Peer-to-Peer Clinical Insight by Dr. Elise Kramer

Peer-to-Peer Clinical Insight by Dr. Elise Kramer Birdshot chorioretinopathy is already a complex disease to manage, but when you layer in NK, meibomian gland dysfunction, and longstanding Demodex blepharitis, the ocular surface becomes a major limiting factor in patient comfort and visual potential. This patient had been using Johnson & Johnson baby shampoo for years as an #eyelid cleanser. We now know this is outdated: Baby shampoo does not eradicate #Demodex It fails to meaningfully reduce bacterial biofilm Its surfactants disrupt the lipid layer, accelerating tear film evaporation And importantly, it is not ophthalmic: not designed for periocular use Today, we have ophthalmic-grade lid wipes, hypochlorous sprays, and now FDA-approved Demodex therapies that target the root cause without compromising the tear film. This patient is now starting a structured #dryeye + lid disease protocol. Looking forward to seeing how the ocular surface stabilizes once we remove the irritants and treat the underlying disease.