Blowing the Lid Off Blepharitis and Chronic Dry-Eye Related Inflammation
Generations ago, moms admonished their kids to wash behind the ears. More recently dentists convinced us of the value of daily flossing and twice-a-year cleanings. The next hygiene ritual we need to broadly embrace is: eyelid cleansing.
It’s no secret that debris builds up in eyelids over time, clogging the Meibomian Glands and eventually leading to unstable tear film and Meibomian Gland Dysfunction (MGD) -- a major cause of blepharitis, and of chronic dry eye.
In a perfect world, patients would follow their ophthalmologist’s advice and perform daily lid cleaning. But in our far-from-perfect world, it likely will fall to us to provide lid cleaning to patients. Which means that no Dry Eye Center of Excellence is complete without professional eyelid cleaning.
Most patients with chronic dry eye will experience anterior or posterior blepharitis to some extent, and most will have elements of both.
Blepharitis is a chronic, inflammatory disease which is often accompanied by an overgrowth of normal bacteria along the lid and the base of the eyelashes. Blepharitis can occur in anyone, but the prevalence increases with age. This overgrowth of bacteria can touch off a vicious cycle that ultimately exacerbates dry eye: The bacteria produces a biofilm that traps debris and harbors bacterial exotoxins along the lid margin. These exotoxins can cause inflammation, which can reduce tear production and alter the quality of the tears. Fewer tears allow even more bacteria accumulate, which leads to a downward spiral of chronic irritation and dry eye.
Regular, thorough lid-cleansing is one of the most effective ways to put the brakes on this cycle and provide your patients significant relief. By removing the exotoxin-laden biofilm along the lid margin, you can help patients avoid long-term inflammatory damage to tear glands, and lessen or even prevent chronic dry eye syndrome.
There are two basic ways to accomplish thorough professional lid-cleaning in the office setting:
• Manual cleansing, using swab sticks preloaded with to-the-trade lid cleansers, such as OCuSOFTSwabstix.
• Microblepharoexfoliation, using the BlephEx system.
With BlephEx, a hand-held device spins a soft micro-sponge, soaked in lid cleanser, along the edge of the eyelids and lashes at 2500 rpm, removing debris. The patented micro sponge is disposable, and is discarded after each use.
BlephEx cleaning takes about 6 to 8 minutes, and is well-tolerated by patients. Some report a mild tickling sensation, which can be avoided if the doctor or technician presses more firmly during the treatment.
Manual cleaning takes 30 to 60 seconds per lid. With the microexfoliation system, the time is virtually the same.
Professional lid cleansing with swab sticks and microblepharoexfoliation are just beginning to be adopted on a routine basis for treatment and prevention of blepharitis, and thus are still relatively uncommon among ophthalmology practices. Both forms of lid cleansing are not covered by Medicare or most private insurance, so for the time being they remain a self-pay enterprise.
A generation ago, most of us knew at least one older adult with missing teeth or false teeth. Improved dental care, including preventive dental care changed that. Eventually, a growing number of experts predict, professional in office lid cleaning will be to ophthalmology what twice-yearly teeth cleaning has become to dentistry: a routine procedure that prevents problems down the road. Creating a Dry Eye Center of Excellence now offers us an opportunity to be at the leading edge of a culture shift that promises to provide a relatively simple means to promote better overall eye health.
Marguerite McDonald, MD, FACS, with OCLI on Long Island, NY, is clinical professor of Ophthalmology at NYU Langone Medical Center, NY, and clinical professor of Ophthalmology at Tulane University Health Sciences Center, New Orleans, Louisiana.