Hypochlorous Acid- Why it Works

March 30th, 2020

As our awareness of eyelid disease has increased and the use of topical lid preparations has increased as well.  When choosing a solution to address common lid disease symptoms, an effective option with minimal side effects is preferred by both clinicians and patients.  When considering a remedy for lid disease, an agent that addresses bacteria, inflammation, and promotes healing without toxic effects to ocular tissues should be considered.  Hypochlorous acid (HOCl) solutions in proper concentrations have been observed to address these issues without significant negative side effects.

EyeLid disease is similar to a chronic wound

Chronic eyelid disease may present with epitheliopathy at the lid margin, erythema, and pain.  The chronicity and physical changes associated with lid disease are similar to a chronic wound.  Wound healing occurs in three stages: inflammation, migration, and remodeling. Wound healing is facilitated by keratinocytes, platelets, and fibroblasts, which may gain benefit from agents that control bacteria without challenging the cellular repair processes.  While silver nitrate, betadine, and povidone antiseptics are commonly used medically, they may have cytotoxic effects.  

In vitro studies of hypochlorous acid (HOCl) 0.01% solution were observed to have equal or potentially greater antiseptic effects without cytotoxicity when compared to isopropyl alcohol 70%, chlorhexidine gluconate 4%, and povidone-iodine 5%[i]It has been reported that hypochlorous acid promotes favorable effects on fibroblast and keratinocyte migration.[ii]  Hypochlorous acid has also been reported to be an effective irrigation solution for wound care[iii], and when used post-operatively, has been found to reduce inflammation and help prevent scarring and infection when combined with scar gel.[iv]   

Hypochlorous acid is a naturally-occurring agent

During the natural human immune response to the introduction of pathogens (a bacterium, virus, or another microorganism that can cause disease), hypochlorous acid is a naturally-occurring agent that forms to help kill the pathogen.  When a cellular pathogen is targeted by the immune system, a neutrophil engulfs the pathogen, creating a phagosome (capsule) that surrounds the pathogen to initiate phagocytosis and destroy the invader.  Reactive Oxygen Species (ROS) within the cell function to generate hydrogen peroxide. Activated myeloperoxidases convert hydrogen peroxide to hypochlorous acid (HOCl) as the final product of the oxidative burst pathway to kill pathogens such as viruses, bacteria, and fungi.[v],[vi] 

To learn more about hypochlorous acid as a naturally occurring agent, click here.

Slow-healing wounds are at risk for infections

Slow-healing wounds are at risk for infection because bacteria favors open wounds for colonization.  Eradication of all pathogens is preferable, and HOCl has been observed to be bactericidal in studies.[vii]  The bactericidal properties of HOCl are due to its oxidant qualities, which function to entirely destroy viruses, bacteria, and fungi on the applicated surface. Hypochlorous acid solutions have several applications in plastic surgery, chronic wound healing, dentistry, and eye care.

To see what bacteria and viruses Zenoptiq Hypochlorous Acid solution is proven to eradicate, click here.

Biofilms and wounds infection

Some bacteria produce biofilms, which are chronic accumulations caused by bacteria growing within a matrix of extracellular polymeric secretions (EPS) and surround and protect cell communities.  Biofilms make phagocytosis difficult, increase resistance to antibiotics, and adhere to chronic wounds. Staphylococcus aureus and Pseudomonas aeruginosa are commonly associated with biofilm formation in wound infections,[viii],[ix] and these bacteria may often be causal of ocular infections.  Hypochlorous acid solutions have been reported to eliminate biofilms,[x] which may promote favorable wound care outcomes for patients.

Describing the use of a naturally-occurring substance to help alleviate lid disease symptoms facilitates patient discussion.  Addressing bacterial growth, biofilms, and inflammation without medication is often accepted by patients who prefer not to use medications long-term.

Zenoptiq™ Hypochlorous Acid Solution is an all-natural, daily eyelid and eyelash cleanser that helps soothe red, itchy, crusty eyelids. Using Zenoptiq may provide relief from symptoms commonly associated with MGD, Blepharitis, and Dry Eye.


Tracy Schroeder Swartz, OD, MS, FAAO
Written by Tracy Schroeder Swartz, OD, MS, FAAO

Resources:

[i] Anagnostopoulos AG, Rong A, Miller D, Tran AQ, Head T, Lee MC, Lee WW.  0.01% Hypochlorous Acid as an Alternative Skin Antiseptic: An In Vitro Comparison.  Dermatol Surg. 2018 Dec;44(12):1489-1493. doi: 10.1097/DSS.0000000000001594..

[ii] Sakarya S, Gunay N, Karakulak M, Ozturk B, Ertugrul B.  Hypochlorous Acid: an ideal wound care agent with powerful microbicidal, antibiofilm, and wound healing potency.  Wounds. 2014 Dec;26(12):342-50.

[iii]Assadian O, Kammerlander G, Geyrhofer C, Luch G, Doppler S, Tuchmann F, Eberlein T, Leaper D.  Use of wet-to-moist cleansing with different irrigation solutions to reduce bacterial bioburden in chronic wounds.   J Wound Care. 2018 Oct 1;27(Sup10):S10-S16. doi: 10.12968/jowc.2018.27.Sup10.S10..

[iv] Gold MH, Andriessen A, Dayan SH, Fabi SG, Lorenc ZP, Henderson Berg MH.  Hypochlorous acid gel technology-Its impact on post-procedure treatment and scar prevention.  J Cosmet Dermatol. 2017 Jun;16(2):162-167. doi: 10.1111/jocd.12330. Epub 2017 Mar 30.

[v] KS Couch, C Miller, LA Cnossen, KJ Richey, SJ Guinn.  Non-cytotoxic Wound Bed Preparation:   Vashe Hypochlorous Acid Wound Cleansing Solution.  http://www.steadmed.com/wp-content/uploads/2016/11/Vashe-Wound-Cleansing-Final-final.pdf.  Accessed 12/15/19.

[vi] Juliet M. Pullar, Margret C. M. Vissers, and Christine C. Winterbourn.   Living with a Killer: The Effects of Hypochlorous Acid on Mammalian Cells.  IUBMB Life. 2000 Oct-Nov;50(4-5):259-66.

[vii] H. J. Kim, J.-G. Lee, J. W. Kang et al., Effects of a low concentration hypochlorous acid nasal irrigation solution on bacteria, fungi, and viruses.  The Laryngoscope, vol. 118, no. 10, pp. 1862–1867, 2008.

[viii] Otto, M. Staphylococcal biofilms. Curr Top Microbiol Immunol. 2008;322:207-28.

[ix] Høiby, N., Bjarnsholt, T., Givskov, M., Molin, S. & Ciofu, O. Antibiotic resistance of bacterial biofilms. International Journal of Antimicrobial Agents 35, 322–332.  https://doi.org/10.1016/j.ijantimicag.2009.12.011 (2010).

[x] Harriott MM, Bhindi N, Kassis S, Summitt B, Perdikis G, Wormer BA, Rankin TM, Kaoutzanis C, Samaha M, Stratton C, Schmitz JE.  Comparative Antimicrobial Activity of Commercial Wound Care Solutions on Bacterial and Fungal Biofilms.  Ann Plast Surg. 2019 Oct;83(4):404-410. doi: 10.1097/SAP.0000000000001996.

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