glands are a type of sebaceous gland.
Imperfections for sebaceous skin include collections of milia (small bumps that occur when skin flakes) or keratin become trapped under the skin. Xanthelasma, a condition in which yellow deposits appear on upper or lower lids, are more visible. Some may require a referral to dermatology.
Blepharitis, in general, is inflammation of the eyelids causing them to look red, swollen, and sore. There are multiple types — anterior, posterior and mixed — based on whether it affects the skin around the base of the eyelashes, the anterior, the meibomian glands, the posterior, or a mix. While the causes are complex and not fully understood, a first step in treatment is to recommend lid hygiene, according to the American Academy of Ophthalmology’s EyeWiki page (eyewiki.aao.org/Blepharitis ).
Commonly seen in clinic is anterior blepharitis, usually caused by seborrheic dermatitis, chronic dandruff-like itchy scaly skin and tiny square-shaped flakes around the eyelashes. Other causes include staphylococcal infection and demodex or D. folliculorum. The primary cause of posterior blepharitis is MGD.
Use language the patient understands
While the professional student in us knows microbes, blepharitis, and abnormal flora, the patient knows dry, itchy eyes, or flakey lids. Communicate in a way the patient understands. In a congenial, professional manner, use words as though you are speaking with a mother, grandfather, sister or brother (someone special). For example: “Healthy tears include oil that comes from glands located in our eyelids. When these glands become blocked, we can experience dry, itchy or burning eyes.”
In addition, when demonstrating, I may tell the patient:
“All the techs do this ourselves at home.”
“Just like brushing our teeth, eyelids also need help.”
“Our job is to keep normal flora, normal.”
“Now, how are you doing your heat for the warm compress?”
“What can I tell you about scrubbing?”
Hot compresses/eye masks
- TheraPearl (Bausch + Lomb)
- Moist Heat Eye Compress (Bruder)
- d.e.r.m. (Eye Eco)
- EyeGiene (Eyedetec Medical)
- Thermoeyes (Ocusoft)
- Tranquileyes (Ocusoft)
- The Eye Doctor (The Body Doctor)
- MGDRx EyeBag (The EyeBag Company)
- Blephasteam (Thea Phramaceuticals)
- Eye Scrub Sterile (Alcon)
- Systane Lid Wipes (Alcon)
- Tea Tree Eyelid & Facial Cleanser (Eye Eco)
- Avenova (NovaBay)
- Lid Scrub (Ocusoft)
- Blephaclean (Thea Pharmaceuticals)
- Blephagel (Thea Pharmaceuticals)
- Blephasol (Thea Pharmaceuticals)
- Sterilid Eyelid Cleanser (TheraTears)
- Tea Tree Eyelid Foaming Cleanser (We Love Eyes)
- NuLids (NuSight Medical)
Demonstrate the product
When it is time to provide a demonstration of a product, it is critical to follow the manufacturer’s instructions or specific instructions provided by the physician. Learn these in advance so that you can confidently provide the demonstration.
A lid hygiene regimen to treat blepharitis or MGD could include:
Warm compress: Microwavable masks, such as those with internal beads or other heating mechanism, are readily available in stores and some clinics. Additionally, a clean, moistened washcloth can work. Reheat any option as necessary.
Lid cleanser: Pre-moistened pads lid scrubs, foams, and gels are sold to meet the patient’s needs. Additionally, a mix of warm water with a small amount of baby shampoo is an option for lid cleanser. (This was shown to be just as efficacious at improving blepharitis compared to a market lid cleanser, according to a study in January’s Ocular Surface. However, the OTC cleanser was shown to reduce ocular surface inflammation, where baby shampoo did not.) Mix in a cup, then swipe with a clean cloth or Q-tip for each four lids with lid margin to remove the debris.
In any of these cases, encourage your patients to wash their hands thoroughly before and after the process.
For cases of financial hardship, most major pharmaceutical companies provide samples, at no cost, for care and patient education. The amount of the samples is enough for trial use with the foreseeable goal of self-maintenance.
Caution against rubbing
With irritation of blepharitis and MGD, patients may feel the need to rub the eyes for relief. But this force can also cause harm, such as keratoconus, and, in more severe cases, detached retina. Our job is to prevent the patient from rubbing.
I say this: “I am here to help you and I understand what you are going through. I understand rubbing may provide temporary relief of itching, but it causes more stinging and can do serious damage to your eyes.”
Lid hygiene for Demodex
Demodex mites live inside pores and hair follicles. Two types are found in humans: demodex follicularum, which live in lash follicles, and demodex brevis, which go deep, such as in inspissated meibomian glands. Classified as arachnid, take care in your discussions with patients. I never use technical descriptive language with this. Rather, I call refer to hygiene regimen as maintenance to reduce problems, “something similar to an allergen” or debris on the skin, keeping it at bay.
It is unlikely washing alone will remove them, however a number of lid wipes, cleansers and treatments, such as products containing tea tree oil or hypochlorous acid, are available.
Educate the patients
Educating the patients on a simple eyelid cleaning regimen with careful diligence ensures hope for patient success, abruptly improving from crusty to smooth. OP