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  • Treatment of blepharitis with terpinen-4-ol lid wipes relieves symptoms

    Cornea/External Disease

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    Review of: Randomized double-blind trial of wipes containing terpinen-4-ol and hyaluronate versus baby shampoo in seborrheic blepharitis patients

    Arici C, Mergen B, Yildiz-Tas A, et al. Eye, April 2022

    Symptom surveys of patients with seborrheic blepharitis indicated improvement of symptoms following use of terpinen-4-ol lid wipes or baby shampoo scrub.

    Study design

    This randomized, double-blind, active control, parallel group, multicenter clinical trial included 48 eyes of 48 patients. Patients with seborrheic blepharitis were randomized 1:1 to receive a wipe containing terpinen-4-ol (the active ingredient of tea tree oil) or a baby shampoo scrub.

    Outcomes

    Both arms showed good clinical responses to treatment with regard to improvements in the ocular surface disease index (OSDI) and blepharitis symptom (BLISS) dry eye surveys. Neither arm showed significant changes in corneal staining, tear break-up time, or tear production (Schirmer test). There was a statistically significant larger improvement in the BLISS survey response in the terpinen-4-ol wipe group, but no similar improvement in the OSDI scale.

    Limitations

    This study lacked a true, unmedicated, control group. Although patients with the baby shampoo scrub showed a statistically significant greater improvement in the BLISS score at 8 and 12 weeks, this represented only 5 additional points on a 39-point scale, so clinical relevance should be interpreted. OSDI did not demonstrate a consistent difference between the groups by 12 weeks.

    Clinical significance

    Most patients with any type of blepharitis are recommended lid scrubs. It is important to have randomized clinical trials to assess efficacy of this oft-prescribed intervention.