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    The role of lid hygiene in ocular surface disease

    Lessen the bacterial load on the lid margin and eyelashes with good practices


    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.7

    Mobile and free-floating bacteria are called the “planktonic” form. Interestingly, 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.

    Related: 4 steps to beating blepharitis

    A biofilm is a structural community of bacterial cells enclosed in a self-produced polymeric matrix that can adhere to inert or living surfaces.8 The biofilm environment provides physical protection to bacteria and also allows them to communicate with each other (quorum sensing), which may lead to an increase in virulence and propensity to cause infection.9

    When bacteria change from being planktonic to biofilm-forming, they undergo changes in gene expression. There is speculation that such alterations create a more virulent strain of the bacteria or cause a conversion from a commensal species to a more harmful form.10

    Related: A different approach to treating demodex blepharitis

    With the constant physical disruption of blinking, tear exchange, tear anti-microbial agents, and 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 upon them becomes a greater concern.

    How lid hygiene helps

    Appropriate lid hygiene practices are in order to lessen the bacterial load on the eyelid margin and eyelashes, aiding the natural ocular surface defense mechanisms. Prof. Benitez-Del-Castillo suggests that eyelid hygiene should be incorporated into a broader concept of eyelid health in which eyelid cleansing is part of a more complete program of care that includes screening and risk assessment, patient education, and coaching.2

    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