{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T01:11:23Z","timestamp":1786756283332,"version":"build-2736575974"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Natural Science Foundation of China","award":["81970766"],"award-info":[{"award-number":["81970766"]}]},{"name":"National Natural Science Foundation of China","award":["82171102"],"award-info":[{"award-number":["82171102"]}]},{"name":"National Natural Science Foundation of China","award":["22Y21900900"],"award-info":[{"award-number":["22Y21900900"]}]},{"name":"National Natural Science Foundation of China","award":["SHDC2020CR3052B"],"award-info":[{"award-number":["SHDC2020CR3052B"]}]},{"name":"Shanghai Medical Innovation Research Program","award":["81970766"],"award-info":[{"award-number":["81970766"]}]},{"name":"Shanghai Medical Innovation Research Program","award":["82171102"],"award-info":[{"award-number":["82171102"]}]},{"name":"Shanghai Medical Innovation Research Program","award":["22Y21900900"],"award-info":[{"award-number":["22Y21900900"]}]},{"name":"Shanghai Medical Innovation Research Program","award":["SHDC2020CR3052B"],"award-info":[{"award-number":["SHDC2020CR3052B"]}]},{"name":"Shanghai Key Clinical Research Program","award":["81970766"],"award-info":[{"award-number":["81970766"]}]},{"name":"Shanghai Key Clinical Research Program","award":["82171102"],"award-info":[{"award-number":["82171102"]}]},{"name":"Shanghai Key Clinical Research Program","award":["22Y21900900"],"award-info":[{"award-number":["22Y21900900"]}]},{"name":"Shanghai Key Clinical Research Program","award":["SHDC2020CR3052B"],"award-info":[{"award-number":["SHDC2020CR3052B"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: To evaluate the efficacy and safety of eyelid hygiene using topical 0.01% hypochlorous acid (HOCL) through ultrasonic atomization after 2 weeks in patients with blepharitis. Design: Randomized controlled trial. Methods: Patients with blepharitis were randomized into two groups: topical 0.01% HOCL through ultrasonic atomization (HOCL group, 42 eyes) or eyelid scrubs (control group, 37 eyes). Patients in both groups received warm compresses twice daily and topical 0.5% levofloxacin three times a day. Primary outcomes were the ocular surface disease index scores (OSDI), lid margin redness, lid margin abnormalities, meibum expressibility, meibum quality, and noninvasive breakup time after 2 weeks. Secondary outcomes were conjunctiva redness, corneal fluorescein staining, and tear meniscus height. A questionnaire of treatment adherence with a free response section was administered to confirm patient compliance and comments. Results: Sixty-seven participants participated in this study. Both groups show an improvement in all primary outcomes, while statistically significant improvements in OSDI, lid margin redness, lid margin abnormality, meibum expressibility and quality are only limited to the HOCL group after 2 weeks of treatment (p &lt; 0.05, p &lt; 0.05, p &lt; 0.001, p &lt; 0.001 and p &lt; 0.001, respectively). Subgroup analysis in HOCL reveals that only the change in lid margin abnormality and meibum expressibility in the mild\u2013moderate meibomian glands loss patients at baseline has a statistically significant difference p &lt; 0.05). Multiple linear regression shows that the improvement in OSDI is negatively associated with meibum expressibility score at the baseline (95% CI [\u221228.846, \u22121.815], p = 0.028). The patient compliance is 7.1 \u00b1 2.0 in the HOCL group and 7.1 \u00b1 1.8 in the control group (p &gt; 0.05). No adverse events are reported. Conclusion: Topical 0.01% HOCL through ultrasonic atomization is a tolerable and effective eyelid hygiene treatment for blepharitis.<\/jats:p>","DOI":"10.3390\/jcm12031164","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T01:53:54Z","timestamp":1675302834000},"page":"1164","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effect of Hypochlorous Acid on Blepharitis through Ultrasonic Atomization: A Randomized Clinical Trial"],"prefix":"10.3390","volume":"12","author":[{"given":"Hong","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China"},{"name":"Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqing","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xichen","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qihua","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyun","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xujiao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxu","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China"},{"name":"Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"P56","DOI":"10.1016\/j.ophtha.2018.10.019","article-title":"Blepharitis Preferred Practice Pattern\u00ae","volume":"126","author":"Amescua","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/S1542-0124(12)70620-1","article-title":"Blepharitis in the United States 2009: A Survey-based Perspective on Prevalence and Treatment","volume":"7","author":"Lemp","year":"2009","journal-title":"Ocul. Surf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"707","DOI":"10.2147\/OPTH.S132851","article-title":"Reduction in bacterial load using hypochlorous acid hygiene solution on ocular skin","volume":"11","author":"Stroman","year":"2017","journal-title":"Clin. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jtos.2017.05.011","article-title":"TFOS DEWS II pathophysiology report","volume":"15","author":"Bron","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1167\/iovs.10-6997e","article-title":"The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on the Epidemiology of, and Associated Risk Factors for, MGD","volume":"52","author":"Schaumberg","year":"2011","journal-title":"Investig. Opthalmol. Vis. Sci."},{"key":"ref_6","first-page":"Cd011965","article-title":"Topical treatments for blepharokeratocon-junctivitis in children","volume":"2","author":"Bunce","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jtos.2014.05.005","article-title":"Treatment of Blepharitis: Recent Clinical Trials","volume":"12","author":"Pflugfelder","year":"2014","journal-title":"Ocul. Surf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/ICU.0000000000000164","article-title":"Medical management of blepharitis","volume":"26","author":"Duncan","year":"2015","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/01.ico.0000244870.62384.79","article-title":"Clinical Treatment of Ocular Demodecosis by Lid Scrub with Tea Tree Oil","volume":"26","author":"Gao","year":"2007","journal-title":"Cornea"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.jtos.2019.06.004","article-title":"Efficacy of treatments for Demodex blepharitis: A systematic review and me-ta-analysis","volume":"17","author":"Navel","year":"2019","journal-title":"Ocul. Surf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1001\/archopht.1988.01060130789005","article-title":"Experience With a New Detergent Lid Scrub in the Management of Chronic Blepharitis","volume":"106","author":"Polack","year":"1988","journal-title":"Arch. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jtos.2017.10.005","article-title":"Randomized double-masked trial of eyelid cleansing treatments for blepharitis","volume":"16","author":"Sung","year":"2018","journal-title":"Ocul. Surf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.freeradbiomed.2012.05.008","article-title":"What really happens in the neutrophil phagosome?","volume":"53","author":"Hurst","year":"2012","journal-title":"Free Radic. Biol. Med."},{"key":"ref_14","unstructured":"(2023, January 01). NovaBay Pharmaceuticals, Inc. Available online: https:\/\/novabay.com\/wp-content\/uploads\/2015\/05\/avenova-with-neutrox-first-and-only-product-in-ophthalmology-containing-pure-hypochlorous-acid-compared-with-otc-product.pdf."},{"key":"ref_15","first-page":"3674","article-title":"Efficacy of topical 0.01% hypochlorous acid in reducing bacterial flora on lid margins compared to topical 5% povidone-iodine","volume":"59","author":"Gonzalez","year":"2018","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_16","first-page":"726","article-title":"Ocular safety profile of a new formulation based on hypo-chlorous acid in rabbit eye","volume":"62","author":"Romano","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/jocd.13280","article-title":"Topical stabilized hypochlorous acid: The future gold standard for wound care and scar management in dermatologic and plastic surgery procedures","volume":"19","author":"Gold","year":"2020","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S87","DOI":"10.1097\/ICL.0000000000000415","article-title":"Short-Term Comfort Responses Associated with the Use of Eyelid Cleansing Products to Manage Demodex folliculorum","volume":"44","author":"Ngo","year":"2018","journal-title":"Eye Contact Lens Sci. Clin. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ultras.2005.09.003","article-title":"Ultrasonic atomization: Effect of liquid phase properties","volume":"44","author":"Avvaru","year":"2006","journal-title":"Ultrasonics"},{"key":"ref_20","first-page":"8631038","article-title":"Hypochlorous Acid Can Be the Novel Option for the Meibomian Gland Dysfunction Dry Eye through Ultrasonic Atomization","volume":"2022","author":"Li","year":"2022","journal-title":"Dis. Markers"},{"key":"ref_21","first-page":"9","article-title":"Efficacy and safety of houttuynia eye drops atomization treatment for meibomian gland dysfunc-tion-related dry eye disease: A randomized, double-blinded, placebo-controlled clinical trial","volume":"12","author":"Liu","year":"2020","journal-title":"J. Clin Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jtos.2017.05.003","article-title":"TFOS DEWS II epidemiology report","volume":"15","author":"Stapleton","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.jtos.2017.05.001","article-title":"TFOS DEWS II Diagnostic Methodology report","volume":"15","author":"Wolffsohn","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Moon, S.J., Lee, W.-Y., Hwang, J.S., Hong, Y.P., and Morisky, D.E. (2017). Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0187139"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1136\/bjophthalmol-2020-317506","article-title":"Randomised assessor-masked trial evaluating topical manuka honey (Optimel) in treatment of meibomian gland dysfunction","volume":"106","author":"Li","year":"2022","journal-title":"Br. J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1016\/j.ophtha.2009.04.037","article-title":"Proposed Diagnostic Criteria for Obstructive Meibomian Gland Dysfunction","volume":"116","author":"Arita","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.ajo.2020.06.029","article-title":"Effect of 3-Hydroxy-3-Methyl-Glutaryl-Coenzyme A Reductase Inhibitors on the Meibomian Gland Morphology in Patients with Dyslipidemia","volume":"219","author":"Wu","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/00003226-199801000-00007","article-title":"Evaluation of subjective assessments and objective diagnostic tests for diag-nosing tear-film disorders known to cause ocular irritation","volume":"17","author":"Pflugfelder","year":"1998","journal-title":"Cornea"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/S1542-0124(12)70139-8","article-title":"Meibomian Gland Dysfunction: A Clinical Scheme for Description, Diagnosis, Classification, and Grading","volume":"1","author":"Foulks","year":"2003","journal-title":"Ocul. Surf."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"982","DOI":"10.3109\/02713683.2014.971929","article-title":"Evaluation of Meibomian Gland Dysfunction and Local Distribution of Meibomian Gland Atrophy by Non-contact Infrared Meibography","volume":"40","author":"Finis","year":"2015","journal-title":"Curr. Eye Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.ophtha.2007.06.031","article-title":"Noncontact Infrared Meibography to Document Age-Related Changes of the Meibomian Glands in a Normal Population","volume":"115","author":"Arita","year":"2008","journal-title":"Ophthalmology"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Wu, Y., Jiang, H., Zhou, X., Zhai, Z., Yang, P., Zhou, S., Gu, H., Xu, J., and Hong, J. (2022). Morphological and Functional Changes of Meibomian Glands in Pediatric and Adult Patients with Allergic Conjunctivitis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11051427"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jtos.2020.05.007","article-title":"Randomized trial of topical periocular castor oil treatment for blepharitis","volume":"19","author":"Muntz","year":"2021","journal-title":"Ocul. Surf."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.ajo.2009.09.023","article-title":"Sodium Hyaluronate Ophthalmic Solution Study Group. Demonstration of Efficacy in the Treatment of Dry Eye Disease with 0.18% Sodium Hyaluronate Ophthalmic Solution (Vismed, Rejena)","volume":"149","author":"Vogel","year":"2010","journal-title":"Am. J. Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ajo.2022.06.013","article-title":"Effect of Thermoelectric Warming Therapy for the Treatment of Meibomian Gland Dysfunction","volume":"242","author":"Gomez","year":"2022","journal-title":"Am. J. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1038\/s41433-021-01642-7","article-title":"Randomized double-blind trial of wipes containing terpinen-4-ol and hyaluronate versus baby shampoo in seborrheic blepharitis patients","volume":"36","author":"Arici","year":"2022","journal-title":"Eye"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2439","DOI":"10.4103\/ijo.IJO_2001_20","article-title":"Hypochlorous acid antiseptic washout improves patient comfort after intravitreal injection: A patient reported outcomes study","volume":"68","author":"Finger","year":"2020","journal-title":"Indian J. Ophthalmol."},{"key":"ref_38","first-page":"6740","article-title":"Dry eye patients report improvement in symptoms with hypochlorous acid use over 30 days","volume":"60","author":"Kern","year":"2019","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.ajo.2014.08.015","article-title":"Effects of Topical Loteprednol Etabonate on Tear Cytokines and Clinical Outcomes in Moderate and Severe Meibomian Gland Dysfunction: Randomized Clinical Trial","volume":"158","author":"Lee","year":"2014","journal-title":"Am. J. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2683","DOI":"10.1038\/s41598-019-38968-y","article-title":"Hypochlorous-Acid-Generating Electrochemical Scaffold for Treatment of Wound Biofilms","volume":"9","author":"Kiamco","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_41","first-page":"CD005556","article-title":"Interventions for chronic blepharitis","volume":"5","author":"Lindsley","year":"2012","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1164\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:21:18Z","timestamp":1760120478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1164"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,1]]},"references-count":41,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12031164"],"URL":"https:\/\/doi.org\/10.3390\/jcm12031164","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,1]]}}}