From the desk of Dr. Mastrota
Meibomian glands, located in the superior and inferior tarsus of the eyelid, deliver meibum, and oily substance, to the ocular surface coating the watery/mucin layer of the tear film.
Meibomian gland dysfunction (MGD) is a chronic, diffuse abnormality of the Meibomian glands that may or may not be accompanied by qualitative and quantitative changes in meibum secretion. Eyelid margin inflammation, microorganism overgrowth, or other functional conditions can induce meibum quality changes and decrease meibum secretion, with or without atrophy of the secretory acini. This condition results in an alteration of the tear film and ocular surface symptoms. MGD is one of the major causes of dry eye disease (DED). MGD can manifest as the result of various causes such as age, underlying disease, environment, and/or other factors.
Lid hygiene, consisting of eyelid warming, massaging, and cleaning is the cornerstone of MGD treatment. Reliable and controlled heating softens impacted Meibomian gland meibum and facilitates its release from the gland by eyelid cleaning and massage or other means of gland evacuation.
Studies demonstrate that up to 45% of patients are non-compliant in maintaining an eyelid hygiene regimen. Most patients cite lack of time for lid hygiene negligence. Appropriate patient education and optimizing methods of lid hygiene however can promote patient compliance in maintaining eyelid health and in managing MGD, a primary driver of dry eye disease.
The aqueous environment of the ocular surface and eyelids and the proteinaceous/lipidic secretions of the Meibomian glands form a convenient locus for infection by Staphylococci and infestation by Demodex species. The accumulation of crusts on the eyelashes and eyelid margin also encourages infection and infestation.
White papers have elaborated the influence of the bacterial biofilm, bacterial lipases, and bacterial colonization on the eyelids and within Meibomian gland secretions with degree of MGD and OSD. Additionally, it has been shown that the bacteria in the biofilm can release virulence factors (cytolytic toxins, proteases, and lipases capable of destroying host tissue) causing escalating levels of inflammation not only on the lid margin, but also on the ocular surface, Meibomian glands, and accessory lacrimal glands.
Additionally, blepharitis, if left untreated, can lead to conjunctivitis and permanent lid margin changes, such as Meibomian gland dropout, marginal keratitis, corneal neovascularization, and cicatricial lid changes. Blepharitis is also a risk factor for endophthalmitis after cataract surgery and is reported in up to 60% of patients preparing for cataract surgery. Reducing blepharitis, and consequently tear film insufficiency, would reduce the bacterial colonization of the ocular surface that can result in postoperative ocular infections.
Cleaning/debridement of the lid margins provides significant symptom relief and improvement in the MG function. The effective removal of crusts around the eyelid margin reduces the possibility of bacterial infection that not only contributes directly to blepharitis, but also has a deleterious effect on Meibomian gland function.
Eyelid hygiene can increase contact lens tolerance by improving Meibomian gland function, decreasing tear evaporation and dry eye, improving the ocular surface and contact lens patient experience. Eyelid hygiene also helps remove allergens from the lid margin, decreasing access to the conjunctiva.
Lid hygiene products have emerged for the prevention or treatment of ocular disease in response to changes in modern society and science, for example the prevalence of new eye cosmetic/cosmetic procedures and/or awareness of the gravity of MGD. Thus, the present time is ideal for the introduction of genuine lid hygiene as a new health routine. A lid margin cleansing routine that includes a lid hygiene agent with mechanical brushing may help patients maintain their eye health, including subjects with Meibomian gland atrophy.
Doctor-tested iLidClean® is a safe, gentle, compact, convenient, economical, re-usable, portable, durable silicone tool used to remove lid margin and eyelash debris including waxy make-up residue and bacterial biofilm quickly and effectively encouraging a clean, healthy lid margin environment. iLidClean’s smooth micro silicone nubs and silicone durometer are designed specifically for the safety of the eye area. In combination with a lid margin cleaning product, iLidClean removes allergens that are deposited daily on the eyelashes and lid margins and gently debrides and removes abnormal keratin from the lid margin, maintaining the healthy architecture of the Line of Marx and tear film stability. Daily use of the iLidClean can breakup cylindrical dandruff at the base of the eyelashes aiding in Demodex identification and population reduction and improved eyelash growth. With an appropriate cleanser/hygiene solution/gel/foam, iLidClean removes mascara, lash glues, and other make-up residue at the base of the eyelashes that wiping does not adequately erase. Home treatment with iLidClean stimulates lid margin circulation, massages Riolan’s muscle that pumps meibum from the Meibomian gland, and uncaps keratin wrapped Meibomian gland orifices encouraging meibum flow from the glands. iLidClean offers gentle, at home, daily lid maintenance, useful alone or after in-office microblepharoexfoliation. iLidClean maintenance of the lid margin can be used as a priming at-home preparation for scheduled in-office eyelid expression (lipiflow/tearcare/iLux etc) and is helpful in the hygiene of patients with eyelash extensions.
iLidClean is a one-piece design that incurs no breakage. It has no synthetic brush fibers that fall out, degrade, discolor, bend or break, or that can harbor bacteria and other pathogens. iLidClean has no wispy fibers that are associated with cotton pads, swabs or tissues. Eyelid margin hygiene with iLidClean and gel reduces excessive tugging of delicate eyelid skin that occurs with cotton round lid-wiping. Economical, iLidClean needs no batteries, chargers or replacement parts – proudly made in the USA. A quick, daily routine combining the iLidClean and doctor-recommended lid hygiene product is encouraged for all patients to maintain the health and beauty of the eyelid margin and eyelashes.
Katherine M. Mastrota, MS, OD, EMBA, FAAODiplomate, American Board of Optometry
Director of Optometry
New York Hotel Trades Council & Hotel Association of New York City, Inc.
305 W. 44th Street, New York NY 10036
September 26, 2022