spotlight on technology & technique
SteriLid: Designed Specifically as an Eyelid Cleanser
By Leslie Goldberg, Assistant Editor

Prior to the invention of EyeCL08 with linalool (SteriLid), ophthalmologists had only baby shampoo to recommend as a cleanser for eyelids.

"Lid care has been an orphan in ophthalmology, in that we've had to use items designed for other uses for lid hygiene. This has been like playing hockey with a golf club. With SteriLid you can now play hockey with a hockey stick," says Jeffrey P. Gilbard, M.D., founder, CEO and chief scientific officer at Advanced Vision Research, Woburn, Mass., creators of SteriLid.

Drawbacks of Current Lid Hygiene

Lid skin has oils that are antibacterial. "By using baby shampoo, which is an alkaline soap and designed to 'degrease' hair, you get rid of these skin oils, basically reducing the skin's natural defense against bacteria," says Dr. Gilbard. In addition, scrubbing the lid can also produce tiny abrasions in the skin that allow bacteria to sneak into the tissues.

The goal in developing SteriLid was that it be antibacterial, gentle to the skin and easy to use. It was created to kill bacteria on the lid margin, and is delivered as a convenient, ready-to-use foam. Linalool, the main ingredient in SteriLid, is a naturally occurring liquid distilled from plant oils used in many personal care products for its floral scent. It is found in many flowers and spice plants, as well as in tea tree oil.

"We found that linalool, as we have formulated it in SteriLid, is antibacterial, against both gram-positive and gram-negative bacteria,"says Dr. Gilbard.

"In kill-time studies SteriLid produced over a one log reduction in seven of eight eyelid organisms within 1 minute of exposure. It killed Staph and MRSA (methicillin-resistant Staphylococcus aureus) more rapidly than betadine."

Daily lid hygiene is important for blepharitis, dry eye, patients with punctal plugs and for patients preparing for eye surgery, in the days leading up to eye surgery, to reduce the risk of endophthalmitis. Dr. Gilbard cites studies showing that patients with anterior and posterior blepharitis have significant bacterial overgrowth on their lids. While systemic tetracyclines decrease lid colonization and improve symptoms, lid colonization increases and symptoms return after cessation of systemic tetracyclines. In addition, long-term tetracycline use has been known to double the risk of and mortality of women from breast cancer. Dry eye also increases bacterial colonization. These bacteria contribute to dry-eye irritation.

In a study conducted by Sarkis Soukiasian, M.D., and colleagues to detect eyelid bacteria with punctal plug use, 19 punctal plugs explanted for side effects were cultured and 100% were culture-positive. "This is like having a contact lens that you never disinfect," explains Dr. Gilbard. "Punctal plugs have a biofilm that is colonized by bacteria."

In addition, endophthlamitis organisms come from the eyelids, and the incidence of endophthalmitis has been increasing as much as threefold with clear corneal cataract incisions, according to a study conducted by Blake Cooper, M.D., and colleagues.

"In addition to its other uses, I think SteriLid promises to quickly become standard of care before all eye surgeries," said Dr. Gilbard.

When to Use SteriLid

► Prior to surgery. Lid hygiene b.i.d. beginning 3 days prior to surgery to decrease colonization that causes endophthalmitis

► For dry eye. Decreases colonization that inhibits goblet cell proliferation

► Blepharitis. Decreases colonization that promotes inflammation

► Punctal plugs. Decreases colonization and prevents super infection of plugs in situ

► In the operating room. For patients allergic to iodine.

SteriLid cleanses the eyelids and eyelashes, reducing bacterial colonization, while maintaining the antibacterial skin oils that help protect the skin from colonization, concludes Dr. Gilbard.

SteriLid will be available OTC, and by prescription as Cleeravue-M where it will be packaged in a kit with minocycline.

To learn more about SteriLid, go to www.theratears.com or call (800) 979-8327.