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Dropping Acid on Dry Eye Disease

(I-MED Pharma)

As the understanding of dry eye disease (DED) increases, so too does the awareness around effective treatment solutions that help in managing this condition. DED is complicated and so is its definition, since it is described as chronic, progressive, and multifactorial, and it can be symptomatic or asymptomatic.[1]

It can be difficult to fully appreciate how this disease affects all areas of life, which is why it is important to find the right management solutions that alleviate both signs and symptoms in a simple and convenient way.

With the addition of a Hypochlorous acid (HOCl) cleansing spray to the I-LID ’N LASH® ocular hygiene line, I-MED Pharma now offers patients the opportunity to create a one-two punch when used in combination with I-LID ’N LASH® wipes or pump to create a better ocular hygiene routine and manage symptoms of DED.

What is HOCl?

A natural antibacterial agent, HOCl is a compound that is effective against a broad range of microorganisms.[2] With different mechanisms for killing bacteria than antibiotics,[3] HOCl is very active against all bacterial, viral, and fungal human pathogens, and a small amount can kill bacteria quickly and effectively.[4] Pure HOCl is generated as part of the human immune response when white blood cells respond to pathogens in the body.3

HOCl, with its powerful antiseptic properties, has a history of use in wound care, since biofilm formation (a structure of microorganisms that generates a protective shell that allows bacteria to collect) are common in chronic wounds.4

HOCl and DED

There are many microorganisms that are part of the natural environment of the eyelids, lashes, and surrounding skin, but diseases and other factors can affect this microbiome which alters the natural bacterial diversity.3 An overgrowth of these microorganisms can cause inflammation and infection, irritating the ocular surface and leading to inflammatory conditions.[5]

Using an HOCl hygiene solution is an effective way to prevent and control an overpopulation of microorganisms that can disrupt ocular and tear film health. Because HOCl drastically reduces bacterial load without significantly altering the diversity of the microbial species found around the ocular area,3 it is a good choice for managing biofilm-associated diseases.

Blepharitis is a biofilm-associated disease and a common cause of ocular irritation. The increased bacterial load on the lids and lashes leads to inflammation and infection.[6] Blepharitis is often chronic and symptomatic, and this inflammatory condition of the eyelids is linked with DED because a poorly performing eyelid can affect the integrity of the ocular surface and tear film.[7]

As with many DED conditions, lid hygiene is the standard therapy for blepharitis, and daily ocular hygiene produces symptomatic benefits.[8] Because HOCl kills bacteria in biofilms, reduces bacterial load, and preserves microbial diversity, it is ideal for use in managing blepharitis.

Is HOCl Safe?

Eyelid skin is very thin, and particular care needs to be taken when using products on this delicate area so as not to irritate the sensitive skin or disrupt the ocular system. When choosing an HOCl cleansing solution for the ocular skin, an important consideration to keep in mind is both the concentration of the HOCl and the stability of the product.

I-LID ’N LASH® HOCL CLEANSING SPRAY is a water-based, all-natural cleanser that contains no toxic chemicals and is formulated with 0.02% pure HOCl, which is safe and gentle enough to use daily on sensitive skin. With its naturally hydrating ingredients, I-LID ’N LASH® HOCL CLEANSING SPRAY can be used throughout the day for a refreshing cleanse as needed. It has a high-purity formulation, created with an optimal pH balance for ideal product stability, and it is the only HOCl spray manufactured in Canada in a Health Canada licensed facility.

Enhancing Daily Ocular Hygiene with HOCl

Daily personal hygiene helps to keep the body healthy, and facial cleanliness, which includes caring for the face, teeth, and eyes, is often included in daily hygiene routines.5 The eyelids and lashes are often overlooked in a hygiene routine, but one way to ensure that this area is properly cared for is by using an effective HOCl cleansing spray. Having a spray design allows for an easy way to coat the lids and lashes with the gentle antibacterial cleansing product and with the I-LID ’N LASH® HOCL CLEANSING SPRAY there is no need to rinse or wipe off the product. Also, because the product is so convenient to use it is more likely to be used regularly, since, in general, therapies that are easily managed in daily life are more likely to be consistently maintained.7

For a safe and effective daily ocular hygiene routine, first use I-LID ’N LASH® wipes or pump to remove existing ocular debris, and then follow with I-LID ’N LASH® HOCL CLEANSING SPRAY. This two-step approach provides optimal lid and lash cleansing. Finally, follow this hygiene routine with viscoadaptive, preservative-free artificial tears to lubricate and hydrate the eyes and nourish the ocular surface.

While DED is complicated, dedication to management therapies and consistency will provide symptomatic relief. Using a combination of strategies that includes effective, easy to use, high-quality products is an excellent way to preserve ocular health.

[1] Craig, Jennifer P, Kelly K Nichols, Esen K Akpek, Barbara Caffery, Harminder S Dua, Choun-Ki Joo, Zuguo Liu, et al. 2017. “TFOS DEWS II Definition and Classification Report.” The Ocular Surface 15 (3): 276–83.

[2] Wang, L, M Bassiri, R Najafi, K Najafi, J Yang, B Khosrovi, W Hwong, et al. 2007. “Hypochlorous Acid as a Potential Wound Care Agent: Part I. Stabilized Hypochlorous Acid: a Component of the Inorganic Armamentarium of Innate Immunity.” Journal of Burns and Wounds 6: e5–.

[3] Stroman, David W, Keri Mintun, Arthur B Epstein, Crystal M Brimer, Chirag R Patel, James D Branch, and Kathryn Najafi-Tagol. 2017. “Reduction in Bacterial Load Using Hypochlorous Acid Hygiene Solution on Ocular Skin.” Clinical Ophthalmology (Auckland, N.Z.)11: 707–14.

[4] Sakarya, Serhan, Necati Gunay, Meltem Karakulak, Barcin Ozturk, and Bulent Ertugrul. 2014. “Hypochlorous Acid: An Ideal Would Care Agent with Powerful Microbicidal, Antibiofilm, and Would Healing Potency.” Wounds 12: 342-50.

[5] Bitton, Etty, William Ngo, and Patrice Dupont. 2019. “Eyelid Hygiene Products: A Scoping Review.” Contact Lens & Anterior Eye 42 (6): 591–97.

[6] Romanowski, Eric G, Nicholas A Stella, Kathleen A Yates, Kimberly M Brothers, Regis P Kowalski, and Robert M Q Shanks. 2018. “In Vitro Evaluation of a Hypochlorous Acid Hygiene Solution on Established Biofilms.” Eye & Contact Lens 44 Suppl 2 (2): S187–S191.

[7] Bruce, Gillian, and Ian Cameron. 2014. “Blepharitis, but Not as You Know It.” Optometry Today (London) 54 (4): 48–.

[8] Pflugfelder, Stephen C., Paul M. Karpecki, and Victor L. Perez. 2014. “Treatment of Blepharitis: Recent Clinical Trials.” The Ocular Surface 12 (4): 273–84.