In the 20 years that Christine W. Sindt, OD, FAAO, director of the contact lens service and clinical associate professor of ophthalmology and visual sciences at University of Iowa, has been working as a contact lens specialist, her views on lid hygiene have evolved, she says. “My general sense is that the eyelids are the cause of most of the evils and discomforts we see on the ocular surface, including meibomian gland dysfunction (MGD) and blepharitis. Clean eyelids are the key to keeping patients comfortable.” Over time, she says, she has become more assertive in telling patients that they have to clean their eyelids. “Dentists tell you, ‘Of course you have to brush your teeth.’ Optometrists should be saying, ‘Of course you have to wash your eyelids.’”
Dr. Sindt says that blepharitis is very com- mon, and it’s also very commonly overlooked. “We’re generally treating symptoms, and unless he patient is complaining, we don’t want to dig up something and make it a problem,” she says. However, the irony is that treating blepharitis and MGD early on is actually easier than treating it after the ocular surface is in a chronic inflammatory state. “Chronic inflammation of the eye will actually cause the meibomian glands to dry and drop out. Once that happens, they cannot be resuscitated, and the ocular surface loses its protective coating. Then the patient has evaporative dry eye disease.”
Maintaining lid hygiene is the most important thing that patients can do. “Simply cleaning the lids reduces the bacterial load. Washing your eyelids removes the oil, debris and excess bacteria. But most people don’t know to wash their eyelids,” she says.
Dr. Sindt recommends a daily routine of using coconut oil. “It’s a bipolar molecule, so like a surfactant, it acts like a soap and will surround dirt and remove it,” she says. Since it’s not a nut oil, the hypoallergenic effect is very low, and it’s also an antimicrobial. If that doesn’t achieve an adequate level of hygiene, she’ll recommend a formula with hypochlorous acid. “That provides the extra kill on bacteria.”
Dr. Sindt says that an evaluation of the lid margin should be a part of every exam. “You start at the eyelids and you work your way to the back of the eye. Look at the adnexa of the ocular area. Have the patient close his or her eyes and look at the lids, lashes and eyelid margin. Make sure there aren’t any strange bumps. See that the lid margin is flat and the glands are open. Make sure the glands aren’t keratinized,” she says. Just as babies and young children typically have fabulous skin until they hit puberty, eyes have a protective effect for some time, too. People often don’t realize that eyelids are an important part of their daily hygiene routine. “It’s as simple as making instructions part of your after-visit summary,” she says. “It needs to become part of their habit.”