Factsheets Eye Lid Hygiene

Introduction

This factsheet will identify some of the problems people may have with eyelid and eyelash hygiene and some of the difficulties that can result from poor hygiene.  It will offer some practical help to keep eyes clean.

• Eyelids and eyelashes protect our eyes which can easily be damaged.  It is important that eyelids and eyelashes are kept clean and healthy so people see clearly and avoid pain or discomfort.
• The front on the eye (the sclera, cornea and conjunctiva) needs to be moist, smooth and clear at all times.  Tears, which cover the cornea, remove dust and dirt particles from eyes.  They also offer some protection against tiny invisible organisms which could cause damage.
• Eyelids also prevent things getting on to the eye.  Eyelids contain glands that secrete oils that travel from the glands through ducts and on to the eye.  These oils help to prevent tears from evaporating. 
• The eyelids have eyelashes that grow out of the edge of the eyelid.  This area is called the ‘eyelid margin’.  The eyelashes help to protect the eye by stopping things getting on to the eye.  Eyelashes also alert people to when something is too close to the eye.

Why eyelid hygiene is important for people with learning disabilities

• People with learning disabilities may not be able to tell other people that their eyelids or eyes need attention. 
• Supporters need to actively look for eye problems and take action promptly. 
• People with learning disabilities may rub or touch their eyes for a variety of reasons.  It is always important to establish why a person frequently rubs or touches their eyes.  Conjuctivitis is very painful, and highly contagious.
• People with certain conditions (such as Down's Syndrome) are  prone to blepharitis (inflammation of the eyelid) and other problems that cause inflammation of the eyelids.  This may cause them to rub their eyes.
• Itchy eyes may be a symptom of a sight-threatening condition.
• Remember, hay fever, allergies to household products, pets and animal etc. can all lead to itchy eyes.  People should be vigilant and refer any concerns to a GP.

Cysts and styes

• When the eyelid glands or ducts are not healthy, the oils from the glands in the eyelids can become blocked.  This can result in cysts.  Cysts look like bumps within the eyelid.
• When a duct is blocked at the eyelid margin it is called a stye.  Styes can look like bumps which may appear red on the eyelid margin.
• Cysts and styes can be unsightly to look at and may become uncomfortable and painful, causing the person to rub or touch their eye.

Eyelid problems

• Blocked glands or ducts in the eyelids can prevent the oils getting on to the eye.
• This means there will be no oil to stop the tears from evaporating.
• When tears evaporate too quickly it can lead to dry eyes.
• Dry eye can be uncomfortable and painful and can eventually lead to a reduction in vision.
• A bacteria called staphylococcus aureus is present on the eyelid skin and eyelid margin.  This can make the eyelids inflamed, so they look red.  Inflammation may make the eyelid feel itchy as well as be uncomfortable and painful.

Eyelid cleansing

• With the consent of the person, eyelids may be kept clean and healthy as part of a daily routine.  Cleaning of the eyelids can be made part of a person's daily routine, like having a wash in the bathroom wash-hand basin or having a shower.
• The supporter should follow strict hygiene guidelines, including hand and fingernail cleanliness and disposal of swabs or paper towels.   Cross infection must be avoided.
• The aim of cleaning the eyelids is to remove the debris of dead skin cells and bacteria that can gather on the eyelids. 

The following should be done to carry out external eyelid cleansing.

1. Use sterile warm water in a small sterilised basin and mix in two or three drops of the ‘non-sting’ anti-allergenic shampoo solution.
2. Dip the cotton end of a bud into the water/soap mixture.
3. Gently move the soaked cotton bud along the front eyelid margin, where the eyelashes grow out of the eyelid.  This may have to be repeated many times over in the one session. 

To cleanse the inner eyelid use Optrex or similar products and always follow the instructions, taking note that many eye drops have to be used within a few days after opening.

This whole process may need to be carried out twice a day, every day, to keep the lids clean, hygienic and healthy.

If there is not an improvement in the appearance of the eyelids or the eyelids get worse, please consult your eye care professional or General Practitioner.

Applying ointment and drops

• Always follow the advice given by a medical practitioner
• Always follow any procedure or recording that might be required

Practice and Familiarity with eye drops and ointments

• Consider strategies for introducing eye drops – get used to water droplets being gently felt on eye lids.  Use sterilised water in a dropper bottle and  practice on each other.  If appropriate introduce sign and symbols for eye drops – it will help people predict and anticipate and help people be in control. 

Getting help

• People’s sight is important.  If a person with learning disabilities has any inflammation of the eyelids, they should be seen by an eye care professional or General Practitioner (GP) without delay.
• Any delay in obtaining the correct treatment for an eye problem can result in the problem getting worse, which may lead to a more serious infection and loss of sight.
• Eye care professionals may recommend that some people have regular eye washing to keep their eyelids clean and healthy.  They may advise on the best way to do this.

June 2009

Related Information:

Eye Poking and Touching in People with Learning Disabilities

Eye Poking and Touching - Strategies for Supporting People