Does oil visibly come out with lid massage?

[redandunhappy]

Hi all,

Should you see oil coming out of the glands when you do lid massage?

The reason I ask is that doing warm compresses does seem to make oil come out (my vision goes cloudy for a bit), but when I try and massage the lids - either with a cotton bud (Q tip) or my fingers or, I never see anything at all.

I have been told that my my oil is quite clear, so I don't think my glands are really clogged, just a little underactive (cause of ocular rosacea and inflammation)....so should I stop trying to get more oil to come out?
Is it possible that mine could be coming out with just the heat?

What should I actually see when doing the lid massage with a Q tip?

Very grateful for any advice...

[littlemermaid]

Hi! If your oil is clear you might see tiny dots on inner lid edge with x10 magnifying mirror (Boots, Superdrug). I have never managed to see 'toothpaste consistency' but have seen 'baby oil consistency' and some interesting 'plugs'. Current techniques we have been advised to try: pull upper lid away from eye surface and pinch edge systematically, or stretch upper lid with finger, draw another finger along lid edge starting nose corner; pull lower lid away from eye surface and pinch systematically starting nose corner. Look at internet pictures of where glands actually are and imagine what you would do to squeeze oil out. Just to confuse you even more: one Dr Latkany thread asks why a patient was habitually emptying out the oil they needed; some here get more comfort from cold compress with rosacea inflammation?

Interested: What is actually making your eyes feel better? Have you found a comfortable oily tear drop?

[irish eyes]

Redandunhappy

It depends on what you mean by massage.

I have to use a fair bit of pressure on my lids to unclog the glands. At times, it has `toothpaste consistency' but in recent days, it has been a yellow, watery discharge. I've no idea why it varies and the consultant cannot advise on any new methods of dealing with it - just more of the same.

[redandunhappy]

Hi,

I knew I could rely on you two to reply! Many thanks for your advice and help again.

Littlemermaid - I'll buy a magnifying mirror and check what is happening, but can you see anything without it?

Re technique, I've tried a couple of times to pull my lid away from eye, but I'm really hesitant about it as I don't want to do any damage to my sore and sensitive lids. Which technique do you use?

Irisheyes - which technique do you use? Can you see the discharge very easily?

Might it be the case that warmth is enough for me to get my oil flowing? In which case I don't need to do the massage?

Not sure that anything is making my eyes feel better yet....I haven't found a comfortable oily tear drop - unfortunately the only one I know to be available over here is Clarymist and that seems to irritate my eyes. Of all the ones I've tried, Systane (Irish eyes very kindly sent me some vials) seems to be the best - doesn't seem to irritate, but on the other hand not sure it is doing much.

I'm trying to try one new thing at a time, so at the moment have just started again with warm and cold compresses.....will see how I get on. I think it does help a bit, but not sure if it's the cold or warm element or both......will do 2 weeks of both, then 2 weeks of just warm, then 2 weeks of just cold...

There are so many factors affecting things that it's very difficult to separate them all out and know what is making things worse or better....Air conditioning, eye drops, eye make up, facial products, warm and cold compresses, eye scrubs...

For example, most of the week I am at work in a horrible air conditioned office which seems to really irritate my eyes. So if I try new eye drops in this environment, I won't know whether any potential irritation is caused by the drops or the air con.

I think it's best to try new things in 'control' conditions - i.e. no air con, no make-up, no products on face, but that's very difficult to achieve.

[irish eyes]

Hi,

I knew I could rely on you two to reply! Many thanks for your advice and help again.

Littlemermaid - I'll buy a magnifying mirror and check what is happening, but can you see anything without it?

Re technique, I've tried a couple of times to pull my lid away from eye, but I'm really hesitant about it as I don't want to do any damage to my sore and sensitive lids. Which technique do you use?

Irisheyes - which technique do you use? Can you see the discharge very easily?

Hi there

Your question to Littlemermaid - I don't think I would manage without a magnifying mirror.

Your question to me about technique - I suggest you try only the lower lid to begin with.

You may not be able to see much in the way of blocked glands or white spots because the lower lid is often thinner than the top.


First bathe the eyes with warm water, clean round the lashes to get rid of any gunge.

Then (this is the way I do it) cover your thumb / nail with a piece of tissue. Place your thumb nail against the lower lid - so the nail itself is against the skin - just below the lashes.

Exert pressure - visualise where the glands will sit beneath the skin. Nudge your thumb nail along the lids a few times. This should dislodge some of the oil. You may need to do it a few times to get the hang of it. Clean the eyes afterwards.


Scroll down this site to the photos of the eyes - the 2nd image shows blocked and inflamed glands. Can you imagine unblocking these glands by gentle force? Q tips are fine but they break and shed fibres - that is not to say that I don't use them. Is this the same method you use?

http://www.eyesite.org/blepharitis

[littlemermaid]

Air conditioning and dry heated rooms

Littlemermaid notices huge difference at school in certain rooms: ICT (air con, also doesn't blink enough) and some classrooms (dry air) - eye probs, headaches, goes out to use drops. Overnight in hospital air con was unbelievably dry, longing for fresh air and rain, had to stick head out of window, medics gasping in heat. Optom said her skin dessicated every day. Environment is a big factor for us - humidifier in bedroom makes huge difference to comfort. Can you have humidifier at work? My husb is an IT manager guy and this is what people are doing now (health & safety, you know).

[irish eyes]

There are so many factors affecting things that it's very difficult to separate them all out and know what is making things worse or better....Air conditioning, eye drops, eye make up, facial products, warm and cold compresses, eye scrubs...

For example, most of the week I am at work in a horrible air conditioned office which seems to really irritate my eyes. So if I try new eye drops in this environment, I won't know whether any potential irritation is caused by the drops or the air con. .

I don't think the air conditioning can be doing your eyes any good at all.

How do you heat your home? I know that if I go to other people's homes and they have the heating on - then it's a nightmare for me. I've been in hospital twice in the last 6 years and on each occasion, I've been more anxious about the environment than the actual medical procedure.

We have woodburning stoves at home and if the room is too hot, I place bowls of water around the room so it gives off a bit of humidity. I've thought about buying a little humidifier but the water works just as well.

Does your employer know about the problems? Might there be a simple solution with office space? Is there anyone at work you can talk to in confidence about?

Sorry - I don't mean to appear like an official inquisitor!

[redandunhappy]

hello again,

Irish eyes - Thank you so much for taking the time to describe the technique you use. I've been using the first technique described in Dr Latkany's book (warming with a rice baggie, then using cotton buds dipped in boiled water to exert pressure under the eyelid, then cleaning the eye - and then I've been doing a cold compress for 5 mins as well), but as you say, perhaps I ought to exert a little more pressure, so will try your thumbnail technique.

I don't mind your questions at all - you are only trying to help me. I have central heating at home, but I have a humidifer that I use in different rooms according to what I'm doing. It's less of an issue now that the heating isn't really on, but the humidity was between 25-30% in the cold months.

Little Mermaid - thank you for your suggestions re work (and Irish eyes also). I did my employers to test the humidity in the building a few months ago and it was very low - around 20%. But unfortunately on my floor and in most of the building , there is no way for them to control the humidity. I did speak to the health and safety advisor, and she said that although it's recommended that the building humidity is between 40-60%, it's not the law. I could have probably made my particular department buy me a humidifier, but in the end it was quicker and easier for me to get one myself, which I did.

However, I work in a big open plan office, so my little humidifier can't really do much to the overall atmosphere....I think it helps increase the humidity in the tiny space around it, so I do try and sit right underneath it, but still it doesn't work that well, and in addition isn't that pleasant having a stream of cold air in your face all the time. But I think my eyes might be even worse if I didn't use it...

What I really need to do is find a good drop to use (Irish eyes I do think systane might be helping a little actually, so thank you) and I'd also really like to try AzaSite....if you now anyway of sourcing it, please do let me know.

Thanks again for your help and support both of you.

[irish eyes]

Hi

I hope you can get the hang of things - I think this is something that eye doctors should really show patients how to do. It's all very well having the procedure done for you followed by comments on how easy it is for you to `do at home'. Well it might be - once you know!

Pleased to hear that the Systane might be helping a bit. Your question about Azasite; it's not available in the UK (as you know) and I'm not aware of any plans for it to be marketed in Europe. Did you see this thread on the same topic?

http://www.dryeyezone.com/talk/showthread.php?t=10962

It's tough about the office environment. If I ever have to go on training events away from the safety of my own little office - I always grab a place near the door so at least I don't get feelings of being hemmed in - should I need to leave because the environment is too stuffy. I sometimes take one of those facial sprays with me -the effects are only short lived but it can be better than nothing. (Isn't this all a pain? As if life wasn't hard enough).

[redandunhappy]

Hi Irish eyes, thanks for alerting me to that thread. Unfortunately, I don't think the product sold by the site that Sazy had found is the same - apparantly it doesn't have the same delivery system (I have messaged Sazy privately and she told me she's tried it, but it wasn't thick enough)

So back to square one re sourcing it here - I will try and find it on the internet and post back if I have any luck...(not holding out too much hope)

By the way have just been to see Michel Guillon in Sloane Square - he has suggested a whole new regime for me including Blephaclean, Theratears gel, Theratears eyedrops and Active (a spray which does have on oil component).

It was good to finally speak to a professional that understands my symptoms, but a little bit depressing too because he told me the new veins in my eyes will never go away although they should become less pronounced (It's the deep vessels which are permanently dilated now - I only have one noticeable one in each eye, but I really hate them).

Also he says that my glands are mostly not blocked, my oil is of an ok consistency but I am just not producing enough of it, resulting in evaporative dry eye.....so he said I'm wasting my time doing warm compresses (and could be aggravating my irritated eyelid margins)...but I'm not sure whether this is the best advice because I do definitely notice oil coming out if I heat my eyelids and my eyes definitely look and feel better aftewards. But on the other hand, I do have ocular rosacea so perhaps it will not help my inflammation in the long term...hard to know what to do for the best...

I forgot to ask him, but I still wonder what is causing the inflammation in the first place and whether it is my ocular rosacea or not...and whether my mild MGD is being caused by the inflammation or something else...

Sorry for rant, I am just thinking aloud!

[littlemermaid]

Saponification

Just to confuse things again, littlemermaid didn't like cleaning products that seemed to strip surface of tears: seemed like saponification process described here by Dr John Hovanesian, Harvard Eye Associates, in Dry Eye Treatment part II on YouTube http://www.youtube.com/watch?v=HSF45...eature=related

Also had veins across iris, now reduced to invisible ghost vessels by FML regime, successfully tapered (eyes maintained by Celluvisc). Only an ophth can prescribe. Have you tried Western Eye Hospital or John Radcliffe, or are you happy?

[redandunhappy]

Hi littlemermaid, thanks for the link. What a great doctor, I ended up watching the whole lecture....if only I could see someone like that here.

Fortunately I don't think saponification is a problem for me as my oil is apparently clearish (just don't have enough of it), but it's interesting to see what can happen if you have oil of toothpaste consistency and then you start add chemicals to the mix. Sounds like it can make things so much worse, so I hope people know about it.

But I appreciate you alerting me to cleaning products. I've read Dr Latkany's book and he doesn't like scrubs or cleaning products either. Keep getting conflicting advice so not sure what to do - particularly regarding warm compresses.

So in answer to your question, I'm not happy at all. Would be great to get a second opinion from someone else who really knows what they are talking about. Have you been to the John Radcliffe or Western Eye Hospital? If so is there anyone there that you recommend? Did you go privately or get an NHS referral?

Your poor child having to deal with this horrible condition - it's bad enough as an adult, but must be awful going through it as a kid. Very glad to hear you have it all under control though. And very pleased to hear that she no longer has visible veins on iris....and that's very encouraging for us folk who think we are stuck with them forever...I suspect I may be, but I hope at least to improve their appearance.
What's FML by the way? I've been racking my brains but can't think...

Thanks so much for help and support again

[irish eyes]

I've read Dr Latkany's book and he doesn't like scrubs or cleaning products either. Keep getting conflicting advice so not sure what to do - particularly regarding warm compresses.

So in answer to your question, I'm not happy at all. Would be great to get a second opinion from someone else who really knows what they are talking about. Have you been to the John Radcliffe or Western Eye Hospital? If so is there anyone there that you recommend? Did you go privately or get an NHS referral?

Hi there

I've reached the conclusion that `cleaning products' are best left alone. I've swapped and changed so often and always return to the old salt & water trick.

Michel Guillon seems to have set you quite a regimen there - I'm not saying he's wrong but I wonder if all of it is necessary? When you say Active spray, is that something like Eye Logic (used to be called Clarymist). What are his goals?

Have you discontinued with the lid massage / expressing?

[redandunhappy]

Hi Irish Eyes,

Good to hear from you. I haven't actually bought any of the products that Michel Guillon recommended, I'm still thinking about what to do.

I was getting mixed up, he said to use Optive, not Active. I'm sure he said it was a spray but now I'm looking on the internet and it's drops. Michel says it has an oil component. Eye Logic/Clarymist seemed to irritate, although I might try once again before finally ruling it out...it does have a preservative in it (which apparently evaporates before hitting the eyes) which I supppose is the problem. But so does Optive.

I do wonder too if all of the things he recommended are necessary. His goal he said was to make my eyeballs as wet as possible all the time (particularly in dry office environment) to try and reduce the inflammatory process going on in my eyes and eyelids.
Dr Latkany seems to initially try to get to the route of the problem if at all possible rather than flood the eye with artificial products. Trouble is I'm not sure how you can fix your meibomian glands not producing enough oil.

I'm sure that when my eyes feel dry, my eyelids start feeling sore too (apart from the friction between dry eyeball and eyelid, there is some sort of feedback loop I think?), so perhaps it is sensible to try and make my eyes as wet as possible for a few weeks, and then the inflammation in my eyelids will decrease too.

He did say that the regime can be tapered if successful after a few weeks. To my horror, he said that if that all didn't help, I'd have to wear moisture goggles at work! There is no way I can do that...I work in a big open plan office - it's bad enough having to field questions all the time about my humidifier, there is no way I can sit there looking like I'm about to go snorkelling!!!!

Anyway, at the very least, I will definitely try Theratears, as many people seem to recommended it, and I haven't tried that category of artificial tear yet.

I haven't stopped doing my warm and cold compresses/massages . I remember now, as well as telling me not to do warm compresses, he also told me off for using frozen peas from the freezer covered in kitchen roll for my cold compresses. He said it was dangerous to use something so cold...perhaps he has a point, but I've tried one of those gel masks that you put in the fridge and it's barely cold for more than about 1 minute! Any suggestions anyone?

Anyway I digress...I'm going to continue to do both compresses for another few days - until I've been doing them 2 weeks - then I'm going to try just cold compresses for 2 weeks and see what the difference is.

Your help is much appreciated again....thank you

[Guest]

To my horror, he said that if that all didn't help, I'd have to wear moisture goggles at work! There is no way I can do that...I work in a big open plan office - it's bad enough having to field questions all the time about my humidifier, there is no way I can sit there looking like I'm about to go snorkelling!!!!

Not sure what's available where you are for goggles... is there anything similar to the Wiley's that we have here? The sunglasses style doesn't look too bad, actually...

I'm a goggles-at-work girl these days... I can totally relate to feeling horrified at the thought... but you get used to it... I wear either my Wiley's or MEG's...

I have not only my co-workers to see me in them, but the tons of strangers every shift, since I work with the public... I would think only dealing with co-workers would be easier since there is a limit to how many people would ask what's wrong... once they are told, there won't be anyone else left to ask...

I must say though, it's starting to get to me... the whole explaining to people why I'm wearing them... had about 5 customers asking me about it tonight... they were very nice and all, but seeing the huge look of sympathy on their faces gets me down at times... it just reminds me how much this totally sucks... weird.. sometimes sympathy is comforting... makes you feel like someone understands you... but other times, not so much... so anyhow, I can totally understand your horror

But on the bright side, although it's tough sometimes to explain about your eyes when you'd rather just forget about it, I haven't had one single person be unkind about my wearing Wiley's or MEG's...

Anyhow, hopefully you won't end up having to wear the goggles... but if you DO, you'll survive... it seems like the most horrible thought to be seen like that, but it's the first time that's the hardest... it gets easier after that every time you wear them...