Download Lid hygiene provides patient relief

6/7/2016
Ophthalmic Professional-Therapy Focus
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Article Date: 5/1/2015
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Therapy Focus
Lid hygiene provides patient
relief
How a lid scrub system helped a challenging
case of ocular surface and lid margin
disease.
B Y S T E V E N I . R O S E N F E L D , M D , FA C S
A recent 68­year­old patient with recalcitrant ocular surface and lid
margin disease reinforced the importance of managing a patient’s lid
hygiene.
Despite seeing about eight other ophthalmologists prior to his visit, the
patient said he failed to gain relief. A treatment regimen that included a
prescription lid hygiene product (NovaBay’s Avenova with Neutrox —
previously known as i­Lid Cleanser) ultimately proved effective.
Product overview
Avenova is indicated to cleanse and remove foreign material, including
microorganisms and skin debris.1 Avenova can also serve as part of the
lid and lash hygiene regimen starting one week prior to intraocular
surgery. Also, Avenova is non­toxic, non­sensitizing, and non­irritating
to the skin and eyes.1 Thus, no special handling of the product is
required.
The product is indicated for twice­daily and as­needed use due to its
non­irritating formulation. Avenova contains Neutrox, 0.01% pure
hypochlorous acid (HOCl) in a normal saline solution. HOCl is an
endogenous compound produced in the human body as an element of
the immune response.2 During a process termed the “oxidative burst,”
small highly reactive molecules generate as white blood cells encounter
invading pathogens in the body.3 In the innate immune system,
neutrophils are the major producers of HOCl.
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Finding a solution
The patient who referred to my office had a two­year history of dry eye
disease (DED) and blepharitis that he believed started immediately after
bilateral cataract surgery. He described constant and chronic symptoms
of dry eyes, redness, tearing, intermittent foreign body sensation, and
sharp shooting pains, worse in his left eye than the right, although
these pains did not awake him. Also, he noted aberrant eyelashes that
he self­epilated with a tweezer and a 15X magnifying mirror at home.
He specifically stated that all previous attempts with eye scrubs actually
made his eyes feel worse and his vision blurry.
He received multiple diagnoses of DED, blepharitis, corneal edema, and
trichiasis and had been treated with an armamentarium of drops,
ointments, tears, warm compresses, baby shampoo lid scrubs, lid
scrubs, and occlusive sunglasses. Unfortunately, no medications or
treatment regimens worked.
His past medical history included diet­controlled diabetes mellitus,
Crohn’s disease (in remission), sleep apnea, thyroidectomy for thyroid
cancer, prostatectomy with radiation therapy for prostate cancer, and a
spinal fusion operation. An allergist told him he had an allergy to dust
mites. His current list of systemic medications included bupropion
(Wellbutrin, Valeant), eszopiclone (Lunesta, Sunovion), gabapentin
(Neurontin, Pfizer), testosterone, thyroxine, baclofen, armodafinil
(Nuvigil, Cephalon), and fish oil.
When I first examined this patient he used cyclosporine 0.05% drops in
both eyes twice a day, prednisolone acetate 1% drops orally once a
day, and tea tree oil in both eyes twice a day. His exam was significant
for facial stigmata of rosacea, bilateral upper and lower lid trichiasis,
bilateral upper lid lash ptosis, moderate seborrheic blepharitis and
meibomian gland inspissation, clear corneas without punctate keratitis
or edema, deep and quiet anterior chambers, well­placed posterior­
chamber intraocular lenses in both eyes, and a normal fundus exam
without diabetic retinopathy.
Our primary goal
In addition to seeing the patient on a regular basis for epilation of his
recurrent trichiatic eyelashes and having him continue his medications
as outlined above, I added doxycycline 50 mg once a day and Avenova
with Neutrox once a day.
As a non­antibiotic topical antimicrobial agent, Avenova addresses
concerns with growing bacterial resistance to existing antibiotics.4 Also,
it is formulated without soaps, detergents, or surfactants. In vitro
studies have shown that Avenova with Neutrox provides rapid
eradication (≥99.99% killing within 60 seconds) of 20 species of
pathogens including aerobic and anaerobic Gram­positive bacteria, such
as Staphylococcus aureus (MRSA).1 This rapid killing of microorganisms
helps prevent harmful biofilms from forming.5 In addition, Neutrox in
vitro inactivates bacterial toxins that can cause inflammation.
After two weeks, the patient felt much better and progressed with each
subsequent visit. When last examined two months after starting
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Avenova treatment, he was very pleased with the comfort of the lid
scrub system, and the treatment effectively controlled the patient’s lid
margin disease. Interestingly, his slit lamp exam still demonstrated mild
residual seborrheic blepharitis and meibomian gland frothing, but no
conjunctival injection or corneal staining. Avenova has helped me to
make this patient comfortable, which is our primary goal when treating
many diseases and particularly with this challenging patient.
Conclusion
Due to Neutrox’s unique characteristics and beneficial tolerability profile,
I would recommend Avenova for any lid hygiene regimen, including dry
eye, blepharitis, ocular surgery and contact lens wear. OP
REFERENCES:
1. Avenova with Neutrox [Package Insert]. Emeryville, CA. NovaBay
Pharmaceuticals, Inc.; 2014.
2. Hurst JK. What really happens in the neutrophil phagosome? Free Radic
Biol Med 2012;53:508­520.
3. Gray MJ, Wholey WY, Jakob U. Bacterial responses to reactive chlorine
species. Annu Rev Microbiol. 2013;67:141­160.
4. Debabov D. Antibiotic resistance: origins, mechanisms, approaches to
counter. Appl Biochem Microbiol. 2013;49:1­7.
5. Crew J, Varilla R, Rocas TA, et al. NeutroPhase in chronic non­healing
wounds. Int J Burns Trauma. 2012;2:126­134.
Dr. Rosenfeld is a fellowship trained Cornea and
External Disease specialist practicing with the Delray Eye
Associates, PA, and is a voluntary professor at the
Bascom Palmer Eye Institute in Miami, FL, and the
University of Miami School of Medicine.
Ophthalmic Professional, Volume: 4 , Issue: May 2015, page(s): 38­40
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