What makes “enough,” ENOUGH and is there such a thing as “too much?” PART 2
What about Lid Hygiene - what’s “enough?”
I think of the lid a bit like a dentist looks at teeth. Scraping the lid margins (I usually use the cut end of a wooden cotton tip applicator, but various metal “scrapers” exist for this purpose) is a bit like removing tartar from teeth. Mechanical (like BlephEx) or vigorous scrubbing (like ZEST - I like a hybrid of BlephEx and ZEST) can remove the remaining “plaque” (what eye doctors call scurf). Some keratin (the tough stuff that also makes up fingernails and hair) along with waxy debris is commonly removed with the “scraping” and it is often possible to express oils a little better after just these lid hygiene maneuvers. Heated expression is generally needed to unclog deeper plugs and probing if there’s much scarring.
There appears to be at least 3 forms of obstruction: keratin, scarring and wax (& probably various combinations of all 3). As glands clog, they also wither (atrophy). Ideally, we will have answers for all of this, but the best is getting early care and addressing issues earlier. I find combination therapy (debridement or “scrapping” for superficial keratin and wax, heated expression for deeper wax, Maskin probing for scars, keratin and waxy residue. Currently we have IPL, “homework” and anti-inflammatories for rejuvenation (anti-withering). Homework is usually pretty straightforward in terms of adequate hydration, Omegas, strong, regular blinking, lid hygiene, and most often, warm moist compresses - but can include other treatments depending on clinical course and findings (& maintenance treatments as needed). How and where a new selenium-based (AZR 001) ointment will fit in the protocols we have is, in my limited knowledge of the information available, still yet to be determined. I’m all for adding arrows to my quiver of treatments, so will stay tuned to this one. See my posts on lid hygiene for a deeper dive.
For “super sensitive skin” there are times when even weak Hypochlorous Acid (Like Avenova) can irritate and Tea Tree Oil-based products are usually even more irritating. The Okra-based Zocugel and Zocuwipe cleaners tend to be less irritating but each patient is different and sometimes less is more. Finding the balance that keeps lids clean (and reduces the inflammation from germs that otherwise can signal inflammation to increase) is a job best left between you and your dry eye specialist. Oral medications (like Doxycycline or Azithromycin - available topically as well as orally) and treatments like IPL can also help to reduce the germ burden and reduce inflammation without directly irritating skin (see my posts on these options).