Lid wipes, hypochlorous spray or just saline? What a randomised trial says about lid hygiene

If you have blepharitis or meibomian gland dysfunction, someone has probably told you to "clean your lids". The harder question is what to clean them with. Lid wipes, hypochlorous acid sprays and plain saline on a pad are all sold for the job, with very little head-to-head evidence between them. A 2026 randomised trial in Scientific Reports (Shi et al.) compared all three. Here is what it found, and what it means for lid hygiene in Hamilton.

What the trial did

Researchers at Beijing Tongren Hospital enrolled 72 adults aged 18 to 70 with dry eye symptoms plus lid margin or meibomian gland findings of blepharitis-associated ocular surface disease, randomised 1:1:1 to one of three twice-daily cleansing routines for 28 days:

• Lid wipes: one pre-moistened commercial eyelid wipe per session (Aishiyoujia/EYESU+), containing aloe leaf juice, purslane extract, panthenol and a mild surfactant.
• Hypochlorous acid: 0.01% hypochlorous acid sprayed (four actuations) onto a dry cleansing pad before wiping.
• Saline: sterile 0.9% saline sprayed onto an identical pad in the same way.

Pads matched the wipes in size and material, and everyone wiped the same way: eyes closed, along the lash roots and lid margin, for 30 seconds. Warm compresses, tea tree oil, IPL and other lid treatments were prohibited, so this tested the cleansing fluid alone.

The primary outcome was a symptom score at week 4: the average of eight 100-mm visual analogue scale (VAS) items (burning, itching, foreign-body sensation, blurred vision, dryness, light sensitivity, pain and discomfort), from 0 (none) to 100 (worst). Examiners were masked to treatment; participants were not, because a wipe and a spray bottle look different.

What it found

Of the 72 people randomised, 64 had a usable follow-up symptom score and formed the analysis set; 59 had week 4 data. All completed more than 90% of the 56 scheduled cleanses.

After adjusting for each person's starting score, the mean week 4 VAS was 27.47 (95% CI 22.18 to 32.76) with wipes, 33.16 (95% CI 27.80 to 38.51) with hypochlorous acid, and 40.83 (95% CI 34.93 to 46.72) with saline. The overall difference between groups was statistically significant (P = 0.007).

A 95% confidence interval (CI) is the range within which the true average plausibly lies; narrower is more precise. A P-value is the probability of seeing a difference this large if the treatments were really equal; below 0.05 is the usual threshold for "unlikely to be chance".

The between-group comparisons:

• Wipes vs saline: wipes scored 13.35 points lower (95% CI −21.51 to −5.20; Holm-adjusted P = 0.005). This was the only comparison that held up after correcting for multiple testing.
• Wipes vs hypochlorous acid: a 5.68-point difference favouring wipes (95% CI −13.13 to 1.76; P = 0.132) that did not reach significance.
• Hypochlorous acid vs saline: a 7.67-point difference favouring hypochlorous acid (95% CI −15.76 to 0.42; P = 0.125 after adjustment), again not significant.

In plain terms: wipes beat saline for symptoms at four weeks, hypochlorous acid sat in the middle, and no wipe-versus-hypochlorous difference was confirmed.

Signs, not just symptoms

Because symptoms and signs often disagree, the researchers also measured the eye itself. Three sign-based measures showed nominal differences, with both active products looking better than saline: Schirmer tear production (adjusted week 4 means 12.43, 12.37 and 6.02 for wipes, hypochlorous acid and saline; P = 0.002), corneal fluorescein staining (0.67, 0.20 and 1.15; P = 0.032) and meibomian gland expressibility (2.41, 2.31 and 3.27, lower is better; P = 0.018). Lid redness, lid margin signs, tear break-up time, OSDI scores, tear meniscus height and overall gland scores did not differ clearly. The authors call all secondary results "supportive" because they were not adjusted for multiple comparisons.

No serious eye adverse events or intolerance-related discontinuations were recorded in any group.

What this means for your lid routine

The message is not "buy brand X". It is that the cleansing fluid appears to matter, at least for short-term comfort, and that saline on a pad may be the weakest option. That fits our experience: a formulated cleanser tends to lift debris and biofilm better than wiping alone.

It also reinforces that lid hygiene is one part of a plan, not the plan. The trial switched off warm compresses and in-office treatments to isolate the cleanser: good science, but not how patients are managed. The right cleanser sits alongside heat, in-office debridement and gland expression, and treatment of drivers such as Demodex mites, which this trial did not separate out. Treating the cause, not just the symptom, is the point of a proper dry eye assessment, and choosing between a wipe, a spray or a foam is a decision the optometrist team at Rose Optometry makes with you based on what your lids look like under the microscope.

What the studies can't tell us

• It was small and short. Around 20 people per arm, one Beijing hospital, four weeks. Whether the advantage lasts is unknown.
• Participants knew which product they were using, and the main outcome was how they felt. Expectation effects could inflate the wipe result; the authors say that bias cannot be quantified.
• The groups were not equal at the start. Baseline symptom scores were 56.36 for wipes, 53.08 for hypochlorous acid and 41.39 for saline. The analysis adjusted for this, but residual imbalance and regression to the mean cannot be ruled out.
• Drop-outs were uneven. Eight randomised participants (five in the saline arm) had no usable follow-up data and were excluded, and five more were missing week 4 scores.
• We do not know what a "meaningful" change is on this VAS; no minimal clinically important difference has been established for it.
• The wipe was a commissioned commercial product. The paper states it was commissioned by a Beijing health technology company; funding and competing-interest statements were not in the full text we accessed, so manufacturer involvement could not be verified. The wipe tested may not be the product available in New Zealand.
• Hypochlorous acid was not shown to be inferior. The authors stress this is not evidence against hypochlorous acid itself; other delivery methods were not tested.
• Mostly older women. Median age was 64 and 85.9% were female, so results may not transfer to younger patients or contact lens wearers.

If your lids are red, crusty or uncomfortable and chemist wipes are not shifting it, a full dry eye treatment plan is worth discussing. The Dry Eye Evaluation at Rose Optometry in Hamilton is a paid, extended consultation where we grade your lid margins and glands, check for mites, and build a routine that treats what is driving the problem.

Where to get this looked at

If you live in Hamilton, the two places to start are Rose Optometry in the city, where the optometrist team (Jagrut Lallu, Jacqueline Rowe and colleagues) runs the dry eye clinic, and Visique Rototuna Optometrists on the north side of town. Both are member practices of the Dry Eye Specialist Group and work the same way: a paid Dry Eye Evaluation first, to find out what is actually driving your symptoms, and only then a treatment plan.

If you don't live in Hamilton, see your local Dry Eye Specialist Group member. The group is a network of independent practices across New Zealand that share this treat-the-cause approach: Illume Eye Care (Ponsonby, Auckland), Bay Eye Care (Tauranga), Feilding Visique Optometry, Naylor Palmer Optometrists (Palmerston North), Ashburton Eyecare and Milburn & Neill Optometrists (Dunedin), alongside the two Hamilton practices. Find your nearest one on the member practices page.

Reference

• Shi R, Guo Y, Li A, Tian L, Jie Y. Comparative efficacy of eyelid cleansing wipes, hypochlorous acid, and saline for blepharitis-associated ocular surface disease: a randomized trial. Sci Rep. 2026;16(1). PMID 42436201. https://doi.org/10.1038/s41598-026-62115-z