Eyelid hygiene requires more attention
Blepharitis, or eyelid margin disease, is a common condition that affects all ages, ethnicities and genders.
The condition is characterized by inflammation of the eyelid margin. It can result in architectural changes to the soft tissue of the lid margin and cause damage to the ocular surface. Clinically, the eyelid margin can be seen as erythematous and thickened initially with effacement of the lid margin and lashes chronically.
While blepharitis tends to be more severe and symptomatic in persons 50 years and older, two specific demographic populations — adolescents and females — deserve attention as the underlying causes can be different and may require individual treatment options.
The etiology of blepharitis is multifactorial and typically involves a cycle of blocked oil glands in the eyelid margin and an overabundance of the microflora of the skin and eyelid margin. In pubescent and prepubescent patients, the same pathophysiologic process whereby hormones induce acne also can cause blepharitis. Anterior blepharitis can be exacerbated by the various periocular skin changes driven by hormones. Patients tend to have a clinical picture of dermatitis around the lid skin, in addition to inflamed eyelids. Specifically, the eyelid skin has an abundance of sebaceous glands and other apocrine sweat glands at the base of the lashes that produce increased sebum in the prepubescent stage. Often, the periocular skin disease drives the blepharitis and vice versa. Diagnostic tests, such as InflammaDry MMP-9 test (Quidel), can help clinicians and patients identify the presence of inflammation and prescribe the proper treatment.
Female patients of all age groups can have episodic exacerbations of severe disease symptoms based on various factors including diet, hormonal changes and specific beauty product use in the periocular region. Beauty product options continue to grow exponentially with new offerings in the realm of eyeshadow, eyeliner and eye creams. However, the various chemicals and preservatives can physically or chemically block oil glands, inducing inflammation of the eyelid margin. Furthermore, depending on the type of lash extension material, application method and duration of use, lash extensions also can change the microflora environment of the eyelid margin and induce inflammation. Clinically, it is important to note all use of make-up products, creams, lash accessories and cleansers to understand the full spectrum of potential inflammation-inciting agents. The chronic use of any of the aforementioned products can lead to downstream effects such as loss of normal microflora, inflammation, lash loss, soft tissue changes and more.
Prevention by way of patient education is vitally important in the treatment and management of patients. Certain ingredients in makeup, cleansers and moisturizers help repair and restore the soft tissue of the periocular region while others incite more inflammation. Patients often are not aware of what can be damaging. Lid hygiene should be advocated as an essential part of the daily skin care routine, especially in the female demographic. Given the unique microenvironment of the eyelid margin and its function in protecting the ocular surface, opportunities abound for clinicians and industry to help patients understand the importance of prevention to reduce downstream effects that lead to both functional and aesthetic loss.
Aesthetic surgeries in the periocular region such as blepharoplasties, canthoplasties and ptosis surgery are often performed in younger patients. Most patients are seeking less recovery time and desire achieving good surgical outcomes sooner rather than later. Using InflammaDry as part of the perioperative regimen helps clinicians and patients understand if there is preexisting low-grade inflammation that should be addressed before surgery. This approach would be similar to the perioperative evaluation for patients undergoing aesthetic facial procedures in which the duration of postsurgical edema and inflammation is important to the aesthetics of the surgical outcome.
Beyond the familiar recommendations to use heat and baby shampoo to treat eyelid margin disease, several eyelid cleanser products are now available. Key ingredients in these cleansers are the same ones that are important for facial cleansing. The goal is to reduce the microbial load without causing dehydration and/or inflammation of the natural skin barrier. The I-Lid ’n Lash line (Quidel) achieves this balance by incorporating both a hydrating ingredient and a natural anti-inflammatory. Hyaluronic acid is one of the building blocks of skin and has the unique ability to retain water, thus modulating skin moisture. Hyaluronic acid is not to be confused with hypochlorous acid, a disinfectant with antibacterial properties that is typically in other formulations of lid cleansers. Tea tree oil has been used as an antiseptic for hundreds of years, and research has shown its effectiveness as an antimicrobial and hydrating agent for various skin and hair conditions such as acne, dandruff, psoriasis and so on. Unlike other products, this combination of ingredients in the I-Lid ’n Lash cleanser and wipes improves the overall patient experience. In addition, use and compliance often increase when the treatment is soothing and effective.
When we begin to think of eyelid hygiene the same way we think of skin care for the face and body, hopefully, the incidence of eyelid margin disease will decrease, and the aesthetics of the lid and lashes will be better preserved throughout the aging process.