This is a great questions!
The answer really depends on skin type for most patients, if you Demodex or if any type of bacterial induced blepharitis is present. Most of the companies say they are the best. Avenova, noted below, needs an Rx and a coupon as it can be pricey. They say the kill the most bacteria and mites out of all the brands. Tea Tree Oil, though, does a good job, at half the price, but I have not seen a good randomized, controlled, double blinded study with thousands of patients in each arm. This mean, every person sometime has to try to see which one they like the best. This is frustrating for the patient and the the doctor.
Most patients do well cleaning their eyelids daily with dilute baby shampoo. Some patients’ skin dry out easily with diluted baby shampoo and prefer Ocusoft or Avenova spray (Rx needed).
If someone has Demodex blepharitis or even bacterial blepharitis (ie, Staphylococcal), diluted Tea Tree oil (diluted 50% with olive oil or water) works best: scrubbing eyelids while closed & washing off after 1minute.
The options to clean your eyes are:
1. Use plain warm water to wash your face alone.
2. Use plain warm water with soap.
3. Use plain warm water with baby shampoo. Some feel this dries out their skin & eyes too much.
4. Use plain warm water with dandruff shampoo: but this can burn. Some patient with a history of seborrhea dermatitis or dandruff, use Selsun blue to clean their eyelashes and eyebrows, but others say it burns too much.
5. Use plain warm water and they scrub eyelashes with Diluted Tea Tree Oil (50% dilution with olive oil, coconut oil, mineral oil, or water) as noted above. Tea Tree Oil is a natural antibiotic, and anti-mite over the counter oil. It works well on
many issues from Blepharitis to Dermatitis for some patients. Some patient’s can have an allergy to TTO. I know 1 patient who does not like the smell. Some patient feel it burns too much and cannot tolerate. I love TTO but am close to a sink when using it as it does burn terribly if I have not used it in a few days or weeks.
6. Cliradex: towlets of pre-diluted Tea Tree Oil. They can be dipped in water or olive oil to “dilute” a bit more if too strong. Sold on Amazon.
10. Ocusoft HypoChlor 0.02% Hypochlorous Acid Eyelid and Eyelash Spray 2 fl oz (59ml): Also works very well. Some patients find it irritating, so it depends on your skin’s tolerance as to which one is the best for you.