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    Hypochlorous acid eyelid wash reduces bacterial load

    Application did not alter diversity of bacteria recovered but can reduce symptoms related to overgrowth


    Direct approach

    Hypochlorous acid is the bactericidal element used by macrophages and other components of the innate immune system to directly destroy invading microbes. Where traditional antibiotics use subtle mechanisms, such as interference with cell wall synthesis, DNA gyrase, topoisomerase 4 DNA replication or other pathways that can be circumvented, hypochlorous acid directly attacks and kills pathogens.

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    “No one product works for every patient, although this is almost universal for meibomian gland dysfunction, dry eye, and blepharitis,” Dr. Epstein said.

    “More importantly, hypochlorous acid is neutralized so quickly that it doesn’t kill all the bacteria,” he said. “It just helps reduce bacterial populations to more normal levels. You don’t want a population of pseudomonads moving in on the lid because all of the staphylococci have been killed off.”

    The next step in the clinical program is to examine changes in bacterial populations and diversity after a normal course of treatment.

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    The product is used twice daily for 10 to 14 days for acute treatment. However, most patients continue use indefinitely.

    Preliminary indications suggest changes similar to the 20-minute sample, Dr. Stroman said, but a controlled trial is needed.

    “It is easy to look at the in vitro data and say hypochlorous acid removes everything, but the reality is that it does not sterilize the skin,” Dr. Epstein said. “You can’t practically sterilize the skin in the clinical setting and you don’t want to. But you can reduce the bacterial load on the lid surface and that makes a phenomenal difference to your patients.”


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    Arthur B. Epstein, OD

    E: [email protected]

    This article was adapted from a presentation by lead author David Stroman, PhD, senior vice president of ophthalmology development for NovaBay Pharmaceuticals, at the 2016 meeting of the Association for Research in Vision and Ophthalmology.

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