The eyelids play a crucial role in maintaining a healthy ocular surface. They help to protect the eyes from foreign material, debris and environmental irritants as well as facilitate evenly spreading tears across the surface of the eye (1). The oil producing glands (meibomian glands) are also present within the thin tissue of the eyelids making the health of this area extremely important for dry eye management. Similar to brushing your teeth or washing your face, cleaning your eyelids should be a part of your daily routine.
Why Eyelid Hygiene Matters
As mentioned previously, routinely cleansing the eyelid and eyelash area is essential for overall ocular health as well as decreasing dry eye symptoms (2). The eyelids are particularly prone to buildup of bacteria, environmental debris, allergens, makeup and even skin mites (Demodex). While small amounts of some of these components are part of a normal and healthy skin barrier, accumulation can lead to significant and potentially chronic eye and eyelid inflammation and infection. Some patients will be more prone to this accumulation than others, and may need more substantial methods for cleansing and maintaining the eyelids free from bacteria and other debris.
The Link Between Poor Eyelid Hygiene and Dry Eye
Chronic meibomian gland dysfunction (MGD) is the leading cause of dry eye disease. Poor eyelid hygiene can be causative for MGD, or worsen the symptoms associated with preexisting MGD. The meibomian gland openings are located on the eyelid margins (commonly referred to as the “waterline” of the eye) and can very easily become clogged if there is any accumulated debris in the area. Clogged meibomian glands contribute to the progression of MGD by preventing the glands from releasing their oils into the tear film and ultimately causing the gland to limit or halt its function altogether (meibomian gland dropout). Without sufficient oil in the tear film, your tears evaporate quicker than they should, the eye surface becomes dry and inflamed, and symptoms like burning, tearing, redness and discomfort start to worsen. Meibomian gland dropout is not reversible, and managing eyelid hygiene routinely can help to limit the progression of MGD as well as mitigate dry eye symptoms over time (3).
What are the Symptoms of Poor Eyelid Hygiene?
Some common symptoms of accumulation of bacteria, debris and eyelid inflammation (known as blepharitis) are:
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Crusting on the lids and lashes
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Redness affecting the eyelid margins
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Swollen eyelids
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Itchy eyelids
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Burning sensation
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Eye watering
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Gritty sensation in the eyes
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Recurrent eyelid infections or styes
Many of the symptoms listed here can mimic or be present with other eye conditions too. If you are unsure or have new symptoms flaring up, it is always best to visit your eye care practitioner for a thorough ocular health assessment (5).
What Are Some Steps for Daily Eyelid Care at Home?
Here are some general recommendations to promote good overall eyelid hygiene (6).
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Gently clean the area with a dedicated eyelid cleanser. Dedicated eyelid cleansers should contain an antimicrobial agent to combat bacterial growth. Blinkjoy’s Lid & Lash cleanser is a great example here, as it contains hypochlorous acid which is a naturally occurring antimicrobial. Other ingredients like hyaluronate, castor oil and GLA help to hydrate the skin at the same time.
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Use a warm compress. Applying moist heat to the closed eyelids for about 10 minutes nightly helps to unclog any blocked meibomian glands before they become atrophied (dropout).
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Avoid sleeping with makeup on. Accumulation of makeup increases the likelihood of clogged meibomian glands and chronic blepharitis. A pH balanced micellar solution that is safe for the eye area is a great option to remove makeup. Generally, these solutions do not contain antimicrobials so it is important to distinguish the physical makeup removing from microorganism reduction.
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Consider an eyelid wipe. Pre-moistened eyelid wipes embedded with antimicrobials such as tea tree oil are another great option to add if you tend to be more prone to debris or Demodex buildup.
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Maintain your routine. Establishing a routine is the best way to keep your eyelids clean and promote a healthy ocular surface. If you’ve already established a routine and found your symptoms have worsened, it is important to make sure that you are assessed to ensure there is nothing else going on that may need attention.
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Inquire with your eye care provider about other available options. The steps here are a great basic routine, however, some patients will have more severe cases. Many optometrists offer in-office hygiene treatments that could be much more substantial for the more severe or stubborn cases.
Conclusion
Eyelid hygiene does not simply end after taking off makeup or cosmetics. It’s an important step in the prevention of a long list of eyelid/ocular infectious and inflammatory conditions. If you have dry eyes and have not yet incorporated eyelid hygiene measures into your routine, starting with the outlined steps above and inquiring about this with your eye care provider would be helpful. Maintenance of proper eyelid hygiene is a crucial step in dry eye management (4). As all patients will have a unique ocular and general health situation, your methods for eyelid hygiene may be somewhat different from the next person.
References:
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Benitez-del-Castillo, Jose M. "How to promote and preserve eyelid health." Clinical Ophthalmology (2012): 1689-1698. https://www.tandfonline.com/doi/full/10.2147/OPTH.S33133
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Alghamdi, Yousef A., et al. "Compliance and subjective patient responses to eyelid hygiene." Eye & contact lens 43.4 (2017): 213-217. https://journals.lww.com/claojournal/abstract/2017/07000/compliance_and_subjective_patient_responses_to.2.aspx
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Guillon, Michel, Cécile Maissa, and Stephanie Wong. "Symptomatic relief associated with eyelid hygiene in anterior blepharitis and MGD." Eye & contact lens 38.5 (2012): 306-312. https://journals.lww.com/claojournal/abstract/2012/09000/symptomatic_relief_associated_with_eyelid_hygiene.9.aspx
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Messmer, Elisabeth M. "The pathophysiology, diagnosis, and treatment of dry eye disease." Deutsches Ärzteblatt International 112.5 (2015): 71. https://pmc.ncbi.nlm.nih.gov/articles/PMC4335585/
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Hosseini, Kamran, Linda B. Bourque, and Ron D. Hays. "Development and evaluation of a measure of patient-reported symptoms of Blepharitis." Health and Quality of Life Outcomes16 (2018): 1-6. https://link.springer.com/article/10.1186/s12955-018-0839-5
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Rocha, Karolinne Maia, et al. "Eyelid margin disease (blepharitis and meibomian gland dysfunction): clinical review of evidence-based and emerging treatments." Journal of Cataract & Refractive Surgery (2022): 10-1097. https://journals.lww.com/jcrs/abstract/2024/08000/eyelid_margin_disease__blepharitis_and_meibomian.16.aspx
Contributors:
Sarah Farrag, OD
Dr. Sarah Farrag is originally from Halifax, Nova Scotia, and is happy to be practicing optometry in her hometown. She graduated with honors from the University of Waterloo Doctor of Optometry program in June 2015. In addition to routine optometric care, Dr. Farrag also facilitates an advanced dry eye clinic offering specialty consultation and treatment for severe dry eye.
