Doctor's Forum > a) Why Comprehensive Treatment Today? + b) Tear Gland Physiology
c) pH and Gland Dysfunction + d) Optimizing Periocular Skin + e) Lid Hygiene. A Summary
f) Why Igiene Cleanser & Conditioner?+ g) Igiene C2 vs Baby Shampoo + h) Directions and Compliance

Keys: Exponential pH scale, pH of skin is acid, building blocks of proteins are amino acids, amino acids are extremely sensitive to changes in pH changing form and function, the difference between regular skin and peri ocular skin

The Ph scale is exponentional. By way of illustration: if a lid scrub or shampoo claims to be “pH balanced” but has, in fact, a pH of 8.5 [while the skin’s protective mantle is 5.5] it should be understood that the surfactant is then 1000 times more alkaline (10x10x10).

Keratin and lipids + pH. The two most important chemical substances in the skin are keratins and lipids, which provide the permeable barrier of the skin. These lipids have many forms including phosholipids, glycolipids and cholestorol, the latter is an extremely important lipid in the cell membrane and the Corneum Stratum.

The ability of the skin to resist permeation is not related to the thickness of skin, but to the amount of lipids present in the skin. It is known that the eyelid is not only thinner (up to ten times), but the lipid content is much less than in other body areas. Thus, when the lipid content is assaulted by a high alkaline surfactant the skin becomes more permeable to microorganisms. This is also because moisture from inside the aqueous interior is allowed to escape, dysfunctioning the functional apparatus of the Corneum stratum. (See conditioning). One has to be careful recommending baby shampoo and other commercial cleansers, since often ‘the solution is part of the problem’ and in fact accelerates a worsening condition.

Amino Acids +pH. It should be remembered that proteins are the most plentiful compounds in the body, other than water. They are involved in nearly all body functions. The building blocks of proteins are amino acids. Amino acids are extremely sensitive to changes in pH, which cause them to change their net electrical charge, structure and function.

GLAND DYSFUNCTION

There are numerous causes for gland dysfunction; here we like you to focus on the causal relationship with the condition of the periocular dermis:

The skin is a porous shield of protection. A normal flora of common bacteria is always present on the skin and is important to the healthy individual. However, it is the over growth that can cause concern, similar to the overgrowth of bacteria in relation to daily dental health. ‘Skin’ is also measured in microns and can become quite porous to pathogens. Sweat gland ducts and cilia follicles serve as further entry portals for a number of bacteria, with Staphylococcus Aureus being the most common of localized folliculitis. While S. Aureus may cause deep-seated infections, it is the leading cause of soft tissue infection (e.g. Styes, chalazions, abscesses of the eyelid are associated with hair follicles and usually caused by S.Aureus). If ducts become blocked they may resemble staphylococcal abscesses or may become secondary infected.

In addition, bacteria produce toxins (Lipase) that not only inflame the lid glands, but cause a further direct dysfunction of the dynamic structure of the fragile tear film, leading to tear evaporation and a promotion of Dry Eye. (Lipase break down the cholesterol compounds within the Meibomian secretions. Freed fatty acids, directly toxic to the corneal epithelium resulting in a punctuate epithelipathy and inflammation. ).

Chances of staphylococcus. Staph exists in air, dust, environmental surfaces. Humans and animals are the primary reservoirs and common with more than half even of healthy individuals.

A word about Demodex: This microorganism thrives in the hair follicles. Chances for getting Demodex in the general population is also about 50% but near 100% with patients over 70. There can be as many as 25 per hair follicle. They each may lay 30 eggs. (there are 150 hair follicles in the upper eye lid alone). Demodex is mite with eyes, legs and moves over the skin (See above).

Using portals such as hair follicles to enter the skin, it is believed that Demodex especially favor the glands of Moll, most disturbing since these glands represent the tear film’s natural antibiotic.

Click here to continue.