A new study reveals that a person’s choice of soap may play a role in eye infections.

This article appeared in EyeWorld, an international newsmagazine for ophthalmologists

by Lisa Samalonis, Correspondent
 

Using antibacterial/deodorant soap before surgery can reduce the amount of external disease in ocular surgery compared with using nonbacterial soap, said Warren D. Cross, MD, of Bellaire Eye & Laser Center, in Houston.

In addition, patients with recurring eye infections who use deodorant/antibacterial soap daily or at least several times a week can decrease disease significantly, said Cross.

A recent  study he conducted included 427 consecutive patients with significant eye infection com-plaints. Diagnoses included ble- pharitis, meibomianitis, chalazia, and corneal ulcer. Criteria for the study required that patient treatments included topical antibiotic drops, topical antibiotic ointment, oral antibiotics, and hot compresses.

The patients were given a ques- tionnaire on symptoms and perso- nal hygiene.  Of the 427 cases, 89% of patients indicated they used nondeodorant  soaps. Of the 89% that used nonantibacterial/non- deodorant soap, 224 cases (52%) said they used Ivory. Other non- deodorants used were Dove (72 cases, 17%), Neutrogena (34 cases, 8%), tap water (30 cases, 7%), cold cream (34 cases, 8%), Canay (15 cases, 4%) and others (23 cases, 5%).

The remaining 11% of patients said they use deodorant/antibacterial soaps, such as Safeguard (13 cases, 3%), Dial (nine cases, 2.1%), Irish Spring (seven cases, 1.6%), Lever 2000 (five cases, 1.2%), Coast (five cases, 1.2%), Zest (four cases, 0.9%), or others (five cases, 1.2%). The study included double- blind cultures from 62 consecutive patients with eye infection complaints. Cross said that 16 patients used deodorant soap and 46 used nondeodorant/antibacterial soap. "Results from the double-blind culture showed that Staphylococcus epi-dennis and aureus infections occurred in 52% of the nondeodor- ant/antibacterial soap users, while 30% occurred with the deodorant- /antibacterial soap users,' he said. The study was performed with patients from the Houston area. According to the study, deodorant soap represents about two-thirds of soap sold in the area. For example, Safeguard represents about 18% of the soap sold in Houston,, roughly three times Ivory sales. The Safeguard patients represented 3% of cases treated. Fifty-two percent of the cases treated were Ivory soap users. In this study, deodorant soap was used by 11% of severely infect- ed patients. There was one Safeguard case for every 16 Ivory cases. "Eighty-nine of every 100 bacterial external disease infections will use a nondeodorant facial soap,' Cross said.

Recommendations

"Based on the results of this study, doctors should recommend deodor- ant/antibacterial soap to patients with contact lenses, especially extended wear contact lenses, recurrent chalazia, and Staphylococcus marginal ulcers," he said.

Cross also recommends that deodorant soap be used before and after intraocular and refractive surgery.

Research indicated that the soap does not have to be used every day. “I suggest to patients who are sensitive to antibacterial soaps that they use it in their morning shower or every other morning or every third morning,” Cross said. “For patients with a long history of recurrent staph ulcers, using Safeguard or Irish Spring every other day seems to break the cycle.” Further study "Although preoperative use of antiseptic/deodorant soaps seems rea- sonable to reduce the rate of infection, further study is needed to prove this point. Dr. Cross's study, when published [in- peer review], may shed some light on this issue," said Walter J. Stark, M,D, professor and director of corneal services, Wilmer Ophthalmological Institute, Baltimore.

Stark noted that multiple studies have shown that topical antibiotic agents given preoperatively, reduce the amount of lid and conjunctival bacteria. Patient's normal lid and conjunctival flora are the most potential sources of infection during intraocular surgeries. Various staphylococcal species, which are the most common organisms causing endophthalmitis, predominate in this flora. “Application of 5% povidone iodine solution on the eye at the time of surgical preparation causes a similar decrease in the number of bacterial colonies. Such prophylactic measures may help reduce the incidence of endophthalmitis, although the evidence is inconclusive,' he said. Routine use of preoperative  antibiotics or antiseptic soaps may lead to alteration of protective nor- mal host flora, development of resistant bacteria, and allergic reactions, he said. “In a large study, up to 95% of eyes had positive culture results for organisms capable of causing severe intraocular infections, yet few of those eyes went on to develop infections," Stark said.