A new hypochlorous acid lid cleanser provides a safe and effective alternative for cleansing the eyelids and surrounding skin. Two doctors found the cleanser to be very helpful in managing blepharitis. It reduced the need for antibiotic and steroid drops, and patients reported good results and found it refreshing to use. The cleanser uses hypochlorous acid, a natural antimicrobial produced by white blood cells. Laboratory tests showed it effectively kills pathogens including MRSA without toxicity to tissues. Both doctors recommend the cleanser for regular daily use to control blepharitis.

1. A
novel eye-care product contain-
ing a stabilized form of pure
hypochlorous acid (0.01%) in
saline(Advancedi-LidCleanser,
NovaBay) offers a safe and ef-
fective alternative for cleansing
the lids, lashes, and periocular
skin of debris and microorganisms, which can
cause irritation, inflammation, and ocular sur-
face disease.
Hypochlorous acid is a bactericidal compo-
nent of the innate immune system. Incorpora-
tion into a commercial product required engi-
neering a formulation that would maintain the
stability of the acid and avoid other impurities.
Results from laboratory studies evaluating
the stabilized hypochlorous acid show it has
fast-acting, broad-spectrum activity against
microorganisms found in the external ocular
flora, including methicillin-resistant Staphylo-
coccus aureus, plus the ability to disrupt biofilm
that harbors bacteria. Laboratory testing has
also established that the product is non-toxic
to human tissues and non-irritating.
M e r i t s o f h y p o c h l o r o u s
a c i d c l e a n s e r
KathrynNajafi-Tagol,MD,founder,EyeInstitute
of Marin, San Rafael, CA, has been involved
in research evaluating the properties of hy-
pochlorous acid. In clinical practice, she has
found that when used in the management of
blepharitis, the lid cleanser is associated with
excellent results and high pa-
tient acceptance.
“Blepharitis is a common
problem seen by eye-care
practitioners. It can have cos-
metic, structural, and func-
tionalsequelae,andtheavail-
ability of different options for
use by affected patients is
desirable,” Dr. Najafi-Tagol said. “Based on its
unique characteristics, the hypochlorous acid
cleanser is a welcome addition to our toolbox.
“In my experience, it is extremely helpful,
and I appreciate that unlike topical antibiotics
and steroids, it can be used safely on a regu-
lar, ongoing basis,” she said. “Furthermore,
the hypochlorous acid cleanser is a simple and
elegant formulation with reduced potential to
cause skin irritation compared with other com-
mercial lid cleansers containing buffering in-
gredients, surfactants, and preservatives. My
patients have been very pleased with the prod-
uct, enjoying not only its efficacy as a cleanser
but also what many describe as a refreshing
feeling.”
M a n a g i n g b l e p h a r i t i s
Steven J. Lichtenstein, MD, associate profes-
sor of clinical surgery and pediatrics, Univer-
sity of Illinois College of Medicine at Peoria
and Chicago, and medical director of pediat-
ric ophthalmology, Children's Hospital of Illi-
nois, Peoria, said he first began recommend-
ing the hypochlorous acid
cleanser for use by patients
with blepharitis at the begin-
ning of 2014, and the results
achievedhavebeenexcellent.
Dr. Lichtenstein noted that
his standard treatment for
children with chronic bleph-
aritis has been dilute baby
shampoo lid scrubs combined with a topical
antibiotic and a steroid as needed to control
significant inflammation.
With this regimen, however, he was always
concerned about the development of bacterial
resistance and steroid-related complications,
especially considering the likelihood that par-
ents might be initiating repeat treatment on
Hypochlorous acid lid cleanser
provides novel advantages
New product associated with excellent results, high patient acceptance in management of blepharitis
By Cheryl Guttman Krader; Reviewed by Steven J. Lichtenstein, MD, and Kathryn Najafi-Tagol, MD
A new hypochlorous acid lid
cleanser is a safe and effective
option for cleaning the lids, lashes,
and periocular skin of debris and
microorganisms.
Take-Home
Dr.Najafi-Tagol
Dr.Lichtenstein
This patient with blepharitis experienced improvement to the eyelid with use of the lid cleanser. She used
it twice a day for 10 days without the need for prescription. (Images courtesy of Kathryn Najafi-Tagol, MD)
VIDEO Watch Kathryn Najafi-Tagol, MD,
and patients discuss the lid cleanser and the
difference it makes. Go to http://bit.ly/1hhtwri.
(Video courtesy of NovaBay)
lid cleanser introduction
Before After
29June 1, 2014 :: Ophthalmology Times
technologytechnology
Continues on page 30 : Lid cleanser

2. lid cleanser
( Continued from page 29 )
their own using medication leftover from a
previous prescription.
“The hypochlorous acid cleanser is not any
harder or any easier to use than the dilute
baby shampoo, but it seems to provide bet-
ter results while eliminating or reducing the
need for antibiotics and steroids along with
their associated costs and concerns,” he said.
The cleanser is packaged in a spray top bot-
tle and should be dispensed onto a cotton pad
or cotton-tipped applicator that is then used
to scrub along the lashes, lids, and as needed,
the periocular skin.
Dr. Najafi-Tagol noted that she only suggests
a cotton-tipped applicator when she is confi-
dent the patient will be able to use it safely
and confirms her impression by asking pa-
tients to demonstrate their technique before
they leave the office.
Both Dr. Najafi-Tagol and Dr. Lichtenstein
said they have used the lid cleanser for the
management of patients with both anterior
and posterior blepharitis.
In patients with meibomian gland dysfunc-
tion (MGD), the lid cleanser is combined with
other lid hygiene methods, such as warm com-
presses directed at relieving gland obstruction,
Dr. Najafi-Tagol said.
“Using the lid cleanser to reduce the bacterial
burden on the eyelids is useful in patients with
MGD because the organisms produce exotoxins
and lipases that can lead to the development
of evaporative dry eye disease through their
inflammatory properties and effects on the
meibomian gland secretions,” she explained.
Dr. Lichtenstein said he recommends twice-
daily use of the lid cleanser, in the morning
and at bedtime. So far, it has been consistently
effective, with resolution occurring in some
patients within 2 weeks.
“I have not yet seen any child whose bleph-
aritis has recurred after the successful use of
this regimen incorporating the lid cleanser,”
he said. “However, because of the safety of
this product, I am comfortable telling parents
that they can re-initiate its use if they notice
returning signs of redness or debris.” ■
Steven J. Lichtenstein, MD
e: eyedoc44@aol.com
Dr.Lichtenstein has no relevant financial interest to disclose.
Kathryn Najafi-Tagol, MD
e: kn@najafimd.com
Dr.Najafi-Tagol is also a member of NovaBay’s OphthalmicAdvisory Board and
serves as medical monitor for NovaBay’s conjunctivitis clinical trials.
LCS reduces use of ultrasound energy
By Cheryl Guttman Krader
bochum, germany ::
analyses of data from a large, pro-
spective, comparative case series show that
laser cataract surgery (LCS) significantly re-
duces use of ultrasound energy. Furthermore,
outcomes from the most recent group of LCS
cases shows that after laser lens fragmentation,
cataract removal can be achieved in almost
all eyes using aspiration only, said Burkhard
Dick, MD, PhD.
“After optimization of laser settings, instru-
ments, and techniques, I am now close to reach-
ing my final goal of eliminating ultrasound in
cataract surgery,” he said.
Dr. Dick is professor and chairman, Depart-
ment of Ophthalmology, Ruhr-University of
Bochum, Bochum, Germany.
Effective phaco time (EPT) was analyzed as
a measure of ultrasound energy utilized dur-
ing LCS using data from a prospective, con-
secutive cohort of 2,400 eyes.
All eyes included in the analyses had a Lens
Opacities Classification System (LOCS) III Nu-
clear Opalescence score of 1 to 4, as graded
preoperatively by an independent European Vi-
sion Clinical Research Institute-certified phy-
sician, and pupil size >6 mm.
All procedures were done using the same
femtosecond laser (Catalys Precision Laser Sys-
tem, Abbott Medical Optics) and phacoemul-
sification platform (Stellaris Vision Enhance-
ment System, Bausch + Lomb).
Dr. Dick first analyzed the outcomes for his
initial 650 LCS cases and compared them with
results from a group of 650 eyes in which he
performed standard cataract surgery. Mean
EPT for eyes with LOCS III grade 2, 3, and 4
cataracts operated on with standard phaco-
emulsification was 1.52, 2.48, and 3.38 seconds,
respectively, but only 0.01, 0.06, and 0.23 sec-
onds, respectively, for the LCS group.
The difference between the LCS eyes and
the standard phaco groups was statistically sig-
nificant for all cataract grades. Overall, about
70% of LCS cases were performed with no ul-
trasound energy.
Subsequent to these cases, Dr. Dick intro-
duced several optimizations into his proce-
dure.The most prominent modification related
to phaco tip design, but another change in-
volved extension of the area of lens fragmen-
tation. These modifications enhanced the ef-
ficiency of LCS as shown in analyses compar-
ing EPT outcomes for consecutive groups of
1,000 eyes each undergoing the laser-assisted
or standard surgery.
For eyes with grade 2, 3, and 4 cataract,
LCS reduced EPT by 100%, 97%, and 98%,
respectively, and allowed 95% of all cases to
be performed without ultrasound.
Dr. Dick noted that in his last 400 cases—
which were done with a slight further change
in tip design—ultrasound energy was needed
to remove the cataract in only 3 eyes, all with
a LOCS III grade 4 cataract.
To address possible criticism that LCS in-
creasesfluidturnoverandsurgicaltime,Dr.Dick
analyzed data on BSS use and procedure time,
beginning from suction on in the LCS cases.
He found no differences comparing LCS and
standard surgery groups.
“Total surgical time for the LCS cases av-
eraged 6.5 minutes, of which about 2 to 2.5
minutes was for the laser portion of the pro-
cedure,” he said.
“After use of the laser, the rest of the pro-
cedure takes less time than when performed
manually,” he concluded. ■
30 June 1, 2014 :: Ophthalmology Times
technology