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  • Treatment

What is Eyelid Hygiene?

  • Last updated November 8, 2022

8 min read

Jovi Boparai MD Profile Picture
Written byJovi Boparai, MD
Edward Lai, MD
Reviewed by Edward Lai, MD
Jovi Boparai MD Profile Picture
Jovi Boparai, MDCo-founder & CEO of CorneaCarePhiladelphia, PA

Bio

Dry eye disease is tough! I get it. I have struggled with dry eyes for several years from contact lens use, and from spending countless hours looking at computer screens. In college, my dry eyes got so bad that I couldn’t wear contact lenses, because of a constant “foreign body sensation” when I had them in. I had to stop reading every 30 minutes because my eyes would start to burn and my vision would get blurry. I tried a plethora of treatments and nothing seemed to work. Dry eye disease was not only impacting my eyes, but also my emotional wellbeing. It was preventing me from enjoying life, and getting in the way of my professional training. I felt overwhelmed, frustrated and hopeless.

It was only when I realized that my dry eyes were linked to my lifestyle, environment and overall health did things start to make sense. I noticed that on days when I spent less time on the computer, my eyes felt better. My symptoms would flare when it was windy, or when there was low humidity. I knew that if I wanted to get ahead of my dry eyes, I needed to not only treat my eyes, but to also address my lifestyle. I started a consistent regimen of artificial tears and eyelid hygiene. I switched from monthly contact lenses to daily contact lenses. I started taking scheduled breaks from looking at a computer. I ate a healthier diet focused on anti-inflammatory/antioxidants foods, and I bought a humidifier for my room. In the beginning doing all this seemed impossible, but over time it became part of my usual routine. Not only did my eyes feel better, but I was overall healthier and happier! Turns out what is good for my eyes, was also good for my mind and body. I carried this lesson with me as I started my career to become an ophthalmologist and ophthalmic surgeon.

Because of my personal journey and professional training, I believe dry eye treatment starts by listening to and empowering the patient. I listen for the struggles and cue in on their strengths, while picking up on their lifestyle. Only then do we together start building a treatment plan that incorporates good eye hygiene with small, but impactful lifestyle changes. Our sight is our most important sense, and it is intimately linked to our very being. I want dry eye patients to not only get their dry eyes under control, but to also enjoy good mental and physical health, and live a fulfilling life. What is good for the eyes should also strengthen the mind and fortify the body!

Get to know me a little better!

Hobby: vintage watches
Food: peanut butter
Superhero: Superman
Guilty pleasure: desserts
Secret power: has never had a headache

Training:

Undergraduate: University of Pittsburgh Honors College
Medical school: Weill Cornell Medicine
Ophthalmology residency: Wills Eye Hospital.

Edward Lai, MD
Edward Lai, MDOphthalmic SurgeonNew York, NY

Bio

Dr. Lai is a fellowship trained cornea specialist with wide ranging expertise in ophthalmology. Through combining cutting-edge technology with clinical and surgical skills, Dr. Lai is able to deliver excellent care to his patients. Dr. Lai has a specific interest in dry eye disease and how it can impact patients physically and emotionally. He has published on the importance of dry eye treatment in patients undergoing eye surgeries, such as cataract and LASIK. Dr. Lai advocates for building dry eye treatment plans that address the eyes, but also incorporate general health, lifestyle and environment.

Get to know Dr. Lai a little better!

Hobby: boxing
Favorite food: lasagna
Superhero: Spiderman
Guilty pleasure: 90s RnB
Greatest weakness: ice cream
Secret power: cooking

Training:

Medical school: Tufts University
Ophthalmology residency: Manhattan Eye, Ear and Throat Hospital
Cornea fellowship: Weill Cornell Medicine

Dry eye treatment starts with eyelid hygiene

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Table of Contents

Key points

  • The eyes and eyelids work in union to maintain your tear film and protect your eyes.
  • The first step in dry eye treatment is eyelid hygiene.
  • Eyelid hygiene includes improving meibomian gland function and reducing eyelid inflammation.
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Keywords

Blepharitis, Demodex, dry eye disease, eyelid hygiene, eyelid wipes, meibomian gland dysfunction

Taking the first step

An individual with dry eye disease (DED) can spend months self-treating before seeing an eye care professional. This means trying countless over-the-counter (OTC) eye drops, warm compresses, eyelid wipes, eyelid cleansers, gels, ointments and oral supplements, all the while suffering from symptoms of dry eyes. OTC treatments can certainly help, but only if they are tailored to your specific needs, used consistently, and fit within the context of your overall health and lifestyle.

Eyelid hygiene is foundational in dry eye treatment. Your eyes and eyelids work together to maintain your tear film, and protect your eyes. If you’re having dry eye symptoms, the first place to start is eyelid hygiene.  

A quick review of dry eye disease

Let’s first review some basics before we dive into eyelid hygiene. DED is also known as dry eye syndrome, keratoconjunctivitis sicca and ocular surface disease.1 The classic dry eye symptoms are blurry vision, eye irritation, light sensitivity, itchy eyes, eye strain, dryness, watery eyes, stinging or burning, gritty sensation and eye pain. 

There are several causes of dry eyes, but we break them down into two categories: aqueous deficient and evaporative. With aqueous deficient DED, your lacrimal glands do not produce enough natural tears to lubricate the surface of the eyes (the cornea and conjunctiva). With evaporative DED, your body makes enough natural tears, but they evaporate too quickly. In reality, most forms of DED are a combination of aqueous deficient and evaporative, leading to tear film dysfunction. 

Causes of dry eye disease

There are several environmental factors that can worsen dry eyes, such as low humidity (dry climate or dry air), high winds, air pollution, and air conditioning. Lifestyle risk factors include long hours on digital screens (phones, tablets and computer screens) and poor diet (low in vitamin A, minerals, and healthy fats and lipids).

DED can impact you on many levels, including physically, emotionally, financially and even socially. A good dry eye treatment regimen can give you symptomatic relief, and protect your mind, body and lifestyle.

The basics of dry eye treatment

One way to think about dry eye treatment is going back to the different causes of DED. In aqueous deficient DED, we want to supplement your tear film with lubrication. In evaporative DED, we want to prevent tear evaporation, and so we want to stabilize your tear film, which we address with eyelid hygiene.  Typically, a good treatment not only lubricates and prevents tear evaporation, but it also addresses nutrition (your diet), the environment and your lifestyle (work and social life). What is good for your eye health should also be good for the mind and body. 

Tear film

The treatment options for dry eye include OTC lubricant eye drops (artificial tears), gels, eye ointments and eyelid hygiene (warm compress and eyelid wipes). A humidifier and air purifier can also help, as can using an oral dry eye supplement. In addition to lubricating eye drops, a person may require dry eye prescription drops and ophthalmic procedures in an eye doctor’s office (ophthalmologist and optometrist).

What is eyelid hygiene?

Eyelid hygiene, in a nutshell, is taking care of your eyelids.2 Taking care of your eyelids is the first step towards dry eye relief. Typically, eyelid hygiene includes warm compresses and lid scrubs. You can either buy a premade warm compress mask at your local drug store, online, or make one at home. Typically, a wet, moist or steamed warm compress works best for eyelid hygiene.

Eyelid hygiene routine

For lid wipes, you can either use baby shampoo and a towelette, or buy pre-moistened eyelid cleansing wipes. Some brands that carry pre-moistened pads include Ocusoft, MediViz, and Systane lid wipes. 

There are several in-office procedures that also address eyelid hygiene. These include LipiFlow, intense pulsed light therapy, iLux, TearCare, BlephEx, Thermoflo and NuLids. These procedures are typically not covered by insurance, and not every eye clinic offers them, so their accessibility is limited.

Eyelid hygiene for blepharitis and meibomian gland dysfunction

We can break down eyelid hygiene into two buckets: getting your meibomian glands to function well and reducing eyelid inflammation (blepharitis). 

The most common cause of evaporative DED is meibomian gland dysfunction (MGD).3 Meibomian glands line your eyelids and secrete oil which makes up the lipid layer in your tear film. The aqueous layer comes from the lacrimal gland and the mucin layer comes from the goblet cells. 

Glands and goblet cells

Meibomian glands sometimes stop working well, and instead of releasing oil into your tear film, the oil can build up on the eyelids or in the glands themselves. This can lead to “caking” or “crusts” on your eyelids, and ultimately cause eye irritation. MGD can happen for many reasons, but it’s mostly related to your genetics, environment, age and gender. 

When the meibomian glands stop secreting oil, your lipid layer in the tear film becomes deficient, which causes the remaining layers in your tear film to break up and evaporate quickly. Moreover, as the oil builds up on your eyelid margin or in the meibomian glands, you can get styes and inflammation of the eyelids, also known as posterior blepharitis. This creates a vicious cycle where MGD directly causes DED, leading to downstream conditions that worsen DED. Posterior blepharitis can also be caused by rosacea, an inflammatory skin condition affecting the face. 

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Anterior blepharitis can be caused by bacteria, mites (Demodex) and dandruff from your scalp and eyelashes (seborrheic dermatitis). Less commonly, allergies and contact lens irritation can also cause anterior blepharitis. 

Eyelid hygiene prevents you from getting into this vicious cycle of MGD <–> blepharitis. Warm eye compresses, and eyelid wipes and sprays may curtail MGD, blepharitis or both. Moreover, eyelid hygiene makes your skin less inflamed, red and “puffy,” which leads to healthy eyelids and vibrant eyes.

Common eyelid wipe and spray ingredients

Eyelid wipes and sprays contain several ingredients. If you’re struggling with all the names and acronyms, you’re not alone. A good way to think about the ingredients is to divide them up into the ten categories below. Please note that some of the ingredients play multiple roles, and this ingredient list is not exhaustive!4-6

  1. Emollients: soften your skin and make it primed for hydration. Examples include: methyl gluceth-20, propanediol, glyceryl oleate, polyethylene glycol (PEG)-120 methyl glucose trioleate, and aloe vera.
  2. Humectants: hydrate and moisturize your skin by attracting water. Examples include: methyl gluceth-20, propanediol, caprylyl glycol, panthenol, and hyaluronic acid.
  3. Occlusives: create a barrier over your skin to prevent the water from evaporating away, and lock in the moisture. Examples include: mineral oil, lanolin, petrolatum (petroleum jelly) and coconut oil. 
  4. Cleansing agents/surfactants: trap dirt and debris, and remove it. Examples include: PEG-80 sorbitan laurate, decyl glucoside, coco-glucoside, glyceryl oleate, polyglyceryl-10 caprylate/caprate, disodium laureth, and PEG-120 methyl glucose trioleate. 
  5. Buffers: control the acidity of the product so it’s gentle on your skin. Examples include: sodium bicarbonate, and sodium citrate. 
  6. Viscous agents: manage the thickness, stickiness, and “gooeyness” of the product. Examples include: sodium chloride, potassium chloride, calcium chloride, and polyglyceryl-10 caprylate/caprate.
  7. Preservatives: protect the product from bacteria, molds, fungus, and yeast, and retain its freshness. Examples include: 1,2-hexanediol, and polyaminopropyl biguanide.
  8. Skin repair/healing: aid in tissue healing and repair. Examples include: panthenol, tea tree oil, and hyaluronic acid.
  9. Anti-inflammatory: reduce inflammation. Examples include tea tree oil.
  10. Antimicrobials: help fend off pathogens, like Demodex (mites) and bacteria. Examples include caprylyl glycol, hypochlorous acid, and tea tree oil.

Perhaps most importantly, eyelid wipes contain lots of water, usually over 95%. Water lubricates and hydrates your eyes and eyelids. Hydrated skin leads to healthy, radiant skin. Hydrated eyes lead to healthy, natural tears. The water also cleanses any debris, flaking or discharge that builds up on the eyelashes overnight. This gets the eyes and eyelids ready for other ingredients. 

The combination and dual-action of tea tree oil plus hyaluronic acid provide an excellent follow-up to the hydration from water. 

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Tea tree oil is derived from evergreen leaves of the Australian Melaleuca alternifolia tree. Tea tree oil has been used worldwide for hundreds of years in various health conditions. The key with tea tree oil is to use just the right amount to gently exfoliate and rejuvenate your eyelids. This helps fend off inflammation, infections and wakes up the meibomian glands in your eyelids to produce oil, which is essential to making a strong, stable tear film. 

Hyaluronic acid retains high concentrations of water, locks in hydration and helps with tissue healing. Where the tea tree oil exfoliates, the hyaluronic acid heals and hydrates. Both work together to soothe and strengthen the eyes and eyelids.

Is tea tree oil bad for my eyes?

Tea tree oil has gotten some bad press recently, stating that it may be harmful to the meibomian glands, which are essential in maintaining your tear film. The study that claimed this was performed in a petri dish (i.e., not in real humans), and the meibomian gland epithelial cells were soaked in varying concentrations of tea tree oil continuously for five days.7 The study doesn’t replicate real-life. Most people aren’t walking around with a strip of tea tree oil on their eyelids 24/7. Moreover, just like with most things in life, the amount of tea tree oil really matters. You want to use just the right concentration, which offers all benefits of tea tree oil without any possible side effects. 

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But what if my eyelid wipes have preservatives?

Preservatives are a tricky business for consumers and healthcare professionals. On one end,  they can irritate the eyes and eyelids, especially if you have sensitive eyes. On the other hand, they prevent your products from getting infected with germs and help maintain their freshness.8

The important concept to consider here is the frequency of use. That is, preservatives really start to have negative effects if you’re exposed to them more than 3-4 times a day on a long-term basis.9 For example, with artificial tears, you’re typically putting in lubricant eye drops 4-6 times a day, so it makes sense that they should be preservative-free. However, eyelid wipes are meant for external use only and shouldn’t come in contact with your ocular surface. Furthermore, you typically won’t use eyelid wipes more than 1-2 times a day. That said, if you’ve tried eyelid wipes and had a bad reaction to preservatives, then you should certainly seek out preservative-free wipes. But the presence of preservatives shouldn’t exclude most people from using eyelid wipes.

Unlike preservatives, exposure to allergens, even once, can cause a reaction leading to dry eye symptoms. Your eyelid wipes should certainly be hypoallergenic. 

How to use eyelid wipes and sprays

This is pretty straightforward. For eyelid wipes, start by washing your hands and removing your contact lenses (if you wear them). With clean hands, open the packet, unfold the wipe, close your eyes, and gently clean your eyelids and lashes in a downward, sweeping motion. Fold the wipe and repeat the same movement on the other side. Repeat 2-3 times on each side. Rinse eyelids and lashes with water or cleanser, if desired. 

For eyelid sprays, you want to spray the solution onto gauze or a pad, and once moistened, use gauze or pad to clean your eyelashes as described above. 

Some, but not all, wipes and sprays can also be used as eye makeup removers, so be sure to read the instructions.

Putting it all together

Eyelid hygiene is the first step in dry eye treatment. Your eyes and eyelids work together to maintain your tear film, protect your eyes and preserve your eyesight. Eyelid hygiene all starts with warm compresses and eyelids wipes, with the goal of improving meibomian gland function and reducing eyelid inflammation. Eyelid wipes play a crucial role in the latter. A combination of hyaluronic acid and tea tree oil can work wonders to hydrate the eyes and eyelids, reduce inflammation and repair tissue.

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What’s next

We really think everyone should take our Dry Eye 101 course. Find it here!

If you’ve already taken it, amazing! Check out more articles in the Continuing Education section below.

Bibliography

  1. Tear Film & Ocular Surface Society. Dry Eye Workshop II Report. Ocular Surface Journal, 2017. TFOS DEWS II Report, https://www.tfosdewsreport.org/.
  2. Benitez-del-Castillo, Jose M. “How to promote and preserve eyelid health.” Clinical Ophthalmology, vol. 6, 2012, pp. 1689–1698. US National Library of Medicine National Institutes of Health, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484726/.
  3. Scott, Christina. “Meibomian Gland Dysfunction and Treatment.” AAPOS, 2020, https://aapos.org/glossary/meibomian-gland-dysfunction-and-treatment. Accessed 01 November 2021.
  4. Dotdash. “Skin Ingredients.” BYRDIE, 2021, https://www.byrdie.com/skincare-ingredients-glossary-4800556. Accessed 17 October 2021.
  5. INCIDecoder. “Decode Ingredient Lists like a Pro.” INCI, 2021, https://incidecoder.com/. Accessed 04 November 2021.
  6. Environmental Working Group. “EWG’s Skin Deep.” EWG, 2021, https://www.ewg.org/skindeep/. Accessed 19 October 2021.
  7. Chen, Di, et al. “Effects of Terpinen-4-ol on Meibomian Gland Epithelial Cells In Vitro.” Cornea, vol. 39, no. 12, 2020, pp. 1541-1546. PubMed, https://pubmed.ncbi.nlm.nih.gov/32387382/.
  8. The Good Face Project. “5 Things You Need to Know About Preservatives in Cosmetics.” Good Face Project, 2020, https://thegoodfaceproject.com/articles/preservatives. Accessed 07 November 2021.
  9. Cole, Jane. “Artificial Tears: What Matters and Why.” Review of Optometry, 15 November 2020, https://www.reviewofoptometry.com/article/artificial-tears-what-matters-and-why. Accessed 18 October 2021.

 

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