baby shampoo, dry eyes, blepharitis and MGD

Update on Baby Shampoo use in the treatment of Eyelid disorders such as Blepharitis and Dry Eyes.

Since  1950, doctors have been prescribing cleaning care of the lid margin with an ever-evolving list of products. Certainly, we can all remember counseling our patients in the use of diluted “tear-free baby shampoo” in heroic efforts to rid the lid of debris, bacterial toxins and allergenic matter. Baby shampoo, presumed to be the gentlest and safest product to use around the eyes, was the best we had.

The good and the bad about Baby Shampoo vs Dry Eye and Blepharitis treatment

The ingredients used to make shampoo look good, smell nice, and foam easily can be harmful to the delicate environmental balance of the ocular surface. Manufacturers have diligently refinded products to remove or limit the concentrations of chemicals that may become toxic with chronic application. As an example, in 2014, a well known manufacturer reformulated its baby shampoo, removing quaternium-15, a formaldehyde-releasing preservative. However, concerns remain regarding the safety of the newer formulation that contains other chemicals known to cause allergic dermatitis or other adverse effects.

For instance, cocamidopropyl betaine (CABP), a coconut oil-derived surfactant and lathering agent found in many cosmetic and personal hygiene products, remains in some that baby shampoo. CABP has been associated with contact dermatitis and eyelid dermatitis. There are, of course, other dyes and fragrances that may also be taxing the eyelids and eye surface. This is particularly true with a daily application.

Current Offerings

Over the past 30 years, products have come to market that are made specifically for cleaning the eye area. Gentle and hygienic, these products are available in a variety of delivery mechanisms, including scrubs, foams, solutions and wipes.

With a appreciation of the association of Demodex overpopulation to blepharitis, tea tree oil (TTO)- containing cleaners have became available, most notably products that contain purified 4-terpineol, the clinically active ingredient of tea tree oil. TTO, the essential oil derived from the native Melaleuca alternifolia plant, is characterized by 15 major components. Studies have shown that 4-terpineol is the most important ingredient found in TTO and has even greater miticidal effects than does TTO itself.

Lid Hygiene has evolved to now include pure hypochlorous acid solution. Hypochlorous acid is a novel lid hygiene maintenance product. Hypochlorous acid is naturally generated in activated neutrophils, and it contributes to the direct destruction of bacteria, provides a blockade of bacteria-associated inflammatory toxins, and inhibits human cell-produced inflammatory mediators (cytokines).

In solution, it is non sensitizing and oxidizes quickly after application, making it ideal for debulking a microbial load and the associated biofilms from the eyelash base and lid margins. Hypochlorous acid has been demonstrated to inactivate bacterial lipases (baby shampoo has no effect on lipase activity). Lipolysis is thought to contribute to the inflammation characteristic of blepharitis. Intuitively, purity and limited, safe, biocompatible ingredients would be the preferred composition, and you should compare product label when prescribing these.

With the wide range of commercially prepared lid care products available, both over-the-counter and prescription, what benefit is there to recommending products meant for the hair or body ? Are the cost savings worth the price of environmental ocular surface challenge ?

*This article originally appeared in the September 2015 issue of Contact lens Spectrum*

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Eyelide Cleanser for dry eye and blepharitis. Lid hygiene with a good quality eyelid care product is very important when suffering from dry eyes. Several patients show signs of inflammation of the meibomian glands which are located in the eyelids. This inflammation is called “blepharitis”. Good eyelids hygiene with a product specifically designed to wash away the oily debris that are produced by these glands, which can irritate the ocular surface, is very important. Over time, if the lid hygiene is not performed regularly, debris and bacteria colonize the lash region and contribute to eye irritation. Eyelid care products such as Ocusoft or Lidhygenix is recommended after applying a hot compress on the eyes.’s products are quality products that are specially designed to clean the eyelids and help reduce the unpleasant symptoms of blepharitis and dry eyes. Cleaning the eyelids is essential to blepharitis treatment. You will find in this section several different type of eyelid cleansers to suit your needs.


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