Eyelid Hygiene
Eyelid Hygiene
Eyelid Hygiene
Journal of Ophthalmology
Volume 2016, Article ID 4292570, 7 pages
http://dx.doi.org/10.1155/2016/4292570
Clinical Study
Effects of a New Eyelid Shampoo on Lid Hygiene and
Eyelash Length in Patients with Meibomian Gland Dysfunction:
A Comparative Open Study
Copyright © 2016 Asuka Kobayashi et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Purpose. Meibomian gland dysfunction (MGD) can lead to abnormalities in the composition and function of tear film, resulting in
dry eye. Eyelid hygiene is a key to management of MGD. We tested a novel eyelid shampoo (Eye Shampoo Long, ESL) for its ability
to maintain lid hygiene. This shampoo is nonirritating and can potentially lengthen eyelashes. This study was aimed to evaluate
the efficacy of ESL in the treatment of MGD and its effects on eyelash length. Methods. Ten patients with MGD and 10 healthy
subjects without MGD applied ESL twice daily for 8 weeks. Patients were examined for lid margin and dry eye before and after the
trial. Subjective symptoms were evaluated. Eyelash length was measured at baseline and at the end of the trial. Results. In the MGD
group, significant improvements were observed in subjective symptoms obstruction of the meibomian orifice, secretion of meibum,
eyelashes contamination, eyelid margin foam, and SPK. Eyelash length became significantly longer. Conclusions. Maintaining eyelid
hygiene using ESL improved the eyelid margins and symptoms of dry eye in MGD patients and increased eyelash length. These
findings are promising and warrant confirmation in a larger randomized controlled study.
(a)
(b)
Figure 1: Lid hygiene technique. (a) ESL. (b) Lid cleansing using ESL. ESL: Eye Shampoo Long.
In this study, we investigated a novel eyelid shampoo Kjellmaniella gyrate extract, and amino acids (see Table 1 ))
formulated for lid hygiene regimens. This shampoo is nonir- [14–18]. The manufacturer confirmed product safety.
ritating and potentially lengthens the eyelashes. The purpose All participants used ESL twice a day for 8 weeks
of this study was to evaluate the effects of this newly according to the prescribed study washing regimen, which
developed eye-cleansing formulation on MGD and eyelash entailed pumping the shampoo onto one hand or a piece
length. of cotton and spreading it gently around the eyes. Next, the
study participants lightly massaged their eyelids to remove
2. Material and Methods impurities located at the eyelash roots and rinsed their eyes
with water (Figure 1(b)). During the study, subjects were
The study protocol was prospectively reviewed and approved asked to continue any eye drops that they were using at
by the Minamiaoyama Eye Clinic Internal Review Board and enrollment.
was conducted according to the tenets of the Declaration of
Helsinki. All subjects provided written informed consent to 2.3. Study Tests and Examinations. Examinations were per-
participate after receiving a detailed explanation of the study. formed in 10 patients with MGD-associated dry eye and in
10 healthy subjects to check for a possible effect on eyelash
2.1. Subjects. Ten patients (2 men, 8 women) with dry eye growth. The characteristics of the two groups are presented in
associated with MGD were enrolled into the study. The Table 2. All subjects completed a background survey (Table 3)
patients in the MGD-related dry eye group were diagnosed at the time of enrollment (baseline) and at the end of the 8-
according to the 2006 guidelines published by Shimazaki [12]. week treatment period.
To determine whether the trial shampoo (Eye Shampoo Long The examinations (Table 4) included tear breakup time,
[ESL], MediProduct Co., Ltd., Tokyo, Japan) had an effect on fluorescein staining score, and lipid layer thickness (LipiView,
eyelash growth, we included 10 healthy subjects (4 men, 6 TearScience, Inc., Morrisville, NC, USA). Eyelid margin
women) for measurement of eyelash length. findings (meibomian gland blockage, eyelash contamination,
eyelid margin foam, and decreased meibum secretion) were
2.2. Eyelid Hygiene Product. ESL is a nonirritating, eye- graded on a 5-point scale ranging from 0 to 4 (Table 5).
cleansing formulation (Figure 1(a)) with a pH of 7.4 and The change in meibum secretion was evaluated by extruding
an osmolality of 300 mOsm/L, which is similar to that of meibum from the lower eyelid using MGE-100 (TearScience,
normal tear film [13]. The product contains components that Inc.). The severity of superficial punctate keratopathy (SPK)
are anti-inflammatory (dipotassium glycyrrhizate, cholecal- was evaluated using a 4-point scale ranging from 0 to 3. The
ciferol [vitamin D3]) and moisturizing (blends of ceramide, corneal surface was divided into nasal, temporal, and central
Kjellmaniella gyrate extract) and promote hair growth regions, and SPK was graded in each area. The final SPK
(cholecalciferol [vitamin D3], Panax ginseng root extract, score was calculated as the sum of all regional scores. Visual
Journal of Ophthalmology 3
Table 1: Composition of Eye Shampoo Long. Table 2: Demographic characteristics of study participants.
Table 5: Grading scales for signs of meibomian gland dysfunction. Subjective symptoms
4 ∗ ∗ ∗ ∗ ∗
Symptom score
Eyelash contamination 3
0 Clear 2
1 Slight contamination 1
2 Mild 0
Sensation Bleary eyes Gritty Sore eyes Heat
3 Moderate of dryness feeling
4 Severe Pre 2.2 1.9 1.9 1.8 0.6
Post 1.8 1.1 1.2 0.7 0.2
Meibomian orifice obstruction
0 Clear liquid Figure 2: Subjective symptom scores for patients with meibomian
gland dysfunction.
1 Yellowish liquid
2 Opaque and toothpaste-like consistency
3 Thickened white material Meibomian gland blockage ∗
∗ p < .05
4 Not possible 6
score
1 3
2 25% to <50% 2
3 50% to <75% 1
4 75% or more 0
Lid margin foam Pre Post
3.4 2.45
0 Clear
1 At the canthus Figure 3: Meibomian gland blockage in a patient with meibomian
gland dysfunction.
2 Lower or upper
3 Lower and upper
4 Lower and upper or at the canthus Eyelash contamination ∗
∗ p < .05
2
Eyelash contamination score
3. Results
3.1. Subjective Symptoms. The patients with MGD showed a 1
significant improvement from baseline in subjective symp-
toms after 8 weeks using ESL. Sensation of dryness, bleary
eyes (foreign body sensation), grittiness (foreign body sen-
sation), sore eyes (burning sensation), and heat (burning 0
sensation) improved significantly (𝑝 < .05) during this time Pre Post
(Table 7, Figure 2). 0.7 0
0.6
3.3. Eyelash Growth. Eyelashes were significantly longer after 0.5
8 weeks of using ESL than they were at baseline in the patients 0.4
with MGD and in the healthy subjects (𝑝 < .05; Table 7, 0.3
Figure 7). 0.2
0.1
3.4. Ocular Surface and Tear Function. SPK significantly 0
Pre Post
improved in the MGD group (𝑝 < .05) during the 8-week
0.2 0
study period. However, no significant changes were observed
in tear breakup time or lipid layer thickness this time (Table 7, Figure 5: Eyelid margin foam in patients with meibomian gland
Figure 8). dysfunction.
Journal of Ophthalmology 5
Table 6: Results of ocular symptoms questionnaire before and after 8 weeks of the study intervention.
Table 7: Comparison of symptoms, meibomian gland function, eyelash length, and ocular surface according to treatment group (we listed
the items with 𝑝 < .05 only).
Baseline 8 weeks
Group/task 𝑝 versus baseline
(mean ± SD) (mean ± SD)
Subjective symptoms
Sensation of dryness 2.20 ± 0.63 1.80 ± 0.79 .046
Bleary eyes (foreign body sensation) 1.90 ± 0.74 1.10 ± 0.57 .011
Gritty feeling (foreign body
1.90 ± 1.10 1.20 ± 0.92 .020
sensation)
Sore eyes (burning sensation) 1.80 ± 0.63 0.70 ± 0.67 .009
Heat (burning sensation) 0.60 ± 0.70 0.20 ± 0.63 .046
Meibomian gland function
Eyelash contamination 0.70 ± 0.86 0.00 ± 0.00 .004
Meibomian gland blockage 3.40 ± 0.68 2.45 ± 0.69 .000
Eyelid margin foam 0.20 ± 0.41 0.00 ± 0.00 .046
Decreased meibum secretion 1.40 ± 0.82 0.80 ± 0.52 .038
Eyelash length
MGD patients and healthy subjects Length 8.13 ± 1.80 8.84 ± 1.86 .020
Ocular surface
Superficial punctate keratopathy 2.95 ± 2.25 1.75 ± 1.77 .002
MGD: meibomian gland dysfunction; SD: standard deviation.
∗
Decreased meibum secretion p < .05 Superficial punctate keratopathy ∗
3.0 ∗ ∗ p < .05
6
Decreased meibum score
5
2.0
SPK score
4
1.0 3
2
0.0 1
Pre Post Pre Post
1.4 0.8 2.9 1.8
Figure 6: Decreased meibum secretion in patients with meibomian Figure 8: Superficial punctate keratopathy in patients with meibo-
gland dysfunction. mian gland dysfunction.
Eyelash length ∗
∗ p < .05
12 expressed in the epithelium of the meibomian glands. Lastly,
lid massage may have promoted eyelash growth because
10 of the presence of Panax ginseng extract and Kjellmaniella
gyrate extract, both of which are known to stimulate hair
(mm)
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