Tea tree oil is a ubiquitous presence in the array of homeopathic treatments for common conditions from acne to athlete’s foot. It appears to have applications in eye care as well, according to a report from the American Journal of Ophthalmology. In a study of 40 patients, a tea tree oil-based shampoo was found to be more efficient than regular lid-cleaning shampoo in controlling both signs and symptoms of meibomian gland dysfunction.
When patients experience meibomian gland dysfunction (MGD), they frequently present with meibomian glands clogged with debris, which is sometimes caused by Demodex mites. This can lead to qualitative and quantitative changes in tear film secretions and can lead to ocular surface diseases, such as blepharitis. In the past, researchers have speculated that tea tree oil, due to its antibacterial and anti-inflammatory properties, can help moderate inflammation and manage MGD.
The current study reviewed 40 patients ranging in age from 28 to 70 years (23 men, 17 women; average age, 49.15±21.15 years) with chronic ocular discomfort, obstructed meibomian glands, and anatomic abnormalities around the meibomian orifice. The patients were randomly assigned to use either a standard baby shampoo or a tea tree oil treatment.
Clinicians gathered their data using slit lamp examinations and the dry eye questionnaires (DEQ5) before treatment and at intervals of 1 and 3 months after treatment initiation. Patients were also asked about MGD symptoms, including itching, dryness, foreign body sensation, photophobia, and irritation. Signs included redness, conjunctiva or corneal staining, abnormal tear break-up time (TBUT), vascularity, plugging and capping of gland orifices, trichiasis, distichiasis, low Schirmer 1 scores, and expressibility of glands.
Before treatment, the tea tree oil shampoo group’s DEQ5 score was 7.00±2.59, while the baby shampoo group’s was 6.95±2.46. The tea tree oil shampoo group’s scores dropped to 3.97±2.03 after the first month and to 1.13±1.47 after 3 months (P <.001). The baby shampoo group’s scores dropped to 5.43±2.28 after the first month and to 4.02±1.99 after the third (P <.001).
The researchers noted a number of other changes after treatment with tea tree oil as well, including mean gland expressibility (which decreased from 2.65±1.63 to 1.13±1.20 and 0.22±0.58 after months 1 and 3, respectively; P <.001). The mean meibum quality score was 11.08±5.01 before treatment, 7.60±4.56 at month 1, and 4.20±3.83 at month 3 (P <.001). Mean TBUT increased from 7.18±1.55 to 8.95±1.60 at month 3 (P <.001) and the Schirmer 1 score increased from 7.05±2.24 to 9.58±2.11 at month 3 (P <.001).
The baby shampoo group also saw decreases, but they were not as robust. Those patients saw mean gland expressibility scores decrease from 3.28±1.69 to 2.60±1.65 at month 1 and 1.92±1.80 at month 3 (P <.001). The group’s mean meibum quality score was 11.72±5.97 before treatment, 9.65±5.54 at month 1, and 7.63±4.79 at month 3 (P <.001). Like the tea tree shampoo group, they saw changes to their TBUT and Schirmer scores across 3 months, from 6.53±1.59 to 7.40±1.26 (P <.001) and 7.15±2.17 to 8.45±2.24 (P <.001), respectively.
No patients reported allergic reactions or contact dermatitis during the treatment, but ocular surface irritation during scrubbing was more common with tea tree oil shampoo (P =.002). The researchers say a limitation of the study may be patient compliance and correct application of the tea tree oil shampoo.
“On the grounds of the higher clinical efficacy observed in the treatment with [tea tree oil shampoo], this treatment seems to be a suitable substitute for regular-lid shampoo and is, hence, recommended for washing ciliary margin of the eyelids in patients with MGD,” the investigators conclude.
Zarei-Ghanavati S, Nooghabi MJ, Zamani G. Comparison of the effect of tea tree oil shampoo with regular eyelid shampoo in meibomian gland dysfunction treatment. Am J Ophthalmol. 2021;229(9):45-51. doi:10.1016/j.ajo.2021.04.009