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    How bacteria load creates a biofilm

    Lid hygiene products help promote ocular health

    First acquired during birth from the mother and rapidly thereafter from the surrounding environment, bacteria colonize our conjunctiva and lacrimal systems. It is estimated that more than 200 species of bacteria commonly inhabit the human conjunctival mucosa.1 The ocular surface is chock full of nutrients to sustain resident bacteria; in fact, in a balanced and intact ocular surface system, commensal bacterial species may protect the ocular surface from pathogenic infection.2 Of course, microscopic life abounds at the lid margin and surrounding lids and eyelashes.

    More from Dr. Mastrota: Why you're missing the dry eye right in front of you

    Biofilm and the eye

    Bacterial life is versatile. Independent, mobile, free-floating microorganisms are referred to as in their “planktonic” form. Interestingly, however, the life cycle of most bacteria is in sessile aggregates: microbes most often construct and live in a complex, film-like meshwork known as a biofilm.

    Costerton et al defined biofilm as a structural community of bacterial cells enclosed in a self-produced polymeric matrix that can adhere to inert (abiotic) or living (biotic) surfaces.3 The bacterial-constructed biofilm environment provides physical protection to bacteria and, because of their close proximity to each other, allows them to communicate through a process called quorum sensing.4 Via a class of signaling chemicals (homoserine lactones), bacterial genes are regulated, which often leads to an increase in their virulence and propensity to cause infection.5

    More from Dr. Mastrota: The connection between dry eye and eyelashes

    With the constant physical disruption of blinking, tear exchange, tear antimicrobial agents, enzymes, and mucins, bacteria generally face a robust ocular surface defense system that prevents generating a biofilm. However, when abiotic surfaces such as contact lenses, ocular prostheses, corneal sutures, and punctal plugs are introduced, biofilm formation becomes a greater concern. Biofilms can also form on biotic surfaces such as the lid margin, particularly in circumstances that favor aggregation. In fact, a recent study demonstrated that microorganisms that remained at the end of cataract surgery—even after standard and customary lid/lash and ocular surface disinfection—had the capacity to produce biofilms and had high antibiotic resistance.6

    Next: The importance of lid hygiene

    Katherine M. Mastrota, MS, OD, FAAO, Dipl ABO
    Director of Optometry, New York Hotel Trades Council, Hotel Association of New York City, Health Center, Inc.

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    Optometry Times A/V