Baby shampoo has long been recommended as a means to clean the eyelids due to its gentle surfactant properties and affordability. Many clinicians doubt its efficacy, and patients almost always neglect our “as directed” recommendations, which beg the question of what is considered efficacious (and realistic). If we only want to recommend general wellness to the non-disease-bearing patient, then it may be enough—it has to be better than nothing! For the patient with lid disease though, baby shampoo fails to sufficiently reduce the microbial load, and more aggressive hygiene is needed.
There are a number of products available as a foam or pre-moistened wipe. Despite the significant overlap in their formulations, they all have a few key ingredients that differentiate themselves from the others and from baby shampoo. In the presence of blepharitis, frothy tears, small marginal infiltrates, etc., consider one of the following in your treatment plan:
- SteriLid contains linalool, which is thought to condition the skin and maintain oils that have antimicrobial properties. Tea tree oil and sodium perborate, a preservative, both may, further reduce the bacterial load.
- OCuSOFT Lid Scrub products are marketed as Original for mild to moderate disease or Plus for moderate to severe disease. These products contain 1,2-hexanediol and 1,2-octanediol, which can penetrate bacterial cell membranes, induce cellular leakage, and thus provide antibacterial properties.
- Systane Lid Wipes contain benzyl alcohol, which is traditionally used as a preservative, though it may function to reduce bacterial counts when applied to the lid.
Since surfactant cleansers are capable of drying the skin, oil-based cleansers may be a reasonable alternative for some patients. Mineral oil is well tolerated and an excellent skin moisturizer that is capable of removing make-up and lash debris. (Personal testimonial: I have been using a mineral oil-based emollient to remove eye make-up for 15 years!)
The antimicrobial effects of coconut oil have been well documented, and its extracts are found in each of the lid scrubs discussed above. Dilute tea tree oil shampoo can also be used, but take caution as it may cause irritation and is not recommended for children or pregnant women. So, help your blepharitis patients in reducing bacterial overgrowth of the eyelids; abandon the baby shampoo and recommend one of these more effective products.