i-Lid Cleanser: A New Treatment for Blepharitis

[AdminWolf]

In this video (given to us by ODwire.org Sponsor NovaBay), Dr. Kathryn Najafi-Tagol and Dr. Art Epstein talk about a new product for the treatment of Blepharitis and Meibomitis.

If you have any questions for the speakers (or the folks at NovaBay), please leave them in this thread.

Thanks!
Adam

 

[JeffBHarris]

In this video (given to us by ODwire.org Sponsor NovaBay), Dr. Kathryn Najafi-Tagol and Dr. Art Epstein talk about a new product for the treatment of Blepharitis and Meibomitis.

If you have any questions for the speakers (or the folks at NovaBay), please leave them in this thread.

Thanks!
Adam

Anybody have any experience w/ this yet? I'm looking for more tools for the chest for treating the ocular surface. A quick comment, I have liked the Systane Lid Wipes fairly well in comparison to the OcuSoft pads but this i-Lid Cleanser looks like it would be easy for compliance. I have not watched this video yet but have watched Christine Sindt's video and it looks like it has an excellent kill rate. The only other product I've seen w/ posted kill rates is the TheraTears foam product. I have mixed reviews from patients on it.

Jeff

 

[Lloyd Pate]

Its active ingredient is hypochlorous acid.

IUBMB Life. 2000 Oct-Nov;50(4-5):259-66.
Living with a killer: the effects of hypochlorous acid on mammalian cells.
Pullar JM1, Vissers MC, Winterbourn CC.
Author information

Abstract
The production of hypochlorous acid (HOCl) by the myeloperoxidase-H2O2-Cl- system of phagocytes plays a vital role in the ability of these cells to kill a wide range of pathogens. However, the generation of a potent oxidant is not without risk to the host, and there is evidence that HOCl contributes to the tissue injury associated with inflammation. In this review, we discuss the biological reactivity of HOCl, and detail what is known of how it interacts with mammalian cells. The outcome of exposure is dependent on the dose of oxidant, with higher doses causing necrosis, and apoptosis or growth arrest occurring with lower amounts. Glutathione (GSH) and protein thiols are easily oxidized, and are preferred targets with low, sublethal amounts of HOCl. Thiol enzymes vary in their sensitivity to HOCl, with glyceraldehyde-3-phosphate dehydrogenase being most susceptible. Indeed, loss of activity occurred before GSH oxidation. The products of these reactions and the ability of cells to regenerate oxidized thiols are discussed. Recent reports have indicated that HOCl can activate cell signaling pathways, and these studies may provide important information on the role of this oxidant in inflammation.

 

[Charles A McBride]

I've been having surprisingly strong results with tea tree oil shampoo. For patients with caked on debris at the follicle bases, I treat in-office with 50% tea tree oil/ 50% almond oil (no reason) wiping vigorously with cotton tipped applicators and then prescribe in-home use of tree tree oil rubbed onto lid margins and leave for 60 seconds before washing off. For mildish cases, just the home remedy. For severe cases, the in-office treatment quarterly and home treatment twice daily. -Charlie

 

[Lloyd Pate]

I've been having surprisingly strong results with tea tree oil shampoo. For patients with caked on debris at the follicle bases, I treat in-office with 50% tea tree oil/ 50% almond oil (no reason) wiping vigorously with cotton tipped applicators and then prescribe in-home use of tree tree oil rubbed onto lid margins and leave for 60 seconds before washing off. For mildish cases, just the home remedy. For severe cases, the in-office treatment quarterly and home treatment twice daily. -Charlie

Ask any of my students. That is what I use all the time. I just have them use tea tree oil shampoo at home. I save the oil for in office.

 

[Charles A McBride]

Ask any of my students. That is what I use all the time. I just have them use tea tree oil shampoo at home. I save the oil for in office.

Heck, I probably got the tip from you Lloyd. Much thanks. -Charlie

 

[DavidWells]

Decided to try in my office.. ordered two cases.

 

[Gretchyn Bailey]

This story just appeared in our October issue:
http://optometrytimes.modernmedicine.com/optometrytimes/news/rx-lid-cleanser-aids-blepharitis-mgd

 

[Mark Horwitz]

I've been having surprisingly strong results with tea tree oil shampoo. For patients with caked on debris at the follicle bases, I treat in-office with 50% tea tree oil/ 50% almond oil (no reason) wiping vigorously with cotton tipped applicators and then prescribe in-home use of tree tree oil rubbed onto lid margins and leave for 60 seconds before washing off. For mildish cases, just the home remedy. For severe cases, the in-office treatment quarterly and home treatment twice daily. -Charlie

where do you get the tree tea oil from that u use in your office? Where do your patients get it from?

After you apply the oil to their lids in the office, do you rinse the eye? Doesn't tree tee oil cause irritation of the eye if it gets in the eye? How do your patients avoid this from happenning and what do they do if they get it in their eyes?

 

[Allan Panzer]

I love the way the pictures in the article leave the NaFl on the lid, then clean it off and state how wonderful it looks.
I have been using Claridex..there is a shameless plug for a company I have nothing to do with.
I did Tea Tree scrubs when tea tree wasn't cool..
I have tried the Nova product, but it just hasn't been out long enough for me to call it a success.
Here is one of my clips from 2010.

 

[Allan Panzer]

When I post all of these self promoting videos, I am sure there are those of you out there wondering..
How does he get all those stories?

So, just to set the record straight...its really pretty easy.

Television stations need stories.

If...if...you have a story, they will cover it. You just have to ask.

I am nothing special. I just have the audacity to pick up the phone and pitch my story.

You are probably thinking that they took every story I pitched. Not a chance. They took the ones they wanted that fit into the time they wanted.
Just so you know...

 

[Jeff Kiener]

I thought we agreed that although TTO has antibacterial properties, the main use is as an antiparasitic.

Using any kind of solvent to clear off crud is probably effective, so probably that almond oil (or olive oil or white petrolatum) should be just as effective. Cleaning lashes in-office is a nice service, but it's not therapeutic, ultimately.

To my knowledge using intense TTO therapy in office is about reducing demodex load and that it takes multiple applications.

TTO shampoo is readily available (and I use it) but it's probably not applied for long enough to be antibacterial. But you gotta scrub with something, and possibly/maybe it can irritate demodex enough to keep them at bay.

 

[Charles A McBride]

where do you get the tree tea oil from that u use in your office? Where do your patients get it from?

After you apply the oil to their lids in the office, do you rinse the eye? Doesn't tree tee oil cause irritation of the eye if it gets in the eye? How do your patients avoid this from happenning and what do they do if they get it in their eyes?

I tell patients it is available at Whole Foods, New Seasons (local) and Sally's Beauty Supply. We have some in the office and they can take a picture of it on their phone and get it from the store or buy it from us. The 50% causes little to mild corneal inflammation and the eye is rinses post scrub, after the second lid. The shampoo concentration I have not been able to verify despite many attempts, but someone, here maybe, said the shampoo is 5%. They rub it on with their eyes closed and then rinse it off.

Jeff's definition of the term therapeutic must be different than mine. I'd classify getting the crap off there as therapeutic. I suppose the tea tree oil may not be doing a thing. Perhaps just scrubbing the stuff off along with a much more serious (than baby shampoo) recommendation to scrub at home makes is what is making a difference. I'm willing to consider that possibility, but my sense is that the tea tree oil/shampoo is making the difference.

I don't recommend this often. But when the build up is significant, this seems to work quite well. I have one patient who has this significant build-up but wasn't symptomatic to begin with. Tough to convince anybody without symptoms to do anything. -Charlie

 

[Lloyd Pate]

I thought we agreed that although TTO has antibacterial properties, the main use is as an antiparasitic.

Using any kind of solvent to clear off crud is probably effective, so probably that almond oil (or olive oil or white petrolatum) should be just as effective. Cleaning lashes in-office is a nice service, but it's not therapeutic, ultimately.

To my knowledge using intense TTO therapy in office is about reducing demodex load and that it takes multiple applications.

TTO shampoo is readily available (and I use it) but it's probably not applied for long enough to be antibacterial. But you gotta scrub with something, and possibly/maybe it can irritate demodex enough to keep them at bay.

I use it for the antibacterial properties too. There is a lot of literature on the antibacterial properties.

 

[Jeff Kiener]

I know we talked about it.

To clarify:
TTO tx in-office for demodicosis
TTO shampoo scrubs at home for maintenance therapy, or as a anti-bacterial lid scrub for staph bleph.

Do I have it right?

 

[Lloyd Pate]

I know we talked about it.

To clarify:
TTO tx in-office for demodicosis
TTO shampoo scrubs at home for maintenance therapy, or as a anti-bacterial lid scrub for staph bleph.

Do I have it right?

That is what I do.

 

[Troy Cassidy]

That is what I do.

Dr Pate, any thoughts on the Theratears Sterilid? Supposedly it contains a tea-tree oil ingredient. Like Dr Harris above, I've mostly had good results with it, but had the odd person report irritation. One thing I like about Sterilid is its ease of use. In my experience, unless patients are experiencing quite severe lid irritation, they tend to be rather lax in actually doing anything about their blepharitis. There's a lot to be said for the therapeutic value of convenience, if that makes sense.

 

[Lloyd Pate]

Dr Pate, any thoughts on the Theratears Sterilid? Supposedly it contains a tea-tree oil ingredient. Like Dr Harris above, I've mostly had good results with it, but had the odd person report irritation. One thing I like about Sterilid is its ease of use. In my experience, unless patients are experiencing quite severe lid irritation, they tend to be rather lax in actually doing anything about their blepharitis. There's a lot to be said for the therapeutic value of convenience, if that makes sense.

I completely agree with convenience and that the patients have to have problems in order to maintain motivation. I like Sterilid, but it is pricey for my patients. I mainly have a poor patient population.

 

[AdminWolf]

I tell patients it is available at Whole Foods, New Seasons (local) and Sally's Beauty Supply. We have some in the office and they can take a picture of it on their phone and get it from the store or buy it from us. The 50% causes little to mild corneal inflammation and the eye is rinses post scrub, after the second lid. The shampoo concentration I have not been able to verify despite many attempts, but someone, here maybe, said the shampoo is 5%. They rub it on with their eyes closed and then rinse it off.

Jeff's definition of the term therapeutic must be different than mine. I'd classify getting the crap off there as therapeutic. I suppose the tea tree oil may not be doing a thing. Perhaps just scrubbing the stuff off along with a much more serious (than baby shampoo) recommendation to scrub at home makes is what is making a difference. I'm willing to consider that possibility, but my sense is that the tea tree oil/shampoo is making the difference.

I don't recommend this often. But when the build up is significant, this seems to work quite well. I have one patient who has this significant build-up but wasn't symptomatic to begin with. Tough to convince anybody without symptoms to do anything. -Charlie

we just put up a short interview with Walter Whitley discussing TTO / Cliradex:
https://www.odwire.org/threads/39-blepharitis-tea-tree-oil-cliradex-with-dr-walter-whitley.84549/

He talks about their new in-office kit (Cliradex Complete) which works immediately to de-gunk the margins, then you follow-on with the wipes. The one-two punch as it were...

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[Gretchyn Bailey]

Here's a story we ran which is garnering a lot of traffic:
http://optometrytimes.modernmedicin...fferent-approach-treating-demodex-blepharitis

 

[Jeffrey C. Jessup]

Anybody have any experience w/ this yet? I'm looking for more tools for the chest for treating the ocular surface. A quick comment, I have liked the Systane Lid Wipes fairly well in comparison to the OcuSoft pads but this i-Lid Cleanser looks like it would be easy for compliance. I have not watched this video yet but have watched Christine Sindt's video and it looks like it has an excellent kill rate. The only other product I've seen w/ posted kill rates is the TheraTears foam product. I have mixed reviews from patients on it.

Jeff

I have used the iLid Cleanser product for a couple of months or so with good results. Even some stubborn cases with several other prior treatment approaches have responded nicely. I have also used the BlephEx system from RySurg with excellent results. My preferred regimen at this point is iLid Cleanser in conjunction with BlephEx with the frequency varying depending on response and severity.

 

[Dean S. Steinberger OD]

Are any of these procedures billable? TIA.

 

[Allan Panzer]

Absolutely..you say..that will cost $xyz.

Will that be "cash, check or credit card". Here is your receipt.
Have a nice day. I look forward to seeing you in the future.

Are those the only words we know..."is that billable?"

 

[Lloyd Pate]

Absolutely..you say..that will cost $xyz.

Will that be "cash, check or credit card". Here is your receipt.
Have a nice day. I look forward to seeing you in the future.

Are those the only words we know..."is that billable?"

Is your advice billable?

 

[James Harper]

I use it for the antibacterial properties too. There is a lot of literature on the antibacterial properties.

Perhaps an effective substitute for AzaSite (in the tx of blepharitis)?

 

[Lloyd Pate]

Perhaps an effective substitute for AzaSite (in the tx of blepharitis)?

I think it works as well if not better.

 

[Angel Adolfo Camblor]

I tell patients it is available at Whole Foods, New Seasons (local) and Sally's Beauty Supply. We have some in the office and they can take a picture of it on their phone and get it from the store or buy it from us. The 50% causes little to mild corneal inflammation and the eye is rinses post scrub, after the second lid. The shampoo concentration I have not been able to verify despite many attempts, but someone, here maybe, said the shampoo is 5%. They rub it on with their eyes closed and then rinse it off.

Jeff's definition of the term therapeutic must be different than mine. I'd classify getting the crap off there as therapeutic. I suppose the tea tree oil may not be doing a thing. Perhaps just scrubbing the stuff off along with a much more serious (than baby shampoo) recommendation to scrub at home makes is what is making a difference. I'm willing to consider that possibility, but my sense is that the tea tree oil/shampoo is making the difference.

I don't recommend this often. But when the build up is significant, this seems to work quite well. I have one patient who has this significant build-up but wasn't symptomatic to begin with. Tough to convince anybody without symptoms to do anything. -Charlie[/QUOTE]

If I think they need treatment, I like taking a photo of their condition and then blowing the pic way up so they can see for themselves. It's a strong motivator. I also point out that by age 70, close to 100% of individuals have demodex mites. High mag, stock pictures of mites are persuasive as well.

 

[Allan Panzer]

One point that has not been mentioned..
Although it seems lots has been said.

I-lid scrub is a prescription. They prefer we dispense it in office, but it costs about $40/box so I have been writing scripts for it.
My problem is getting them back to see if it is doing any good concerning demodex.

Just not sure...I also want to try the in office Cliradex, but $70 my cost kind of gets my attention.

Anyone used the ointment from Cliradex yet?

 

[David P Hauk]

One point that has not been mentioned..
Although it seems lots has been said.

I-lid scrub is a prescription. They prefer we dispense it in office, but it costs about $40/box so I have been writing scripts for it.
My problem is getting them back to see if it is doing any good concerning demodex.

Just not sure...I also want to try the in office Claridex, but $70 my cost kind of gets my attention.

Anyone used the ointment from Clilradex yet?

How exactly do you write the Rx? And is it stocked at local pharmacies or must they order it to fill the Rx?

 

[Allan Panzer]

I write...I-lid Scrub by NovaBay..
What they do next...not sure.

 

[James Harper]

One point that has not been mentioned..
Although it seems lots has been said.

I-lid scrub is a prescription. They prefer we dispense it in office, but it costs about $40/box so I have been writing scripts for it.
My problem is getting them back to see if it is doing any good concerning demodex.

Just not sure...I also want to try the in office Claridex, but $70 my cost kind of gets my attention.

Anyone used the ointment from Cliradex yet?

My understanding is that Cliradex is $24.00/box( of I think 30 pads), but you have to order a case of 20. 20% off first order.
The suggested retail sale price is $39.
I have not yet decided to pull the trigger.

 

[Frederick Frost]

My understanding is that Cliradex is $24.00/box( of I think 30 pads), but you have to order a case of 20. 20% off first order.
The suggested retail sale price is $39.
I have not yet decided to pull the trigger.

It is also available on Amazon for $39.99, prime eligible.

 

[AdminWolf]

If you haven't taken a listen, we have a radio show with one of your peers discussing tea tree oil & Cliradex -- and the difference between the in-office treatment ("Cliradex Complete") and the at-home pads.

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[James Harper]

From the website:

"Cliradex comes in a 3 x 2.5” x 3.75 carton containing 24 individually packaged towelettes. At present, Cliradex is sold in cases of 20 cartons only and can be purchased here online by eye care providers. The MSRP for Cliradex is $39.00."

 

[Kandi S. Moller]

Decided to try in my office.. ordered two cases.

How's it going?

 

[Richard Rebuck]

I've been having surprisingly strong results with tea tree oil shampoo. For patients with caked on debris at the follicle bases, I treat in-office with 50% tea tree oil/ 50% almond oil (no reason) wiping vigorously with cotton tipped applicators and then prescribe in-home use of tree tree oil rubbed onto lid margins and leave for 60 seconds before washing off. For mildish cases, just the home remedy. For severe cases, the in-office treatment quarterly and home treatment twice daily. -Charlie

I'm assuming you meant tea tree oil, right?

 

[Edmundo C.Fimbres]

I tell patients it is available at Whole Foods, New Seasons (local) and Sally's Beauty Supply. We have some in the office and they can take a picture of it on their phone and get it from the store or buy it from us. The 50% causes little to mild corneal inflammation and the eye is rinses post scrub, after the second lid. The shampoo concentration I have not been able to verify despite many attempts, but someone, here maybe, said the shampoo is 5%. They rub it on with their eyes closed and then rinse it off.

Jeff's definition of the term therapeutic must be different than mine. I'd classify getting the crap off there as therapeutic. I suppose the tea tree oil may not be doing a thing. Perhaps just scrubbing the stuff off along with a much more serious (than baby shampoo) recommendation to scrub at home makes is what is making a difference. I'm willing to consider that possibility, but my sense is that the tea tree oil/shampoo is making the difference.

I don't recommend this often. But when the build up is significant, this seems to work quite well. I have one patient who has this significant build-up but wasn't symptomatic to begin with. Tough to convince anybody without symptoms to do anything. -Charlie

Any brand recommendations? You say you use 50% concentration, cut with water? TTO different from TTO shampoo?

 

[AdminWolf]

Any brand recommendations? You say you use 50% concentration, cut with water? TTO different from TTO shampoo?

I would be remiss in doing my job running the joint if I didn't mention another sponsor, Cliradex -- they put the 4-terpinol onto wipes, so it is easy for patients to get their lids without getting the TTO into their eyes, which in my experience burns. See our radio show with walt whitley for more details.

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[Charles A McBride]

Any brand recommendations? You say you use 50% concentration, cut with water? TTO different from TTO shampoo?

TTO cut with another oil. I use almond oil for no reason in particular. For the shampoo I have used (on patients) a couple of different brands and they both seem to work. Lately it's Sally's generic brand. -Charlie

 

[AdminWolf]

Just got a press release from NovaBay, thought I would share:

I wanted to make sure you saw the news NovaBay release this morning regarding the rebranding of our i-Lid Cleanser as Avenova™.
This name change, effective immediately, helps NovaBay to differentiate prescription Avenova from other products marketed as eye cleaners, in particular generally ineffective over-the-counter (OTC) products not intended for continuous daily use.

Avenova is the only eye care product to contain Neutrox, NovaBay’s pure hypochlorous acid (HOCl), which is a naturally occurring substance produced by white blood cells to fight microbial invaders. Laboratory tests show it has potent antimicrobial activity in solution yet is non-toxic to mammalian cells; it also neutralizes bacterial toxins.

Thanks
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