Eyelid cleanser can reduce bacterial colonization

Key Points

An eyelid cleanser with antimicrobial activity (SteriLid, Advanced Vision Research) can reduce bacterial colonization in patients with dry eye or blepharitis and should be a component of the overall therapeutic approach. The cleanser can prevent progression to meibomitis when included in the treatment protocol of blepharitis or combined blepharitis and dry eye, both of which involve bacterial overgrowth.

Stuart Kaufman, MD, has recommended several blepharitis treatments over the course of 30 years of practice-including diluted baby shampoo and different types of lid scrubs-and said he prefers this antimicrobial eyelid cleanser for numerous reasons.

"One, it's the easiest for patients to use," said Dr. Kaufman, who is in private practice in Zephyrhills, FL. "Two, it's the only treatment that is bactericidal."

Linalool an effective ingredient

The cleanser's effectiveness is based on the ingredient linalool, a colorless, fragrant liquid distilled from the oils of many plants, including herbs, flowers, and trees. Often used in lotions, soaps, and other products because of its fragrance and moisturizing properties, linalool also exhibits strong antimicrobial activity against a range of gram-negative and gram-positive bacteria, according to Jeffrey P. Gilbard, MD, director of the Dry Eye and Ocular Surface Disease Clinic at the New England Eye Center, Boston. He is also founder, chief executive officer, and chief scientific officer of Advanced Vision Research in Woburn, MA, which markets the cleanser.

In laboratory tests, the cleanser was antibacterial at 1 minute against Pseudomonas, Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus aureus, Serratia marcescens, Staphylococcus epidermidis, and Moraxella. In the same tests, at 1 minute 10% povidone iodine was effective against all of these bacteria except MRSA and S. aureus. This may explain why MRSA is now the most common cause for infection following LASIK and cataract surgery, Dr. Gilbard said.

Convenience to patients

Paul C. Kang, MD, an ophthalmologist in private practice in Washington, DC, said he also uses the eyelid cleanser for patients with blepharitis. The cleanser is the first option he recommends in these cases because it is highly effective, extremely convenient, and easy to use, he said.

The often-recommended practice of scrubbing the lids with diluted baby shampoo has several drawbacks that make an antimicrobial cleanser a better choice, Dr. Kang said. Baby shampoo is not specifically developed for use in the eyes, it has no antibacterial qualities, and scrubbing increases bacterial colonization of the skin, he said.

"It's inconvenient for people to be making concoctions of baby shampoo during the evening or once a day," he added. "[This cleanser] is effective, and it's very convenient for treating blepharitis. My patients really take to it."

Practicing in Washington, DC, where many of his patients have high-powered, demanding jobs and can't spare much time on managing the symptoms of a health problem, Dr. Kang said he finds the eyelid cleanser ideal.

"It just takes an extra 15 or 20 seconds out of [a patient's] day," he said. "I have a lot of patients who swear up and down by it, and it's been great for our practice."

Many patients are reluctant to try other therapies for blepharitis because they don't want to use medicine, such as an antibiotic ointment, on their lids, he said.

"By prescribing something that's a soap and it's over the counter as the first line, patients in my practice really respond favorably," Dr. Kang said.

Understanding of blepharitis and dry eye has grown considerably in recent years as researchers have learned more about the composition of the tear film, and this has influenced patient management decisions, Dr. Kang said. Blepharitis, for example, causes changes in the lipid component of the tear film such that neither artificial tears nor medications such as corticosteroids or cyclosporine A will be beneficial.

"If you're not addressing the key problem, which is the bacterial overgrowth and associated blepharitis, you're not going to solve the issue because you're not changing the components of the tear film or the quality of the tear," Dr. Kang said. "If I'm looking at a patient with dry eye and the eyelids are inflamed or they have a lot of meibomian gland dysfunction, I might use [this eyelid cleanser] in conjunction with artificial tears to see if that might help improve their symptoms before trying something else like a medication that isn't necessarily geared toward improving the lid aspect of dry eye."