How to promote and preserve eyelid health

Abstract

Disorders of the lacrimal functional unit are common in ophthalmological practice, with meibomian gland dysfunction, blepharitis, and dry eye forming a significant part of the general ophthalmologist's practice. The eyelid and its associated structures form a complex organ designed to protect the fragile corneal surface and improve visual acuity. This organ is subject to a number of disorders, including meibomian gland dysfunction, dry eye syndrome, anterior blepharitis, allergic and dermatological conditions, and disorders associated with contact lens use. Although commonly described separately, disorders of the lacrimal function unit are better considered as a group of interacting pathologies that have inflammatory mediators as a central feature. Eyelid hygiene, in the sense of routine cleansing and massage of the eyelids, is well accepted in the management of many disorders of the eyelid. However, a broader concept of eyelid health may be appropriate, in which eyelid cleansing is but a part of a more complete program of care that includes screening and risk assessment, patient education, and coaching. The ophthalmologist has an important role to play in helping patients persist with routine eyelid care that may be long-term or lifelong. A number of preparations exist to make routine eyelid care both more effective and more pleasant, and might also improve compliance. Several such preparations have been devised, and are being assessed in clinical studies, and appear to be effective and preferred by patients over traditional soap and water or baby shampoo.

Keywords: disorders; eyelid; health; lacrimal functional unit.

Figure 1

Schematic sagittal section of the lacrimal functional unit.

Figure 2

Location of the meibomian gland orifices.

Figure 3

Meibomian gland dysfunction: strings of waxy, dysfunctional meibomian secretion.

Figure 4

(A) Eyelid cleaning procedure: eyelid massage to express waxy meibomian secretion. (B) Eyelid cleaning procedure: cleaning of eyelid margin.

Figure 5

Appraisal of efficiency and acceptability by subjects in the presence of the investigating ophthalmologist. Notes: Acceptability and efficiency (as a “cleaning product for eyelids and eyelashes”) of the product was assessed by a self-administered questionnaire (on a 5-point ordinal scale: nil, poor, fairly good, good, very good). Reprinted from Clin Ophthalmol. (6). Doan S. Tolerability and acceptability of Blephagel: a novel eyelid hygiene aqueous gel. 6:71–77. © Copyright (2012), with permission from Dove Medical Press Ltd.

Figure 6

Subject appraisal of the qualities and efficacy of Blephagel^®. Reprinted from Clin Ophthalmol. (6). Doan S. Tolerability and acceptability of Blephagel: a novel eyelid hygiene aqueous gel. 6:71–77. © Copyright (2012), with permission from Dove Medical Press Ltd.