Scrub, lid

Although baby shampoo is frequently used for cleaning the eyeUd margin, commercially available eyelid cleansers are effective, with potentially less ocular stinging, burning, or toxicity. Commercial lid scrub products are designed to aid in removal of oils, debris, or desquamated skin from the inflamed eyelid. The lid scrubs can... 

Figure 3-11 Technique of lid scrub. Drug application to the lid margin is accomplished with a cotton-tipped applicator applied to the opened (A) or closed (B) eyelids.

Another factor to consider in developing a treatment plan is to determine which physical procedures might augment the drug therapy. Such procedures can be especially useful when appreciable quantities of purulent exudate or necrotic tissue are present and must be removed from the site of infection. As an example, the application of hot compresses and lid scrubs to improve circulation and to remove crusting deposits on the lids and lashes is especially useful in the treatment of lid infections with staphylococci. 

Lid hygiene consists of hot compresses, lasting 5 to 10 minutes and performed two to four times daily, followed by lid scrubs using a mild detergent cleanser such as baby shampoo and a washcloth or prepackaged commercially available lid scrubs (Box 23-2). Dilution of the shampoo is not necessary imless the patient has an unfavorable reaction to full strength. The hot compresses serve to loosen lid debris and dilate blood vessels to allow increased blood flow to the area. The scrubs not only facilitate removal of debris but also serve to lyse bacterial membranes and to reduce the bacterial load. Antibiotic ointment should then be applied directly to the lid margin two to foiu- times daily. Antibiotic drops are used when a secondary conjunctivitis is also present. 

The fan which must be designed in such a way that it can cope with the necessary aii volume and also the pressure difference in the scrubber, is located in the lid of the scrubber. The water distributor which must be able to operate without restriction from skin, hair and such particles in the scrubbing liquid, is located at the lower edge of the lid. 

With the eyes closed, gently scrub the lids and eyelashes, in a horizontal motion from left to right, for approximately 20 passes across each lid. 

Management. As with infectious blepharitis the first step in successful management is explaining the longterm nature of the condition and the importance of lid hygiene (refer to the treatment for staphylococcal blepharitis above).After improvement, the patient should continue daily warm water washcloth scrubs, preferably in the morning, to maintain control. 

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