More than 20 years ago, personal computers ran Windows 95, everyone was doing the Macarena, and optometrists were recommending baby shampoo for blepharitis. Lid hygiene has come a long way in two decades—but have all practitioners bought in, or do some still cling to the good ol’ days?
What’s the harm?
First do no harm is fundamental to medical professionals. Certainly, one would assume that nothing could be safer than a product designed for use with children. Television commercials with smiling, happy babies covered in frothy bubbles imply the product is harmless. Ubiquitous marketing alone creates a subconscious sense of safety for both doctor and patient.
Baby shampoo contains mild detergent due to children’s limited sebum production.1 However, baby shampoos also contain an abundance of other ingredients, some of which are benign and others that have proven to be potentially dangerous. In 2013, Johnson & Johnson removed formaldehype and 1,4-dioxane from its No More Tears baby shampoo.2
While formaldehyde occurs naturally in many products, there are risks associated with both acute and long-term exposure. Though most risk associated with exposure is caused by inhalation, eye irritation can occur.3 Concerns about long-term exposure and mounting public safety concerns prompted the company to revise its popular formulation.2
Similarly, 1,4-dioxane can cause eye irritation as well. However, it may be more difficult to avoid because it is often a manufacturing byproduct.4
The updated version of Johnson’s baby shampoo and other similar products continue to contain ingredients like cocamidopropyl betaine (CAPB). CAPB is an amphoteric synthetic detergent used in a variety of hygiene products, including some contact lens cleaners. Increasing rate of allergic reaction to CAPB, including delayed T-cell mediated type IV hypersensitivity reactions, have been noted. In 2004, CAPB had the dubious of honor of being named “Allergen of the Year” by The American Contact Dermatitis Society. Prevalence of contact sensitization due to CAPB or manufacturing impurities is between 3 and 7 percent.5
Baby shampoos were not designed for application to the eyes nor as lid hygiene products. In an effort to provide patients with an inexpensive mild cleanser, doctors may not only be recommending something less effective but also potentially irritating. However, lid scrubs with baby shampoo continue to be recognized by the American Optometric Association6 and the American Academy of Ophthalmology as a viable lid hygiene option.7