Eyes are an "environment" with a high risk of infection and inflammation due to the watery consistency of the surface and eyelids, the viscous secretions of the meibomian glands (involved in the correct balance of the tear film) and the accumulation of crusts on the eyelashes and on the margin of the eyelids. Furthermore, the ocular surface is an anatomically complex structure and its physical location, close to the nose, cheeks and eyebrows, is not as easily accessible for daily cleaning as the surrounding glands and organs are.
The benefits of correct daily eye hygiene, not restricted to ophthalmic patients but extended to the entire population, are valuable. Just for instance, reducing the presence of dust, very small debris, allergens and bacteria from the eyelids decreases the risk of diseases such as conjunctivitis. Washing with soap and water is essential, but it may not be sufficient to ensure effective cleaning of the eyelid margin. On the other hand, the use of cotton or pads can cause discomfort and irritation given by the microfilaments released by the cotton or by the too rough surface of the pads.
Cosmetics used in the ocular region, despite the fact that today they have quite safe formulations, if not removed for a long time, can have a negative impact on the ocular appendages, on the ocular surface, on the all system and on the tear film. For example, makeup not remuved on the eyelashes and eyelids can penetrate the eyes and cause infection and inflammation, and eyelashes that are too heavy with mascara are less likely to protect the eyes from dirt and wind.
Good periocular hygiene is therefore able to prevent infections and eye inflammations in healthy subjects.
There are conditions in which the cleansing of the eye and its appendages becomes even more important.
For individuals with eye infections or inflammations such as conjunctivitis, chalazion, styes and blepharitis, hygiene of the eye area, in association with the most appropriate medical therapy, it is an indispensable factor in limiting the symptoms and shortening the course of the disease.
Blepharitis
Blepharitis can be acute, ulcerative or non-ulcerative, or chronic, meibomian gland dysfunction, seborrheic blepharitis.
Acute ulcerative blepharitis is usually caused by a bacterial infection, usually staphylococcal, of the free eyelid margin at the insertion of the eyelashes; the eyelash follicles and meibomian glands are also affected. This picture may also have a viral etiology (eg, herpes simplex, varicella zoster). Bacterial infections typically have more crusting than viral infections, which usually have more of a clear serous discharge.
Acute nonulcerative blepharitis is usually the consequence of a local allergic reaction, e.g. eg, atopic blepharodermatitis and seasonal allergic blepharoconjunctivitis causing intense itching and inflammation (usually along the edges of both eyelids); Rubbing (an itch response that can increase conjunctival itching and exacerbate atopic dermatitis [eczema] of the eyelid); o Contact sensitivity (dermoblepharoconjunctivitis).
Chronic blepharitis is a noninfectious inflammation of idiopathic etiology. The meibomian glands, located in the thickness of the eyelid, produce a mixture of lipids (sebum) capable of reducing tear evaporation through the formation of a lipid film that covers the aqueous tear film. In meibomian gland dysfunction, the composition of the lipid film is altered. This causes dilation of the glandular ducts and orifices and the formation of tenacious waxy plugs. Many patients suffer from rosacea and experience recurrent onset of styes and chalazions.
Many patients with seborrheic blepharitis have seborrheic dermatitis of the face and scalp or acne rosacea. The formation of scales on the free eyelid margin often leads to secondary bacterial colonization. The meibomian glands can become blocked.
Most patients with meibomian gland dysfunction or seborrheic blepharitis develop keratoconjunctivitis sicca secondary to increased tear evaporation, also known as dry eye.
Although experts have not yet demonstrated precisely the causes of the phenomenon, it seems that the onset of blepharitis is linked to the combination of at least two factors. The alleged perpetrators are:
- Bacterial infections supported in particular by streptococcus
- Viral infections mainly caused by herpes simplex virus type I (ocular herpes)
- Allergies, including allergic reactions to eye drops, eye ointments, contact lens solutions, and eye cosmetics
- Acne Rosacea, a particular form of chronic dermatitis characterized by the appearance of erythema, telangiectasias and pimples on the face
- Dandruff
- Eyelash mites or lice
- Side effects from drugs; isotretinoin (synthetic retinoid used in the treatment of severe cystic acne) can favor the proliferation of bacteria in the eyelid, altering the tear production mechanisms
- Allergic, irritative, or infectious conjunctivitis (inflammation of the conjunctiva that progresses to blepharitis)
Although it often appears typically with acute symptoms, blepharitis tends to become chronic. Given that the disease proves rather reluctant to heal, the symptoms can soon degenerate causing even serious complications, such as: sty, loss of eyelashes or alteration of ciliary growth, chalazion, dry eye/tear hypersecretion and, in some cases, inflammation of the cornea (keratitis) and/or of the conjunctiva (keratoconjunctivitis). In ulcerative-type blepharitis, crusts can form that tend to bleed after removal.
Chalazion
Painful cyst growing in the eyelid due to obstruction of the excretory duct of the meibomian gland. The chalazion is a rather common eyelid disorder, which comes from an inflammation of a meibomian gland, responsible for the production of the lipid component of the tear secretion, following the obstruction of its excretory duct.
The chalazion is easily recognizable: the obstruction manifests itself externally with the swelling of the eyelid in correspondence with the affected gland.
Each eyelash follicle in the eyelid margin has a gland of Zeiss, which produces sebum. In the same area, near the base of the eyelashes, there are some modified sweat glands called Moll's glands. Along the inner margin, at the emergence of the eyelashes, however, the meibomian glands (or tarsal glands) secrete a substance rich in lipids which prevents the eyelids from sealing against each other. This organization affects the eyelid margin with the exception of the medial portion (which represents about the internal eighth of the fissure), which presents the lacrimal punctuations, which coincide with the beginning of the lacrimal outflow ducts.
All accessory glands of the eyelids are subject to occasional bacterial contamination. From infections of a meibomian gland, a chalazion can be formed. The infectious process of a sebaceous gland of an eyelash or of one of the accessory lacrimal glands that open to the surface between the eyelid follicles, on the other hand, causes a localized painful swelling, known as a sty.
The chalazion is caused by inflammation of one or more meibomian glands, which are arranged crosswise in the lower and upper eyelids. Normally, these glands contribute, with their secretion, to produce the oily layer of the tear film.
If the orifices of the excretory ducts of the meibomian glands present on the eyelid margin are blocked, the lipid component produced cannot flow outwards and determines the characteristic nodular lesion (granuloma) in the point corresponding to the gland affected by the obstruction. In the surrounding soft tissues of the eyelid, redness, pain, discharge and inflammation of the conjunctiva may appear.
The obstruction may be due to the presence of "external" obstacles or to modification of the mebo itself.
Some people with problems associated with sebaceous secretion (e.g. seborrhea, oily skin) have a tendency to have a more dense mebo. Other times, an unbalanced diet or a period of intense stress is sufficient for an "altered" gland production compared to the norm.
Sometimes, the chalazion can be the result of chronic blepharitis. If this inflammation of the eyelid is neglected, the accumulation of small flaking skin fragments (similar to dandruff) can favor the obstruction of the excretory duct.
In other cases, the chalazion depends on the use of contact lenses. These intervene as external obstacles, as they can cause eyelid trauma, triggering an inflammatory process.
Finally, it seems that a constitutional predisposition, mostly on a hereditary basis, to present allergic diseases (allergic diathesis) may emphasize the disorder.
Eye surgery
In patients undergoing eye surgery, both in the pre- and post-operative phase, cleaning around the eyes is essential to prevent the establishment and spread of infections as well as to promote the wound healing. In these cases, cleaning must necessarily be done with disposable and sterile systems.
Both in preventive hygiene and following infections or surgery, the most used devices are sterile wipes, in gauze or TNT (non-woven fabric), soaked in various substances with moisturizing, anti-inflammatory, emollient and healing properties. In cases of inflammatory and infectious diseases of the ocular annexes, the wipes are usually heated, in order to perform hot compresses. In cases of swelling however, the wipes can be cooled in the refrigerator to make cold compresses.