If you have blepharitis, meibomian gland dysfunction (MGD), recurrent styes or dry, irritated eyelids, you may have been told to clean your eyelids regularly.
But not all eyelid cleansers work in the same way.
One ingredient we particularly like for eyelid hygiene at Illume Eye Care is hypochlorous acid, often shortened to HOCl.
It sounds rather chemical, but hypochlorous acid is actually a molecule our own immune system naturally produces. In carefully formulated eyelid products it provides a gentle antimicrobial action, helping reduce the microbial load around the eyelids and eyelashes without the need for harsh soaps or scrubbing.
And increasingly, there is clinical evidence supporting its role in the management of blepharitis and ocular surface disease.
What is hypochlorous acid?
Hypochlorous acid is a weak acid naturally produced by immune cells called neutrophils.
It forms part of our innate immune system — one of the body's first lines of defence against microorganisms.
For eye care, HOCl can be stabilised at very low concentrations and incorporated into sprays or eyelid cleansers designed specifically for use around the delicate eyelid margin.
One concentration commonly used in ophthalmic lid-hygiene products is 0.01% hypochlorous acid.
At these low concentrations, HOCl offers useful antimicrobial activity while being generally very well tolerated around the eyes.[1,2]
Why do the eyelids need cleaning in the first place?
The edges of our eyelids are surprisingly busy places.
Each eyelid contains rows of meibomian glands, which produce the oil that forms the outer layer of our tears. Eyelashes emerge immediately alongside them, and bacteria naturally live across the surrounding skin and lash line.
Problems can develop when there is a combination of:
- excessive bacterial load
- accumulated oils and cellular debris
- inflammation
- blocked meibomian glands
- changes to the normal eyelid microbiome
- skin conditions such as rosacea
- or Demodex mites around the eyelashes
This can contribute to blepharitis and meibomian gland dysfunction, both of which frequently coexist with dry eye disease.
Symptoms can include:
- burning or gritty eyes
- sore or red eyelid margins
- crusting around the eyelashes
- fluctuating vision
- dry eyes
- watery eyes
- itchy eyelids
- recurrent styes or chalazia
Good eyelid hygiene therefore forms an important part of treatment for many people with ocular surface disease.
So what does hypochlorous acid actually do?
1. It helps reduce microorganisms around the eyelids
This is the main reason we use HOCl.
Hypochlorous acid has broad antimicrobial activity and can help reduce the number of bacteria present around the eyelid margin and lashes.
In a prospective randomised study of patients with blepharitis and mild-to-moderate dry eye disease, HOCl eyelid hygiene resulted in a significant reduction in bacterial load.[2]
For someone with blepharitis, reducing excessive microbial load can be an important part of creating a healthier lid-margin environment.
2. It can help improve blepharitis
Blepharitis means inflammation of the eyelid margins.
A 2023 randomised clinical trial investigated 0.01% hypochlorous acid in patients with blepharitis. After two weeks, patients receiving HOCl showed significant improvements in measures including [1]:
- eye symptoms
- eyelid-margin redness
- eyelid-margin abnormalities
- meibomian gland secretion quality
- and meibomian gland expressibility
Another randomised study followed patients with blepharitis and mild-to-moderate dry eye disease for four weeks. Those using HOCl had improvements in tear-film stability as well as symptoms and meibomian gland function.[2]
These are encouraging findings, although the clinical evidence base is still relatively small and we would not consider HOCl a stand-alone treatment for every form of blepharitis.
What about meibomian gland dysfunction?
Meibomian gland dysfunction (MGD) occurs when the oil-producing glands within the eyelids do not function normally.
Their oil may become thick, glands can become blocked and, over time, gland structure can be lost.
Because the oil produced by these glands helps prevent tears from evaporating, MGD is one of the most common contributors to evaporative dry eye disease.
Hypochlorous acid can be very useful as part of MGD management because it helps improve the environment around the openings of the glands.
But there is an important distinction:
HOCl cleans the eyelid margin. It does not physically unblock obstructed meibomian glands.
For this reason we will often combine lid hygiene with treatments such as:
- a 10-minute warm compress to improve meibomian oil flow
- lipid containing lubricating eye drops
- optimisation of omega-3 intake
- prescription anti-inflammatory treatment
- or in-clinic treatments such as IPL, LLLT, LipiFlow or Tixel-i when indicated.
The best combination depends on what is actually causing your symptoms.
Can hypochlorous acid help dry eyes?
Potentially — but usually indirectly.
Dry eye disease is not simply a lack of tears. It can involve tear evaporation, meibomian gland dysfunction, inflammation, altered tear-film stability and abnormalities of the ocular surface.
When blepharitis or MGD is contributing to dry eye, improving eyelid hygiene may improve the environment from which the tears are being produced.
In the four-week randomised HOCl study, tear break-up time improved significantly in the HOCl-treated group.[2]
That does not mean everyone with dry eye needs a hypochlorous acid cleanser. Someone with predominantly aqueous-deficient dry eye, for example, may require a very different management plan.
This is why identifying the underlying cause matters.
What about Demodex?
This is an area where it is worth separating HOCl's benefits from some of the claims made online.
Demodex are microscopic mites that can live within eyelash follicles and around the meibomian glands. In higher numbers they can contribute to Demodex blepharitis, characteristically producing small waxy collarettes around the base of the eyelashes.[3]
Hypochlorous acid can still be useful for keeping the eyelid margin clean in someone who has Demodex blepharitis.
However, we don't consider HOCl to be a reliable treatment for killing Demodex mites themselves.
An in-vitro study comparing 0.01% hypochlorous acid with terpinen-4-ol found very little direct demodicidal effect from HOCl. Most mites exposed to HOCl remained alive after 90 minutes.[4]
So if we see significant Demodex blepharitis, we may recommend a treatment specifically targeting the mites rather than relying on hypochlorous acid alone.
Why not just use baby shampoo?
Baby shampoo was historically recommended for eyelid cleaning because it was inexpensive and readily available.
Today, we generally have better choices. The eyelid margin is a specialised part of the ocular surface. Purpose-designed eyelid products allow us to clean this area without relying on detergents intended primarily for hair and skin. We also now know that baby shampoo can negatively impact the goblet cells in the conjunctiva and make dry eye worse.
Is hypochlorous acid an antibiotic?
No.
HOCl is an antimicrobial molecule, not an antibiotic. That distinction is useful in chronic eyelid disease, where daily or long-term lid hygiene may be required.
Antibiotics still have an important place in eye care when appropriately prescribed, but routine long-term antibiotic use is neither necessary nor appropriate simply to maintain everyday eyelid hygiene.
Is hypochlorous acid safe around the eyes?
Commercially prepared ophthalmic HOCl formulations use very low concentrations specifically designed for the eyelid area.
Published clinical studies of 0.01% HOCl have reported good tolerability, with no significant adverse events in the randomised trials described above.[1,2]
Importantly, this does not mean that any household product containing hypochlorous acid should be used around your eyes.
Concentration, purity, formulation, pH and stability all matter.
We recommend using a product specifically formulated for ophthalmic or eyelid use.
How do you use a hypochlorous acid eyelid cleanser?
Always follow the instructions for your particular product.
For a product such as TheraTears SteriLid Hypochlorous Eyelid Cleanser, we generally recommend:
- Wash your hands.
- Remove contact lenses and eye makeup.
- Apply the cleanser to a clean cotton pad.
- With your eye closed, gently wipe along the upper and lower lash lines.
- Repeat with a fresh pad for the other eye.
- Allow the area to dry — no rinsing is required.
Depending on your eyelid condition, it may be recommended once or twice daily.
Consistency matters. Blepharitis and MGD are often chronic conditions, so eyelid hygiene usually works best as a routine rather than something you do only when your eyes flare up.
Who might benefit from a hypochlorous acid eyelid cleanser?
We most commonly recommend it for people with:
- anterior blepharitis
- meibomian gland dysfunction
- oily or debris-prone eyelid margins
- dry eye associated with lid-margin disease
- ocular rosacea
- recurrent styes or chalazia
- sensitive eyelids where harsher cleansers are poorly tolerated
- or anyone for whom regular lid hygiene forms part of their dry-eye management plan.
It can also be helpful for people who wear eye makeup or contact lenses and have been advised to pay particular attention to their eyelid hygiene.
Why we love HOCl at Illume
We like treatments that are simple, targeted and easy enough for people to actually use consistently. Hypochlorous acid ticks many of those boxes. It is:
- gentle
- easy to incorporate into a daily routine
- antimicrobial
- suitable for regular eyelid hygiene
- supported by a growing clinical evidence base
- and useful across a number of common eyelid and ocular-surface conditions.
But perhaps most importantly, we don't see it as a cure-all. If your eyes remain dry, watery, gritty, red or uncomfortable despite regular lid hygiene, the next step shouldn't necessarily be more cleanser.
Blepharitis, MGD, ocular rosacea, allergy, Demodex, tear deficiency and other ocular-surface conditions can look and feel surprisingly similar.
A Dry Eye & Ocular Surface Assessment allows us to look at the eyelids, meibomian glands, tear-film quality, tear stability and ocular surface in detail and work out what is actually contributing to your symptoms.
Because when it comes to dry and uncomfortable eyes, knowing what you're treating — and why — makes all the difference.
References
1. Zhang H, et al. Effect of Hypochlorous Acid on Blepharitis through Ultrasonic Atomization: A Randomized Clinical Trial. Journal of Clinical Medicine. 2023;12(3):1164. doi:10.3390/jcm12031164.
2. Mencucci R, et al. Hypochlorous acid hygiene solution in patients affected by blepharitis: a prospective randomised study. BMJ Open Ophthalmology. 2023;8. doi:10.1136/bmjophth-2022-001209.
3. Wolffsohn JS, et al. Ocular Demodex: a systematic review of the clinical literature. Ophthalmic and Physiological Optics. 2020.
4. Murphy O, O'Dwyer V, Lloyd-McKernan A. In vitro demodicidal activity of commercial lid hygiene products. Clinical Ophthalmology. 2019;13:1493–1497.