Cleaning Your Eyelids: Baby Shampoo and the Alternatives

Key takeaways

• Baby shampoo is not banned or discredited. As of its 2023 Preferred Practice Pattern, the American Academy of Ophthalmology still describes lid cleaning with "diluted baby shampoo or commercially available eyelid cleaner" as something that can be done safely.
• The best head-to-head trial found a dedicated cleanser did better on the tear film, while meibomian gland capping and the mucin MUC5AC worsened on the baby shampoo side. Both improved crusting equally.
• A second trial in 60 people found no significant difference in symptoms between baby shampoo and a commercial cleanser at 4 and 12 weeks. The evidence is not one-sided.
• The formula changed. The Johnson's Baby Shampoo recommended in the 1990s is not the product on the shelf now, which matters for both the old advice and the old studies.
• "As gentle to the eyes as pure water" is a claim about shampoo splashing a child's eye in the bath. It is not a claim about twice-daily scrubbing of the lid margin, and the manufacturer does not make that claim.

Why you were told to use baby shampoo

If an eye doctor told you years ago to scrub your lids with diluted baby shampoo, they were giving you the mainstream advice of the time. It was cheap, available in every supermarket, and formulated not to sting. For a condition whose treatment is mostly about doing something small every day, cheap and available count for a lot.

What has happened since is not that the advice was debunked. It is that the comparison got tested, purpose-made alternatives arrived, and the evidence turned out to be more mixed and more interesting than either side of the argument usually admits.

What the trials actually found

Two randomised trials have compared diluted baby shampoo directly against a commercial lid cleanser, and they do not agree.

The study that changed minds

A 2018 trial in The Ocular Surface enrolled 43 people with blepharitis in a double-masked, paired-eye design: a dedicated eyelid cleanser on one eye, diluted baby shampoo on the other, twice daily for four weeks.

Both treatments improved crusting and several other signs, with no difference between them. Baby shampoo was not inert and it was not useless. That part often gets left out.

Where they differed matters, though. Improvement in the tear film lipid layer and in the inflammatory marker MMP-9 was limited to the dedicated cleanser side. On the baby shampoo side, meibomian gland capping worsened, and so did expression of MUC5AC, the mucin that conjunctival goblet cells produce.

Being precise about that last one, because it gets overstated: the study measured MUC5AC expression, not goblet cell density. We have not found any study measuring goblet cell numbers before and after baby shampoo scrubs, so anyone telling you baby shampoo destroys your goblet cells is going beyond the evidence.

Read the trial at its size: 43 people, four weeks, one centre, surrogate endpoints. It is the best comparison available and it is still a small early study.

The study that cuts the other way

A 2020 trial in Medicine enrolled 60 people with grade 2 meibomian gland dysfunction, randomised to diluted baby shampoo or a commercial foaming lid cleanser, assessed at 4 and 12 weeks.

Symptom scores improved significantly in both groups, and the difference between the groups was not statistically significant at either point. The authors concluded that efficacy, compliance and complications were not significantly different between the two.

That study ran three times longer than the 2018 one, which is a real strength. Its endpoint was a symptom questionnaire rather than tear film measurements and cytology, which is a real weakness. Both groups also used warm compresses, so the compress effect cannot be separated out.

Put together, the fair summary is that baby shampoo relieves symptoms about as well, and that where the two have been compared on the tear film and the glands themselves, the dedicated cleanser came out better.

Who currently recommends what

This is where it gets genuinely confusing for patients, because respected bodies have not converged.

The American Academy of Ophthalmology's Blepharitis Preferred Practice Pattern, approved in September 2023, states that "cleaning the eyelid can be safely accomplished by having the patient gently rub the base of the eyelashes using either diluted baby shampoo or commercially available eyelid cleaner on a pad, cotton ball, cotton swab, or clean fingertip". The same document notes that hypochlorous acid at 0.01 percent "has a strong antimicrobial effect which has been used for the treatment of both anterior and posterior blepharitis", and adds a caution worth carrying: "Although some efficacy has been demonstrated for several types of eyelid wipes, there remains a lack of robust evidence to support their routine recommendation."

The American Optometric Association's consumer page tells patients to "gently scrub the eyelids with a mixture of water and baby shampoo or an over-the-counter lid cleansing product".

The NHS in the UK, in a page reviewed in June 2025, suggests cleaning the lids with cotton wool or a cotton bud and says "it might help to use a small amount of baby shampoo in water".

Against that, EyeWiki, which is published by the Academy of Ophthalmology, argues the other way, stating that aside from colour and fragrance, "baby shampoo contains soaps that can destabilize the tear film and damage the ocular surface".

So the Academy's formal practice pattern and the Academy's own wiki take different positions. That is not a scandal, it is what a field looks like while evidence accumulates, and it is more useful to you than a false consensus.

The detail almost nobody mentions: the formula changed

The product an older customer was told to buy is not the product on the shelf today.

The older US formula listed ingredients including sodium trideceth sulfate, quaternium-15, and the dyes Yellow 10 and Orange 4. Current listings show a different set built around cocamidopropyl betaine, decyl glucoside and sodium cocoyl isethionate, with the dyes gone, and the product now marketed as having no added parabens, sulfates, dyes or soap.

Two consequences follow. Your doctor's advice from 2004 referred to a formula that no longer exists. And the studies that tested baby shampoo tested whichever formula was current at the time, which is a limitation nobody can fully resolve.

About "as gentle to the eyes as pure water"

This is the manufacturer's claim and it is doing a specific job. It describes a diluted, rinse-off product that splashes into a child's eye during a bath and does not sting. It is a claim about irritation on brief accidental contact.

It is not a claim that the product is appropriate for deliberate twice-daily application to the lid margin, where the meibomian glands open, and the manufacturer does not make that claim.

On ingredients, one deserves naming: cocamidopropyl betaine appears in both the old and current formulas, and it is the only component with a documented eye-adjacent harm in the literature, a 2014 case report of chronic eyelid dermatitis from cocamidopropyl betaine allergy in a patient using baby shampoo lid scrubs. One case report is the weakest kind of evidence, and a 2018 review confirmed it was the only adverse reaction case study identified. It is worth knowing, not worth panicking over.

For the other surfactants in the current formula, we found no study testing any of them individually on the human ocular surface, lid margin, tear film or meibomian glands. We are saying that plainly rather than inferring harm from absence.

Other things people use, and what is actually known

Ranked roughly by how much evidence sits behind them.

Hypochlorous acid. The best supported of the alternatives. The Academy's practice pattern states that 0.01 percent hypochlorous acid has a strong antimicrobial effect used in both anterior and posterior blepharitis.

Tea tree oil and terpinen-4-ol. The practice pattern notes reports of tea tree oil being effective for controlling Demodex blepharitis. A 2022 randomised double-blind trial of wipes containing terpinen-4-ol against baby shampoo found lower symptom scores with the wipes at 8 and 12 weeks, and concluded that they "may provide a better symptomatic relief compared to BS after 8 weeks of treatment". Note the hedge, and note that baby shampoo was the active control, meaning that as recently as 2022 it was the standard to beat.

Plain warm water and a clean flannel. Endorsed by the NHS as the first step, and the warm compress part is the least controversial element of any lid routine.

Facial cleanser, micellar water, dish soap, witch hazel, baking soda, tea bags. We looked for evidence on these and did not find studies examining them on the lid margin. That is not a finding that they are harmful; it is an absence of evidence, and we would rather tell you that than invent a verdict. Dish soap is the one where the general principle about concentrated surfactants near the eye should give anyone pause.

Technique matters more than the product

The Academy's description is specific about gentleness: gently rubbing the base of the eyelashes, using a pad, cotton ball, cotton swab or a clean fingertip. The NHS describes soaking a clean flannel in warm water and holding it on the closed lid for 5 to 10 minutes, a gentle 30-second massage, then wiping along the lid edge.

Two things are worth drawing out. The warm compress comes first, because it softens what you are trying to remove. And the target is the lid margin at the base of the lashes, not the eyeball and not the whole eyelid.

A 2012 Cochrane review of 34 studies in 2,169 people concluded that despite all those trials "there is no strong evidence for any of the treatments in terms of curing chronic blepharitis", while noting that lid hygiene "may provide symptomatic relief". That review is now well over a decade old and predates the trials above, but its central point stands: lid hygiene manages this condition, it does not cure it, and consistency matters more than which bottle you buy.

What we would actually suggest

If baby shampoo is working for you, your doctor recommended it, and your eyes are comfortable, the evidence does not say stop. The Academy's own practice pattern still lists it.

If you are choosing now, a dedicated cleanser is the better-supported option, and it is the one that performed better on the tear film and the glands in the trial designed to compare them. If your issue is Demodex or crusting at the lash base, that is a specific conversation to have with your eye doctor, since the products aimed at it differ.

And whichever you use, the routine is what does the work. A product used four times a week beats a better product abandoned in week three.

Frequently asked questions

Is baby shampoo safe for cleaning eyelids?

The American Academy of Ophthalmology's 2023 Blepharitis Preferred Practice Pattern states that lid cleaning can be safely accomplished using either diluted baby shampoo or a commercially available eyelid cleaner. The American Optometric Association and the NHS also still suggest it. Trial evidence comparing it with dedicated cleansers is mixed, and is summarised above.

Has baby shampoo been proven to damage the eyes?

No. The strongest specific findings come from one 43-person, four-week trial, in which meibomian gland capping and MUC5AC expression worsened on the baby shampoo side while the dedicated cleanser side improved on the tear film lipid layer. A separate 60-person trial over 12 weeks found no significant difference in symptoms or complications between the two.

Does baby shampoo reduce goblet cells?

That claim goes beyond the evidence. The trial in question measured expression of MUC5AC, the mucin goblet cells produce, not the number or density of goblet cells. We found no study that has measured goblet cell density before and after baby shampoo lid scrubs.

The bottle says it is as gentle as pure water. Why is this even a question?

Because that claim describes a diluted rinse-off product briefly splashing a child's eye, which is about stinging. It is not a claim about applying the product to the lid margin twice a day, and the manufacturer does not make that claim.

Is the baby shampoo I was told to use the same one on the shelf now?

No. The older US formula included ingredients such as sodium trideceth sulfate, quaternium-15 and the dyes Yellow 10 and Orange 4. The current formula is built around different surfactants, with the dyes removed.

What should I use instead?

Dedicated lid cleansers come as wipes, foams and hypochlorous acid sprays. Hypochlorous acid at 0.01 percent is described in the Academy's practice pattern as having a strong antimicrobial effect used in both anterior and posterior blepharitis. Which suits you depends on what is actually going on with your lids, which is worth confirming at an exam.

Can I use facial cleanser, micellar water or dish soap?

We found no studies examining these on the lid margin, so we cannot give you an evidence-based answer either way. Given that the whole debate above is about how mild surfactants behave on the lid margin, a concentrated detergent such as dish soap is not a sensible place to experiment.

How often should I clean my eyelids?

Follow the routine your eye doctor gives you and the instructions on whichever product you use. The consistent finding across this literature is that lid hygiene manages blepharitis rather than curing it, and that long-term compliance tends to be poor, so a routine you will actually keep is worth more than an ideal one you will not.

Sources

1. American Academy of Ophthalmology. Blepharitis Preferred Practice Pattern, approved September 2023.
2. Sung J, Wang MTM, Lee SH, et al. Randomized double-masked trial of eyelid cleansing treatments for blepharitis. The Ocular Surface. 2018;16(1):77-83.
3. Aryasit O, Uthairat Y, Singha P, Horatanaruang O. Efficacy of baby shampoo and commercial eyelid cleanser in patients with meibomian gland dysfunction. Medicine (Baltimore). 2020;99(19):e20155.
4. Arici C, Mergen B, Yildiz-Tas A, et al. Randomized double-blind trial of wipes containing terpinen-4-ol and hyaluronate versus baby shampoo in seborrheic blepharitis patients. Eye. 2022;36:869-876.
5. Khaireddin R, Hueber A. Lid hygiene for contact lens wearers with blepharitis. Der Ophthalmologe. 2013;110(2):146-153.
6. Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database of Systematic Reviews. 2012.
7. Welling JD, Mauger TF, Schoenfield LR, Hendershot AJ. Chronic eyelid dermatitis secondary to cocamidopropyl betaine allergy. JAMA Ophthalmology. 2014;132(3):357.
8. College of Optometrists. Evidence base for the effectiveness of lid hygiene in the management of blepharitis, August 2018.
9. American Optometric Association. Blepharitis, consumer guidance.
10. NHS. Blepharitis, last reviewed 12 June 2025.
11. EyeWiki, American Academy of Ophthalmology. Blepharitis.