How can I treat MGD without warm compresses? Scared.

[eyes78]

I've posted here before about how warm/hot compresses make me worse, and I've "re-discovered" this at least 3 times now. The first time, I started doing them after I went to the Dr. for a blocked tear duct. I wasn't having dry eye issues at the time, but the Dr. informed me that I have blepharitis and told me to use HOT compresses.

A few days later, my eyes burned so badly I couldn't stand it, and I realized that the only thing I had changed was doing the compresses. So I stopped. Viola, eyes got better. (the blocked tear duct reopened the evening after my appt, my theory is the Dr. worked the blockage loose when he injected the saline to see if the duct was blocked).

A couple months after the above, I had eyelid surgery and my eyes got really dry. I did warm compresses to make them better. They got worse. I stopped the compresses, they got better.

About 6 weeks ago I began experiencing some burning in my left eye. Went to Dr., started Lotemax, Restasis. Eyes got better for a few days but got worse again when I discontinued the Lotemax. I started warm compresses again (taking the temperature of the water to make sure it wasn't too hot).

Eyes got so much worse, but it was strange, they were ok in the mornings, started getting bad midday, intolerable by bedtime.

I stopped the Restasis and the burning subsided immensely. Another week went by and I realized (duh!) - the warm compresses! I stopped them a few days ago - eyes are much better.

So what is my problem, you might ask? Well, 2 Dr.s have told me I have MGD. So what am I supposed to do about it if I don't do warm compresses or take Restasis??

I'm scared. My anxiety over my eyes possibly getting worse with OR without the warm compresses is through the roof.

I should note that I'm also taking 50mg doxycycline plus 1 - 2 doses of Theratears Nutrition (omega 3) supplement. Do you think this will be enough? Are warm compresses crucial to MGD treatment? I obviously can't do them . ..

Hopefully if the doxy helps I can just stay on it forever.

[khmedia]

Have you tried a shower with the water quite hot and the pressure low. I've been trying this in place of hot compresses which I find doesn't leave any white in my eye i.e so much inflammation.

[PotatoCakes]

One of my former doctors required me to use hot compresses multiple times a day. Besides sucking up all of my time, it didn't help my eyes because it only increased the inflammation. If *warm* compresses help a bit, or at all, try limiting the number of times you do them. Another thing you could try is following up the warm compress with a cool, green tea bag to help with the inflammation.

Remember, Dry Eye Disease isn't a one size fits all disease. Your doctor may be fantastic but it doesn't mean he's infallible or all-knowing and a disease like this doesn't have one specific 'cure'. The negatives of warm or hot compresses may be greater than the benefits for you (they are for me). Try modifying your pattern and if they still don't help or hurt, it's okay to discontinue them. This isn't something like a drug where you will have withdrawal symptoms so it's ok to experiment and find the right thing for you.

[PotatoCakes]

Someone posted this in a previous thread http://www.ncbi.nlm.nih.gov/pubmed/23665651

Also, Rebecca, I think, posted an article, blog or other a while back about whether compresses were a good thing. I can't find it now but maybe someone has it favorited or something and can post? I'll try looking again and if I can find it, I'll post.

[eyes78]

Thanks, Potatocakes. As it turns out, I will NOT be doing warm compresses anymore. I went back to the ophthalmologist yesterday and he said he was certain I have ocular rosacea and to stop with the warm compresses.

[Rebecca Petris]

There's a lot of ways to treat MGD... if heat IS necessary, as PC said, some kind of cool pack afterwards can help counteract heat-induced inflammation. But a doctor specifically recommending HOT compresses... ouch, not good advice, any recommendation of a compress must be accompanied by caution not to get it too hot. No reason for it to be any warmer than what's needed therapeutically. The only reason, I think, people get them too hot is so they'll stay warm longer. For people with rosacea who have been advised that they do need heat it can be helpful if you stick with the smallest possible heat source (like Thermoeyes Beads) so that you're literally only heating the lids, not the skin on your face.

PC I think maybe the one you're thinking about was about the perils of overdoing things. Sometimes doctors are pushing frequent compresses but sometimes patients figure more is better and they get to massaging the heck out of their lids and in their zeal, the poor lids get over-handled.

Personally... unless someone finds that warm compresses are really good as a feel-good thing with no detectable side effects, I think that they should only be done under the advice of a doctor who actually knows what they're talking about i.e. can distinguish between MGs that can benefit from heat versus situations where other treatments are more appropriate or where it's an underproduction issue not a chronic blockage issue for example. And again just personally, I think that having them checked out regularly is helpful... some people get an immediate boost from compresses but for others it's more of a long term maintenance thing that doesn't necessarily translate into immediate relief.

Anyway eyes78 wishing you the best for a new way forward with your MGs

[Rebecca Petris]

A couple months after the above, I had eyelid surgery and my eyes got really dry. I did warm compresses to make them better. They got worse. I stopped the compresses, they got better.

Blepharoplasty? It's pretty common to have dry eye afterwards from lids not quite meeting... have they checked for that?

[eyes78]

Thanks Rebecca! Yes, they checked to see if my eyes close completely (they do). I've also asked my husband to check when I am actually asleep (not closing my eyes for the Dr!).

[tealeaf]

Hi Eyes78,
I am currently doing warm compress (lightly warm only) once in the morning. Whenever I visited eye specialists and talked about MGD, they would recommend hotter compress or at least 8 mins or twice a day and each time when I followed their instructions, I would suffer a week of agony! Reading from this forum, I learnt that whatever routine that works for me, don't change even when doctors or other patients recommend as each one of us is different. If your eyes cannot take warm compress, don't do it. Maybe take warm showers instead and thereafter, massage lid gently using Q-tip and with another Q-tip, wipe off the debris from the lids. I will follow up by using cold eye drops to flush out any remaining debris.

[MGD666]

For people with rosacea who have been advised that they do need heat it can be helpful if you stick with the smallest possible heat source (like Thermoeyes Beads) so that you're literally only heating the lids, not the skin on your face.

Excellent advice here! My rice baggies (stockings) are quite small now, so that when applied, only cover the lids, and not the skin around or underneath the eyes. I did pick up a Therapearl™ eye mask recently (smaller version than their normal one) which is also about the perfect size actually, and can be microwaved or put in the freezer - and is a snap to clean. The one downside is that, being covered in plastic, it's a little too rigid to conform as well as it should. For a cold compress, I still like the imak™ mask, or a small bag of frozen peas.

[eyes78]

Thank you so much, all!

I just went to the dermatologist today to get another confirmation on the rosacea that my ophthalmologist diagnosed. I didn't really NEED confirmation, I just wanted a 2nd opinion; and since I've already blown through my deductible for the year, I figured why not.

He seconded my ophthalmologist's opinion that I can stay on the doxycycline long-term, plus he gave me about 20 sample tubes of some new drug (cream) that is supposed to lessen flushing/blushing for 12 hours at a time. I'll only use it on occasion, like if I have something really stressful come up that I don't want to be blushing for. Otherwise, my eyes are my main concern.

Note - I agree, MGD666, I have a Therapearl mask, too, that I use frozen. It's ok, but a little stiff. It works pretty well though.

[hannidan]

Good for you on stopping the warm compresses. I gutted out the warm compresses (at the recommendation of several eye doctors) and never did anything but harm my eyes. Finally, after 2 years, eye doctor #12 admitted my formally inflamed MG's were actually now ulcerated. The result is that one half of my MG's are now so badly scarred they can never function properly again. I suppose the eye doctors are happy, they got to charge my insurance company plenty of times for all those visits.

[PerfectEyes]

This string is old but just reading it as I am new. I was told to use hot compresses - to get them as hot as possible and even use the microwave. I would get them scalding hot to the touch. I did this the last month and just the last few days decided not to get them that hot. She also said to push really hard on the glands to get them moving. I stopped doing that so vigorously as well - that didn't seem right. I did end up in the ER last week though they said everything seemed ok. (?)

Oh well. I wish I had insurance that allowed me to follow-up properly. For now this site has been a great support and source of information, even the short time I've been part.

[MGD1701]

Hi, indeed w. compress (wc) (& massage, lid scrubs etc) issues are complicated and hard to monitor/master.

I think key points are identify
1) if glands are functional? if oil coming out, if yes, if oil is clear, thick, toothpaste-like etc.
as they link to what kind of w.c, temperature, how long wc should be etc.

2) Do you feel oil secretion when do wc? if not, adjust time or temperature should help for better results

I use
* Belphasteam/42.5C, proved to be (safe and) effective, according to research/doctors.
* a 20-zoom mirror to monitor gland status - often I can see (oil) drops (especially after wc.)

if you use microwaved/boiling masks/Gels - good to check temperature with Infrared Thermometer.