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: Effects on Metachromasia markings, TBUTBlepharitis and Rosacea patients

For years, due to a lack of viable commercial alternatives, Baby Shampoo (and its commercial claim of being ‘tearless’) was seen as the only and last resort for doctors to 'prescribe' to their patients. Becoming a ‘standard’ by default, we thought it important to highlight just three clinical studies showing that Baby Shampoo is not a proper ophthalmic alternative and that Igiene C2 is ‘significantly” superior to the benefit of your patients.

Benefits of Igiene C2 vs. Baby Shampoo on skin. Clinical Study on the effect on keratin proteins
Keys: Metachromasia, keratin proteins, the stratum Corneum, Acrine Orange

As seen above eye hygiene should be administered daily and as continuous as toothpaste for dental hygiene. Important is then the effects of products on the skin, especially given the dramatic increased fragility of the periocular skin

Metachromasia markings. A healthy stratum Corneum will display regular patterns of the markings of the metachromasia and the cellular detail between the markings or ridges. (These ‘ridges’ also fulfill the critical function of scattering damaging omni present UV light). Denatured proteins would suggest a damaged stratum Corneum that would be more permeable. The rate of transepidermal water loss is directly related to the degree of damage in the stratum Corneum. Surfactants are well known to be responsible for much of this damage.

A study to determine the effects on keratin proteins was based on the principle of denaturation of protein by surfactant systems. It is well known that surfactants adversely affect protein structure and can remove lips from the stratum Corneum.

Some notes on Acridine Orange: The method used in this study is based on the Acridine Orange (AO) staining of the stratum Corneum. AO is a fluorescent stain used to detect biopolymers. It is a very sensitive technique that provides a means for qualitative and quantitative comparison and correlation between data obtained from solutions and from data obtained from cells. When AO is in a concentration in excess of 2 x10 –6 M the dye molecules will interact with each other and produce metachromasia. The monomer of the dye emits a green fluorescence with a peak at 540 nm. The dimmer and higher polymers emit a red fluorescence with a peak at 660 nm. The color emitted depends on the nature of the biopolymer and the dye-to polymer ratio. Studies have shown that glycosoaminoglycans emit red fluorescence with AO, except hyaluronic acid which emits green gluorescense. Nucleic acids emit green and at time red fluorescence

IGIENE C2 versus Baby Shampoo: Results and conclusion: While the control (water) showed regular pattern of markings the metachromasia and the cellular detail between the markings or ridge, Baby shampoo treated skin showed marked deterioration of the marking with unraveled appearance of the keratin. Cellular detail is distorted and obscured in most areas. IGIENE showed only mild to moderate changes in the surface pattern and is therefore less damaging to the skin than regular baby shampoo.

Benefits of Igiene C2 vs. Baby Shampoo ; The effect on Tear Break Up Time in Chronic Blepharitis.

Objective: To determine whether daily lid hygiene with a proprietary lid cleanser (Igiene Daily Eyelid Cleanser) has a significant effect on the tear breakup time (T.B.U.T.) in patients with posterior Blepharitis /Meibomianitis.

Methods: Various sub-groups of patients with chronic (> 6 months) Blepharitis were identified and placed on a regimen of Igiene® Daily Eyelid Cleanser on one eye, and hypoallergenic baby shampoo on the other. Cleansing solutions were randomized between right and left eyes, placed in non-marked plastic dispenser bottles labeled Right and Left, and neither patient nor examiner was informed which solution was which. Patients were instructed to perform lid cleansing twice per day, once in the AM, and again in the PM prior to retiring for the night. Patient symptoms, slit-lamp findings, and Tear Breakup Time (T.B.U.T.), were determined at 30, 45, and 60 days.

Results: At the end of 60 days, a significant difference between patients presenting with Meibomian gland dysfunction (MGD) was observed with regards to the tear breakup time in the eyes using the Igiene product versus baby shampoo. Patients with MGD and a frothy/foamy tear film (N=22) showed an overall increase in T.B.U.T. of +4.03 seconds versus a decrease of –0.57 seconds for the baby shampoo cohort of eyes. Patients with MGD and non-frothy/foamy tear film (N=15) exhibited an increase in T.B.U.T of +2.83 seconds in the Igiene lid cleanser eye versus only a slight increase of +0.39 seconds for the eyes treated with baby shampoo.

Conclusions: Igiene® Daily Lid Cleanser, a non-soap, proprietary lid hygiene product significantly improved the quality of the tear film in patients with posterior Blepharitis /Meibomian gland dysfunction as measured by the tear breakup time (T.B.U.T.) when compared to generic hypoallergenic baby shampoo in a masked trial of both cleansers.

Benefits of Igiene C2 vs. Baby Shampoo; The effect on Tear Break Up Time in Chronic Blepharitis. Rosacea-associated Meibomian Gland Dysfunction

Objective: To determine whether daily lid hygiene with a proprietary lid cleanser (Igiene Daily Eyelid Cleanser) has a significant effect on the tear breakup time (T.B.U.T.) in patients with Meibomian gland dysfunction (MGD) secondary to ocular Rosacea.

Methods: Two sub-groups of patients with ocular Rosacea (a total of 35 patients) were identified and placed on a regimen of Igiene® Daily Eyelid Cleanser on one eye, and hypoallergenic baby shampoo on the other. Both groups were also given doxycycline 100 mg po bid for 60 days. Group I had foam/froth present at the Meibomian orifices, and/or foamy/frothy tears. Group II did not exhibit foaming or frothing at the gland orifices or in the tear film. Cleansing solutions were randomized between right and left eyes, placed in non-marked plastic dispenser bottles labeled Right and Left, and neither patient nor examiner was informed which solution was which. Lid cleansing was performed bid, AM & PM according to instructions given. Patient symptoms, slit-lamp findings, and Tear Breakup Time, were determined at 30, 45, and 60 days.

Results: At the end of 60 days, a significant difference between the Igiene product and the baby shampoo was noted in both groups In patients presenting with foamy/frothy tears (N=19) an increase in T.B.U.T. in the Igiene cleanser eye of +3.49 seconds versus a smaller increase of + 1.53 seconds for the eyes treated with baby shampoo was noted. In the non-foamy/frothy tear film group (N=16), the Igiene product was determined to increase the T.B.U.T. by +3.03 seconds compared to +2.17 seconds for baby shampoo.

Conclusions: Igiene® Daily Lid Cleanser, a non-soap, proprietary lid hygiene product, significantly improved the quality of the tear film in patients with ocular Rosacea and Meibomian gland dysfunction as indicated by an increase from baseline of the tear breakup time (T.B.U.T.) when compared to generic hypoallergenic baby shampoo in a masked trial of both cleansers.

To learn what other eye care providers say about Igiene C2 click here.