Hypochlorous Acid: A Natural Antiseptic for the Eyelids

One of the newest products on the market to help in the treatment of some common eye conditions like blepharitis, styes, and some cases of conjunctivitis is a naturally occurring antiseptic called Hypochlorous acid (HOCl.)

At Doig Optometry in Calgary, we sell the I-Lid ‘N Lash HOCl cleansing spray that is safe and easy to use. You simply spray the product on your closed eyelids twice a day or as directed by your optometrist.

If you have concerns about blepharitis, dry eye symptoms, or would like more information about HOCl and whether it is right for you, you can call our optometrist clinic in SW Calgary to book an appointment with Dr. Doig or Dr. Chorel for an assessment and recommendations.

What is Hypochlorous acid?

HOCl was first identified in 1834 by Antoine Jérôme Balard and has been used for a long time in healthcare for wound care and disinfection. It is also used as an antiseptic in other industries like farming and restaurants. Even though it seems like putting an acid near our eyes should be damaging to the eyes and eyelid tissues, HOCl is actually produced in our bodies by our immune system to help fight infections.

Neutrophils are white blood cells, and they produce HOCl to destroy viruses, bacteria, fungi and spores that invade our bodies. HOCl neutralizes very quickly when exposed to air, so it is very mild on the eyes. In fact, there are several advantages to using HOCl over other commonly used disinfectants:

  • HOCl is easily produced for healthcare and commercial use by passing a mixture of water and salt through a special electrolytic chamber.
  • It is quickly effective against a large variety of microorganisms.
  • HOCl is not toxic to the eye like chlorhexidine gluconate or isopropyl alcohol, and it does not discolor the skin like povidone-iodine.
  • Bacteria are becoming more and more resistant to antibiotic treatment, but bacterial resistance to HOCl has not been an issue.

HOCI and eye health

As discussed in last month’s blog on blepharitis, normal skin, including our eyelid skin, has its own ecosystem of bacteria, viruses, and fungi that are harmless and sometimes even beneficial. However, the disease can result if these normal colonies of microorganisms overpopulate our skin or move to tissues where they are not usually present, such as into a wound, into our bloodstream, or into our eye because of an injury or surgery. Some common bacteria found on the healthy eyelids are:

  • Staphylococcus aureus
  • Coagulase-negative Staphylococcus species
  • Propionibacterium acnes
  • Coryneform bacteria

These same bacteria are also commonly found in blepharitis patients but in >14 times the concentration as on healthy eyelids. It is this overpopulation of the normal bacteria that contribute to the disease process of blepharitis by the production of exotoxins which result in inflammation, and by lipase activation which interferes with the important lipid layer of the tear film. Without an effective lipid layer on the surface of our tears, the tear layer evaporates very quickly, leaving our eyes feeling sore and dry.

How Hypochlorous acid works on the eyelids

HOCl 0.01% has been shown to decrease the bacterial load on the eyelids by >90% after one application. It is important that not all bacteria are killed as we require some beneficial bacteria to prevent more pathological bacteria from taking up residence on our eyelids.

HOCl has also been shown to be able to kill bacteria within a biofilm (a thin film composed of proteins, glycoproteins and carbohydrates that harbors microorganisms such as bacteria.) This is an advantage over antibiotics as antibiotics are often not effective against many bacterial species within a biofilm.

Additionally, HOCl maintains the bacterial diversity on our eyelids. What this means is that even though the numbers of bacteria are significantly reduced, of those remaining, the variety of bacterial species found on a healthy eyelid are still present.

How to use HOCI cleansing spray

HOCl needs to be used at least a couple of times a day as the bacteria on the skin around your eyelids will repopulate quickly on the eyelids. It is also important to use the HOCl spray in conjunction with a lid scrub product designed to be used around your eyes, such as I-Lid ‘N Lash cleansing pads. These pads gently remove the dead bacteria, the biofilm discussed earlier, and any other debris and make-up that has collected on the eyelids and at the base of the eyelashes.

With all the benefits of HOCl, it is an important addition to the products at our disposal to treat blepharitis and improve dry and red eye symptoms.

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