Eyelid hygiene

Place of eye hygiene in morning routine

The daily morning routine begins with complete undressing and a visual inspection of the skin. Special attention is paid to the hygiene of the face and eyelids. To cleanse the eyes, use a cotton swab pre-moistened with regular boiled water.

Basic processing rules:

• The direction of movement is strictly set: from the lateral (outer) corner of the eye to the medial (inner) one.
• It is strictly forbidden to use the same swab for both eyes — a new one is taken for each.
• When performing the procedure on a child, their head must be turned toward the eye being washed (e.g., to the left when treating the left eyelid). This prevents fluid from flowing into and potentially transferring infection to the healthy eye.

Infectious threats from poor hygiene: gonoblenorrhea

A gross violation of sanitary standards and personal hygiene rules can lead to infection introduction into the eyes. One of the most severe diseases is gonoblenorrhea (from Greek blennos — mucus, rheo — to flow). The causative agent is the Gram-negative diplococcus Neisseria gonorrhoeae (Neisseria gonorrhoeae).

In adult patients (most often aged 20–24), the infection is introduced into the eyes by dirty hands against the background of existing urogenital gonorrhea. The process begins as unilateral 2–4 days after contact and proceeds extremely severely. In children, infection occurs from the outside — through contaminated linen and care items. In newborns, the disease manifests on the 2nd–5th day of life (usually both eyes are affected) due to infection during passage through the birth canal of an infected mother.

Stages of untreated process:

1. Infiltration (initial): eyelids acquire a purplish-cyanotic color, pronounced dense edema appears. The discharge is serosanguineous, resembling "meat slops".
2. Suppuration (in 3–4 days): eyelid edema subsides, but chemosis (sharp edema of the bulbar conjunctiva in the form of a ridge) forms. Abundant thick yellow pus appears, gluing the edges of the eyelids together. This is the most dangerous stage: in 15–40% of cases, the cornea is affected, and purulent infiltrates and ulcers prone to perforation develop.
3. Proliferation (in 1–2 weeks): the pus becomes liquid and greenish, the conjunctiva becomes rough due to papillary proliferation. The total duration of the disease without treatment reaches 1–2 months.

Chlamydial conjunctivitis (parachlamydia)

Another eye disease closely related to hygiene and urogenital infections is parachlamydia. It develops in more than 50% of patients with urogenital chlamydia and accounts for 3 to 30% of all conjunctivitis cases.

The causative agent is Chlamydia trachomatis (serotypes D-K), which infects the columnar epithelial cells of mucous membranes, multiplying inside them. Young people aged 16–30 are predominantly susceptible to the disease, with women falling ill three times more often than men (gender ratio 1:3).

Prevention and treatment principles

Prevention of bacterial lesions of the eyelids and conjunctiva directly depends on the etiology of the pathogen:

• Staphylococcal conjunctivitis: strict adherence to personal hygiene, timely treatment of blepharitis, skin and nasopharyngeal diseases, as well as dry eye syndrome.
• Pseudomonal conjunctivitis: careful contact lens care, avoiding prolonged and uncontrolled use of topical glucocorticosteroids (they reduce local tissue antibacterial resistance).
• Neonatal gonoblenorrhea: specific prevention in the maternity hospital. During the initial toilet, a 20% sodium sulfacetamide solution is instilled into the conjunctival sac three times (at 10-minute intervals), or a strip of tetracycline or erythromycin ointment (up to 1 cm long) is placed behind the lower eyelid.

When an infection develops, local antibacterial therapy (cephalosporins, fluoroquinolones) is prescribed. In pediatrics, the choice of drug is strictly limited by age guidelines. For pseudomonal infection, a combination of fluoroquinolones, aminoglycosides, and antiseptics (e.g., Okomistin) is used. If the cornea is involved in the pathological process, the patient requires urgent hospitalization.

Class and exam questions

What else to study on this topic

• Antibacterial therapy for conjunctivitis (cephalosporins and fluoroquinolones)
• Features of combined treatment for pseudomonal eye infection
• Pathogenesis and epidemiology of chlamydial conjunctivitis (parachlamydia)
• Algorithm for a newborn's complete morning toilet (treatment of skin folds, ears, nose)
• Connection between urogenital infections and inflammatory eye diseases

Other topics in the "Additional Topics" section

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