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(I-MED Pharma)
Dry Eye Disease is a common, worldwide disorder that affects over 6.3 million people in Canada alone.[1] The accompanied symptoms of Dry Eye Disease – which can include itching, burning, crusting, red and swollen eyelids – reduces both health and vision related quality of life and, over time, leads to ocular surface damage. With a growing number of ocular clinicians recognizing the need to diagnose and address this prevalent disorder[2] and with the advancement in both treatment options and Dry Eye Disease knowledge that has become available within the last ten years,[3] there are ways to manage and control your dry eye symptoms. While Dry Eye Disease can be caused by various factors including eye disorders, environmental influences, and even lifestyle behaviours, this post will look at three aspects of this disorder: Demodex (eyelash mite infestations); Blepharitis (inflammation of the eyelids); and MGD (meibomian gland dysfunction). In the management of all three conditions, daily ocular hygiene is important for both the prevention and relief of symptoms, as well as being beneficial for controlling Dry Eye Disease in general.
-Demodex Explained
Demodex are eight-legged mites that belong to the arthropod family. These mites can live in the eyelash follicles, and in large numbers, they can physically block the sebaceous glands, including the meibomian glands in which they reside. Demodex infestations are a more common occurrence than is generally thought[4] and the percentage of people colonized with Demodex mites increases with age. While it is normal for some Demodex mites to live on the eyelids and eyelashes of healthy people, they can quickly become an infestation when skin and eyelash cleaning is not done thoroughly and regularly, and these infestations leads to the Demodex condition. In addition to the unpleasant symptoms associated with Demodex such as eyelid itching, burning, crusting and redness, they create cylindrical dandruff on the eyelashes[5] and these parasitic mites can contribute to various other skin and eye conditions such as rosacea and blepharitis.[6]
-Blepharitis Explained
Blepharitis, while having the simple definition as inflammation of the eyelids (or lid margins), can be triggered by a number of reasons including bacterial, viral or parasitic causes.[7] It is one of the most common ocular conditions, affecting both children and adults and, in addition to being difficult to manage, is often chronic. Blepharitis has a range of symptoms, some of which overlap with Dry Eye Disease, such as irritation, tearing, burning sensation, redness, crusting of the eyelids, sensitivity to light, and feeling of foreign-body sensation in the eyes. Blepharitis can cause inflammation in both the anterior section the eyelid (such as the base of the eyelashes) and the posterior section of the eyelid (such as the section of the eyelid that comes into contact with the cornea), as well as also affecting the meibomian glands, causing MGD. Blepharitis can also be caused by Demodex mites, since the infestation and waste produced by the mites can cause blockages in the follicles and glands as well as inflammation.[8]
-MGD Explained
Meibomian Gland Dysfunction is a broad term that describes a complex, chronic condition that affects the functioning of the meibomian glands. Located in the eyelids, these glands produce meibum, an oily substance in the tear film that is important for both eye health and comfort. Patients with MGD can produce less or lower quality meibum, and since meibum is responsible for slowing evaporation of the tear film, these patients have tears that evaporate more quickly, leaving the eyes more prone to ocular surface damage and discomfort. Some patients with MGD can be asymptomatic while others have symptoms similar to those in other Dry Eye Disease conditions such as light-sensitivity, eye infection, feeling of foreign-body sensation in the eyes, dryness, and inflammation.[9] A number of factors can increase your risk of developing MGD including age, medications, contact lens wear, and environmental factors (such as prolonged use of visual displays, air pollution, and seasonal changes).
Importance of Daily Ocular Hygiene for the Management of:
-Demodex
To manage Demodex infestation usually the eyelid and lashes are wiped and cleaned using a solution that contains tea tree oil (TTO).[10] Tea tree oil has antibacterial, antifungal, and anti-inflammatory properties and is one of the most effective solutions to fighting these mites. Using a solution of just 5% tea tree oil as part of your ocular hygiene routine is effective in helping to eradicate Demodex and reducing eye inflammation.[11] I-LID ’N LASH® PRO and I-LID ’N LASH® PLUS is recommended as a combined program for patients requiring more intensive cleansing of the periorbital region, such as patients with Demodex infestations. This two-step cleansing process involves an in-clinic professional application using I-LID ’N LASH® PRO (containing 20% TTO), and daily at-home follow-up applications by the patient using I-LID ’N LASH® PLUS (containing 5% TTO). Once the Demodex mites are eliminated it is important to keep the eyelids and eyelashes clean with daily applications of I-LID ’N LASH® wipes to prevent any further or future infestations.
-Blepharitis
For the management of Blepharitis daily eyelid hygiene is essential. Since Blepharitis is often a chronic disease, daily eyelid hygiene is important even after the symptoms have been resolved to help prevent future reoccurrences of symptoms.[12] The usual management of Blepharitis includes warm lid compresses to aid in oil secretions, followed by eyelid massage and eyelid and lash scrubs. I-MED Pharma’s I-RELIEFTM HOT & COLD THERAPY EYE MASK provides moist heat therapy to increase blood circulation and stimulate lipid oil production. Following the heat therapy, I-LID ’N LASH® is used to clean and remove ocular debris. If Blepharitis is caused by Demodex, following the two-step cleansing process of I-LID ’N LASH® PRO and I-LID ’N LASH® PLUS can help to relieve Blepharitis symptoms caused by these eyelash mites.
-MGD
The aim in the management of MGD is to increase the quality and quantity of meibum produced, which in turn improves the quality and quantity of the tears, protecting the ocular surface and relieving symptoms. One step to managing MGD is by educating yourself to understand the medication, lifestyle, and environmental risks that can contribute to the development of MGD. Another step for MGD management is by modifying diet to increase essential fatty acid intake, which is beneficial in relieving both Dry Eye Disease and MGD symptoms.[13] Increase your daily essential fatty acid intake by incorporating one of I-MED Pharma’s I-VU® nutritional vitamins into your daily routine. Another step to MGD management is to improve the meibum flow which can be helped by warming the eyelids to encourage meibum production. The I-RELIEFTM HOT & COLD THERAPY EYE MASK provides moist heat therapy to stimulate lipid oil production. Finally, eyelid hygiene is one of the most important factors for MGD management since bacteria and parasites such as Demodex can also contribute to the condition.[14] Use I-LID ’N LASH® to keep the ocular area clean and free of debris.
Importance of Daily Ocular Hygiene for Prevention of Dry Eye Disease
Daily ocular hygiene is essential in the prevention of many Dry Eye Disease issues. Daily ocular hygiene with the right products is an important step to achieving and maintaining optimal ocular health. Because the eyelids are not as accessible on the face to routine hygiene practices since it is surrounded by protruding facial structures such as the nose, cheeks, and eyebrows, our eyes can often be neglected in our daily hygiene practices. Daily use of I-LID ’N LASH® helps to ensure proper ocular hygiene and I-LID ’N LASH® PLUS and I-LID ’N LASH® PRO, which both contain tea tree oil, are used when more intensive ocular cleansing is needed.
I-MED Pharma is proud to offer a wide range of products to help manage symptoms of Dry Eye Disease including preservative-free artificial tears, ocular hygiene products, a night-time dry eye ointment, therapeutic eye mask and nutritional supplements. Seek the medical advice of your eye care professional to learn more about what dry eye products will work best for your specific needs.
[1] Barbara Caffrey et al., “Prevalence of dry eye disease in Ontario, Canada: A population-based survey,” The Ocular Surface 17, no. 3 (2019): 526, http://www.elsevier.com/locate/jtos.
[2] “Improving the Identification, Diagnosis, and Treatment of Dry Eye,” Ophthalmology Times 43, no. 12 (July 15, 2018): SS3+, https://link.gale.com/apps/doc/A551168301/AONE?u=lond95336&sid=AONE&xid=a5faef3f.
[3] Bill Kekevian, “Modernize Your Methods of Dry Eye Care: Put Your New Understanding of Ocular Surface Dynamics into Action with These Updated Guidelines,” Review of Optometry 154, no. 8 (August 15, 2017): S11+, https://link.gale.com/apps/doc/A503775035/AONE?u=lond95336&sid=AONE&xid=f4683e24.
[4] “Improving the Identification,” SS3+.
[5] Jingbo Liu, Sheha Hosam, and Scheffer CG Tseng, “Pathogenic Role of Demodex Mites in Blepharitis,” Current Opinion in Allergy and Clinical Immunology 10, no. 5 (2010): 507, https://doi.org/10.1097/ACI.0b013e32833df9f4.
[6] Yucel Karakurt and Erhan Zeytun, “Evaluation of the Efficacy of Tea Tree Oil On the Density of
Demodex Mites (Acari: Demodicidae) and Ocular Symptoms In Patients With Demodectic Blepharitis,” Journal of Parasitology 104, no. 5 (2018): 475, https://doi.org/10.1645/18-46.
[7] Kristina Lindsley et al., “Interventions for Chronic Blepharitis,” Cochrane Database of Systematic Reviews 5 (May 16, 2012): 7, https://doi.org//10.1002/14651858.CD005556.pub2.
[8] Lindsley, “Interventions for Chronic,” 7.
[9] Priyanka Chhadva, Raquel Goldhardt, and Anat Galor, “Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease,” Ophthalmology 124, no. 11 (November 2017): S24, https://doi.org/10.1016/j.ophtha.2017.05.031.
[10] William Ngo, Lyndon Jones, and Etty Bitton, “Short-Term Comfort Responses Associated With the Use of Eyelid Cleansing Products to Manage Demodex folliculorum,” Eye & Contact Lens 44, no. 6 (November 2018): S87, https://doi.org/10.1097/ICL.0000000000000415.
[11] Liu, Hosam, and Tseng, “Pathogenic Role,” 505.
[12] Lindsley, “Interventions for Chronic,” 7.
[13] Tommy CY Chan et al., “Update on the Association Between Dry Eye Disease and Meibomian Gland Dysfunction,” Hong Kong Medical Journal 25, no. 1 (January 31, 2019): 44, https://doi.org/10.12809/hkmj187331.
[14] Chan, “Update on the Association,” 42-43.