No More Baby Shampoo.

Posted by Rebecca Petris on

Baby shampoo for blepharitis? No.

It's not that it doesn't do good things.

It's that (1) it doesn't do them as well as the alternatives, and (2) there is considerable evidence that it does quite bad things at the same time.

Diluted baby shampoo was the conventional wisdom for blepharitis for a long time, and with reason. It really does clean the lids pretty well, and in the absence of something better, it's not a bad choice.

But... this is 2018. Tear film and ocular surface science moved on a long, long, long, LONG time ago. So did industry. 

Many optometrists and ophthalmologists have not yet caught up with where science is at, however.

I remember when Jeff Gilbard first formulated Sterilid. If memory serves, it was the first lid scrub product with tea tree oil. He was advertising it in some of the medical magazines. He had quite an effective ad, showing baby shampoo as great for hair washing and Sterilid as great for eyelid hygiene. 

Shampoo is detergent.

Do you really want it in your eyes, no matter how dilute?

There might be a decent argument for it if it only ever got on your eyelids. But you simply can't wash your eyelids with something without it getting into your eyes. Once in your eyes, baby shampoo, like all 'detergents', is going to be damaging in some way to the tear film. One of several findings in recent studies is that it may be damaging to the goblet cells in the cornea - which are responsible for producing the crucial mucin layer of the tear film that keeps moisture firmly anchored to the eye surfaces.

What TFOS DEWS II says about baby shampoo

TFOS DEWS II is the dry eye bible. It was nearly a three-year project of 150 top experts from around the world, published as a series of reports in 2017.

Here's what it says about baby shampoo in section 3.1.1 of the Management and Therapy subreport:

Appropriate lid hygiene is important in the management of a variety of lid conditions that result in dry eye (particularly blepharitis) and, if used appropriately, can reduce lipid by-products and lipolytic bacteria associated with these conditions [379–385]. Lid scrubs using a mild dilution of baby shampoo applied with a swab or cotton bud have been the most widely accepted therapy [382,386,387]. A recent Level 1 study demonstrated the efficacy of lid scrubs for removal of crusting in anterior blepharitis, with both a commercial lid cleanser and dilute baby shampoo [388]. However, relative to the baby shampoo, the dedicated lid cleanser showed reduced ocular surface MMP-9 levels, improved lipid layer quality and was better tolerated. Baby shampoo was further reported to be associated with a reduction in ocular surface MUC5AC levels, suggesting that baby shampoo may have an adverse effect on goblet cell function [388]. In preference to using baby shampoo, there are now a wide variety of proprietary lid cleansing products available, which utilise a diversity of delivery mechanisms, including scrubs, foams, solutions, and wipes; their individual description is outside the scope of this review.

That's from a report based on all of the major research done up through 2016.

But there has been more since then, for example, this study published in 2018 in The Ocular Surface which indicates that baby shampoo really just isn't as good, either, but also can cause damage:

...Improvements in the tear lipid layer, inferior lid wiper epitheliopathy (LWE), cylindrical collarettes, and MMP-9 expression were limited to the dedicated eyelid cleanser....

...Meibomian gland capping and MUC5AC expression worsened with baby shampoo treatment...

CONCLUSIONS: Clinical improvements in blepharitis occurred with both treatments. However, only the dedicated eyelid cleanser proved effective in reducing ocular surface inflammation, and was the preferred therapy. Long term impact of decreased goblet cell function secondary to baby shampoo treatment requires further exploration.

Take care of your lids properly.

This is not a sales pitch. You do not need to buy something at the Dry Eye Shop. There's plenty of lid scrub products available in your drugstore. (Though of course we always appreciate your support.)

But please, if you have blepharitis or your eye doctor has asked you to do lid hygiene, do yourself a favor and use a product designed for the purpose. What works on your hair and scalp is NOT the best and safest thing for your eyes. 

 


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7 comments

  • Is there an eyelid scrub WITHOUT oil? I have blepharitis and wear sclerals. The last thing I want to do is limit my vision even further with oil on my lenses. Hoping to find something for good eyelid hygiene without the risk of oil on my contacts.

    Jean Buhite on
  • This blog is very informative for taking care of eyes. Thanks for sharing this blog.

    Brandon Chick on
  • Nice Blog. Your post will very helpful for all those people who really want to know about baby shampoo. Thanks for sharing with us. Keep up the great work

    Pearl Vegas on
  • I agree that baby shampoo is useless for scrubbing the eyelids when you have blepharitis. However, the lid wipes in the stores, like Steralid, etc. are not much better. And the ingredients like tea tree oil, just burn my eyelids and make the redness and swelling worse! I wish someone would please invent a cleanser for this purpose that is really gentle on the eye area, but will stop the blepharitis. I have suffered with this off and on for the past 20 years.

    Kathleen Poetzsch on
  • I have Sjogrens and have been using Sterilid for daily eye cleansing years and find it to be most effective. Baby shampoo is harsh on both your hair and your eyes. Not sure why drs would even recommend it. I’m assuming they’ve never used it themselves.

    Patty witte on

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