Keep a Lid on Bacteria
Non-scrub eyelid cleanser decreases bacterial colonization of the lids, precluding the onset of disease.

BY JEFFREY P . GILBARD, M.D.

The use of baby-shampoo-derived- scrubs and diluted baby shampoo placed on a pad or a cotton-tipped swab to decrease bacterial colonization of the lids can actually dry out the eyelid skin and remove antibacterial skin oils. Also, scrubbing the skin increases bacterial penetration and colonization. Moreover, none of these products have an antibacterial effect. The good news: TheraTears brand SteriLid Eyelid Cleanser, from Advanced Vision Research, is formulated to decrease bacterial colonization of the lids, while maintaining the skin oils.
Sterilizing the lid
SteriLid’s prime ingredient is linalol, a plant oil widely used in personal-care products, such as moisturizing creams. In SteriLid, linalol is formulated in a moisturizing wash that kills gram-negative and gram-positive organisms. Also, SteriLid contains a cocktail of non-soap, but soap-like cleansers. Anti-bacterial soaps contain disinfectants, such as benzalkonium chloride (BAK) or ethyl alcohol, which remove skin oils and so are inappropriate for use near the eye. Mission to cure conditions Because SteriLid destroys gram-negative and gram-positive organisms, while preserving the integrity of the skin, it’s especially beneficial in the treatment of:
• Blepharitis. Patients with either anterior or posterior blepharitis have bacterial overgrowth on their eyelids. In anterior blepharitis, this overgrowth is associated with “scurf,” or greasy skin flakes on the lashes, and inflammation of the anterior lid margin. In posterior blepharitis or meibomianitis, the overgrowth of bacteria contributes to the symptoms of sandy-gritty irritation upon eye opening in the morning, researchers have hypothesized. The production of bacterial lipases and esterases hydrolyze the wax and sterol esters in the meibum, creating free fatty acids that irritate the eye and may promote inflammation and affect tear film stability. For these patients, I use q.d. or b.i.d. dosing depending on eyelid appearance.
• Dry Eye. Dry eye patients also have bacterial overgrowth on their eyelids. This bacteria has been shown to inhibit conjunctival goblet- cell proliferation in tissue culture, relative to normal controls. The mucus from these goblet cells helps lubricate the ocular surface, and dry-eye patients already have a decrease in goblet cell density secondary to increased tear film osmolarity. Although punctual plugs are a treatment option, these tiny devices are covered by a biofilm colonized by a wide-range of organisms. When these organisms are pathogens, patients develop increased eye irritation and a discharge around the plug (“Microbiology of Explanted Punctal Plugs.” Soukiasian S.H., the Association for Research in Vision Ophthalmology 2004; “Silicone Punctal Plugs and the Ocular Microbial Flora,” Soukiasian S.H. and Bharwaj N., ARVO 2006). For dry-eye patients, with and without plugs, I recommend q.d. SteriLid use.
• Endophthalmitis. The organisms that cause endophthalmitis come from the eyelid. To date, use of povidone iodine on the lids in the operating room prior to cataract surgery, and draping of the lids and lashes during the surgery has addressed this. SteriLid has been found to be bactericidal (at least a 90% or 1 log reduction in colony-forming units at one minute) for Pseudomonas aeruginosa, Escherichia coli, Serratia marcescens, Moraxella, Staphylococcus aureus, Methicillin Resistant Staphylococcus Aureus (MRSA) and Staphylococcus epidermidis. I start all my surgery patients on SteriLid b.i.d. three days pre-op. I have my intravitreal injection patients do the same thing. SteriLid is available over-thecounter without a prescription and by prescription as well as in a kit that also contains 50mg tablets of minocycline (Cleeravue-M, Stone- Bridge Pharma L.L.C.). For mild to moderate posterior blepharitis, I use SteriLid to reduce bacterial colonization, and TheraTears Nutrition (flaxseed-fish oil omega-3 supplement) to thin meibomian gland oils and suppress inflammation. For moderate to severe posterior blepharitis, I simultaneously start a one- to two-month course of 50mg q.d. of minocycline. Minocycline works synergistically with SteriLid to reduce bacterial colonization, and with TheraTears Nutrition to suppress inflammation. These blepharitis patients get a prescription for Cleeravue-M, a kit that has both the SteriLid cleanser pump and 60 50mg tablets of minocycline, and then get TheraTears Nutrition over-the-counter.

How to Use SteriLid
1. Thoroughly clean your fingertips with the SteriLid foam prior to use on the eyelid(s). Then rinse.
2. Pump the SteriLid foam onto the clean fingertips.
3. Close eye(s), and gingerly massage the foam into the lid(s) and lashes.
4. Rinse the foam with water.

DR. GILBARD IS CLINICAL ASSISTANT PROFESSOR OF OPHTHALMOLOGY, HARVARD MEDICAL SCHOOL, DIRECTOR OF THE DRY EYE AND OCULAR SURFACE DISEASE CLINIC AT THE NEW ENGLAND EYE CENTER AND FOUNDER, CEO AND CSO OF ADVANCED VISION RESEARCH. E-MAIL HIM AT JGILBARD@THERATEARS.COM.