My Hygiene,Glands Openning & Squeezing (expressing oil), Complete Routine

[HOSADOS]

Over the years, I have tried many drugs/ drops and nothing helped even a little bit.

However earlier this year, I came up with a way to put the belpharitis under control. I figured that the bacterial are inside the meibomain glands as well, so if I release the trapped oil and try to stabilize the unstable lipid oil frequently and clean the lid margin and eye lash every two hours or so that would help. Doing so even at night for two month did the trick so now I just must keep up with this routine.

If I'm not mistaken, since I started using Clarymist I think it improved the melting point of the trapped lipid oil, so I find that I don't have to squeeze the meibomian glands as frequent as before (every 2-3 hours), however, Clarymist doesn't seems to help as a eye drop for my dry eyes so I use it only to treat my MGD .

After adding Dr. Holly's drop ( in June/Jully) that was the first time something really helped with the my dry eye, and I think that also improved the blepharitis and MGD. those drops really keep the eye wet for quite some time. This where the point when my eyes started to heal their damage. So after 1-2 months when the damage was recovered, the drops was even more effective in terms of keeping the eye wet. Not that it completely solved my problem but for the first time something actually worked ! and that is a big achievement.

Another secret is that medidate to deal with body and mental pain (as I explained in the past) and use TranquilEyes while I meditate and while I sleep and that of course help a lot.

[HOSADOS]

Warm compresses may be combined with eyelid massage. This is especially important in patients who have Meibomian gland dysfunction (MGD). An analogy here will clarify the issue. In MGD the meibomian secretions are turbid and the gland openings are clogged. Think of a toothpaste tube which has butter (instead of toothpaste). When cold, you will not be able to express the butter out of the tube. However, once you heat it, then the butter will soften enough to come out of the tube, but pressure on the tube (squeezing) would still be necessary. Going by this analogy, after warm compresses, the turbid meibomian gland secretions are more fluid, but massage is necessary to express them.

[HOSADOS]

my the basic treatment+ eye drops I use

(1) The Goal: is to open the glands oppening and clean the greasy oil
I start my routine with lid care (external and internal side of the eye lashes, and I also clean the lid margin where the gland openings are.

For that take the lower lid for instant: take a Q-Tip holding the q-tip at the eye lashes area (external side) just below the eyelid margin, and then press it gently into the skin (it's ok to feel the eyeball), so you get the effect of the lid margin flip/curl over the q-tip. Now you could easily gently clean/scrub/rinse your lid margin and the internal side of the lashes while having your eyes open. Repeat this procedure for the upper lid and for the other eye.



(2) The Goal: to melt the lipid oil trapped inside. Usually one of the problem or symptom if you will in MGD is a higher melting temperature of the lipid oil.

Followed by a hot compress (baggy rice). I apply the hot compress at least for 3-5 minutes on each lid (upper and lower lids separately). Now that my glands are open, I could actually feel when the trapped oil reach to its melting point. Each individual, has to figure out based on his or her own experience, how long and what level of heat is appropriate for his condition.

My personal experience, suggests that in the beginning of the process, when my eyes condition were horrible and damaged, my lid skin was very sensitive to the heat and many times I found my lid skin getting burned.I also had to apply the hot compress for quite a long time and to keep it very hot in order to get the melting effect.

However, as my eyes recovered and as my epithelium started to heal, my sensitivity was significantly reduced, and I found that I require shorter time and less heat in order to reach to the melting point.

After many trials, I found methods and products that work for me, and I would be more than happy to share that with you all. I use Tears Again Advanced Liposome Spray (Clarymist in the u.k) and Dr. Holly's drops. I found that when using Clarymist, the melting pointing of the trapped lipid oil was lower, thus, shorter heating time and lower temperature was required until reaching the melting point. This finding, make sense if you review the science behind this (I'm not going to get technical here, but stabilizing the lipid oil is what probably do the trick).

Moreover, at least in my case Clarymist has with not doubt reduced the sensitivity of my lid skin to heat due the moist it add directly to the lid skin. Whereas Dr. Holly's drop (personally, I'm a big fan of the combination of Freshkote [Clinitas Ultra 3 in the u.k] and Nutratear [contains vitamin B12 that heal the epithelium] which keeps my eyes wet, and played an essential role in my eyes healing and recovery, and in this context made both my eyes and lid skin less sensitive to the heating effect.



(3) The Goal:to express and squeeze out the trapped lipid oil after it melted, by forcing the oil out all the way from where the glands start to their opening in the lid margin

Immediately right after the hot compress, I squeeze and express the lipid oil from the Meibomian Glands. In short, take a Q-tip (Cotton Bud) and divide it into two parts in 1/3 of its length. so now you have 1/3 of a Q-tip for the lower lid, and 2/3 of a q-tip to the upper lid.

For what I do next, let's take the left eye for example to better illustrate the procedure: Let's start with the upper lid. Put the index finger of your left hand on the outer corner of the eyelid. Pull the eyelid sideways towards the ear, so that the eyelids are stretched taut. Then with the right hand (opposite hand) , position the 2/3 length Q-tip in parallel to the lid margin/ eyelashes area line horizontally, balancing and supporting it with the finger of the left hand.

Now, starting from the top of the lid (where the lid start starts), roll it like a roller-pin all the way down toward the lid margin and to the eye crack, while applying firm but gentle pressure. The closer I get to the lid margin, I use more force when pressing into the eye (it's ok to feel the eyeball), and squeeze the lid margin tips.

Do the same for the bottom lid of the left eye: Put the index finger of your left hand on the outer corner of the eyelid. Pull the eyelid sideways towards the ear, so that the eyelids are stretched taut. Then with the right hand (opposite hand) firmly roll the 1/3 Q-tip like a rolling-pin horizontally up and down all across the meibomain glands from the bottom of the lid (above in the upper lid margin) all the way up to the lid margin, in order to stimulate it and force the lipid oil and push it toward the lid margin all over the lid all the way toward the lid margin.

Following that, once again put the index finger of your left hand on the outer corner of the eyelid. Pull the eyelid sideways towards the ear, so that the eyelids are stretched taut. Use the Q-tip pointed head with your right hand (opposite hand) to apply direct pressure to the taut eyelid margin starting at the inner aspect of the eyelid near the base of the nose. Sweep and slide it with firm but gentle pressure towards the ear, and all the way back toward the base of the nose. Repeat this maneuver four to five times.
Remember, that the goal is to apply gentle pressure to the eyelids - so just rubbing the eyelid surface will do you no good.

*Some folks, might find it more comfortable to use their finger instead of a q-tip. In this case, follow the same procedure only with your one of your fingers (which ever make sense to you) instead of using a q-tip. With that said, don't forget to wash your hands with soap prior to this.



(4) The Goal: to open the clogged gland openings that remained closed after the previous step, giving it more care and attention

* this step is optional, and I do this step only as part of my twice a day routine(morning/evening routing) but not during the day, you may choose to apply this step based on the time available and the severity of your condition.

For some folks this might be appropriate only once in a while, while for others whose glands are still blocked and clogged a more frequent action would be more appropriate.

First of all, put the index finger of your left hand on the outer corner of the eyelid. Pull the eyelid sideways towards the ear, so that the eyelids are stretched taut.start with stimulating the Meibomain Glands. Take the lower lid for instant, and with your other hand- apply the pointed head of a Q-tip into the bottom of the lid where it starts, and slide it gently from one side to the other. Then move Q-Tip a little bit higher and repeat with this maneuver. and then move up again and repeat that process until you reach the lid margin.

When I get to the eye lash area I usually poke gently moving from one side to the other instead of sliding in order to avoid tearing out (cutting off) eye lashes unintentionally…

Some folks, might find it more comfortable to use their finger instead of a q-tip. In that case gently close the eyelids. Put your index finger on the outer corner of the eyelid. Pull the eyelid towards the ear, so that the eyelids are stretched taut. Next, use the index finger of the opposite hand to apply direct pressure to the taut eyelids starting at the inner aspect of the eyelid near the base of the nose. Sweep with firm but gentle pressure towards the ear. Repeat this maneuver four to five times. Remember that the goal is to apply gentle pressure to the eyelids - so just rubbing the eyelid surface will do you no good.

Following that, I take a Q-Tip holding the q-tip at the eye lashes line (external side) just below the eyelid margin, and then press it gently into the skin (it's ok to feel the eyeball), so you get the effect of the lid margin flip/curl over the q-tip. Now, with the other hand hold another Q-tip and poke/press firmly the inner side of the lid margin toward and against the horizontal q-tips, in order to squeeze the oil (I like to press it firmly and slide it up firmly to the tip of the margin squeezing it tightly). You could raise the horizontal q-tips until you find the right position. Don't be afraid to squeeze it firmly, since when you have a very tiny skin area pressed between the two q-tips, pain is minimal if at all...You could also slide firmly the q-tips in the internal side of lid margin or near the tip of margin along the margin, while pressing it to the horizontal q-tips. I guess one picture worth a thousand words...but I hope you get the picture.

Similarly, while sustaining the flip/curl effect pushing the Q-tip horizontally bellow the eye lashes line, you could poke and press firmly on the external side of the lid margin.

•Use your own instinct and common sense to figure out where your Meibomian gland openings are located. In some cases, you could clearly see it, in other cases once you after trying different positions you would eventually get the feel of where it's located.

Similarly, this should be done in the upper eyelid, which is quite easy !



(5) The Goal: Stimulating and expressing the lipid oil, after opening the glands

Personally, after opening the blocked glands opening as much as possible, at this stage I like to apply hot compress for a short time just to melt the lipid oil (usually at this stage this require substantial shorter time) and repeat step 3 also in a much shorter version.



(6) The Goal: Stabilzing the tear film and wet the occular surface

Finally, I instill Dr. Holly drops (I use all of them: Dakrina, NutraTear, Freshkote and Dwelle. I also use Tears Again Advanced Liposome Eyelid Spray (equivalent to Clarymist in the u.k) which contains liposome/phospholipid (Soy lecithin) which is similar to the lipid ingredient in Freshkote. In both products, it's a polar lipid as oppose to non-polar ingredient in lipid ointments and other lipid products which make the difference. (not to mention that gels and ointments are bad for you...)

Tears Again Advanced Liposome Eyelid Spray also contains Vitamin A and Vitamin E. In general, I personally think and feel that taking vitamins through drops or spray that really work (of course ) is by far more effective for the eyes than taking it through pills which I am personally doubt if they ever done anything for me...like many other folks here.



* I follow the basic routine twice a day-morning and evening, and use the eye drops and spray as frequent as I need. I found that I am using it less and less, since it's working for me. Initially, when my condition was very severe, I had repeated all the above steps 3-4 times a day!

* and I use baby shampoo or lidcare as in step 1 every 2 hours or so, very quickly followed by a short version of step 3



I really hope that some folks would find this useful ! it worked for me and made a big difference in my life and I would be more than happy if other may benefit from that even just a little.

--> Of course, if anyone has any comment, remark or constructive criticism, by all means-feel free to share it with me and all the members of this forum.

Get Well !!!
Together we will growth through this strugle and eventually have our upper hands and win this, while becoming better people in the process.

With kind regards & Mettas,

H

[Jen72]

Thank you for your detailed description. I never really knew the mechanics of expressing oil. Now how do you know if its working, I never see any extrusion? Do you always see oil come out? What is your diagnosis, how did you get DES? thanks

[HOSADOS]

Thank you for your detailed description. I never really knew the mechanics of expressing oil. Now how do you know if its working, I never see any extrusion? Do you always see oil come out? What is your diagnosis, how did you get DES? thanks

Good question Jen. One things is certain- you won't know if you don't try. With that said, the following video clip might be useful to answer your question, and to give you a sense where to look for the Meibomian Glands openings http://www.youtube.com/watch?v=YV130urz4ME

If I take my experience to answer your question then in the beginning my eye were really bad and no oil was coming out, but I could feel the effect of hot compress and the squeezing. I was focusing on poking or step 4 in my routine if you will. At that time I didn't use Dr. holly's drops or Clarysmist and was suffering from severe inflammations. Usually when MGD is severe, there is pouting or plugging of meibomian gland openings which are quite obvious to discover. Hence, all I had to do is to poke it from the side/top and squeeze it firmly utnil it was opened. Believe you will feel that or be able to observe it.

Later on, as my condition improved, I could have felt the lipid oil being released as I was squeezing and expressing it. In my case the swollen glands got less and less puffy, and I could feel the pain being reduced in real time.
Personally, I could all see the oil coming out in the worst days it was milky and greasy, and those days it's clear and smooth. Believe it or not, but I could also here a weak sound of squish when the oil is being released.

The bottom line, if you keep your focus and awareness, you would figure it out, and find the relevant indications, and as that take place your confidence would be on a rise. On that note, when I started, I had no idea where are the gland opening and what should I look for, but I realize everything I needed by trial and error. In that regards you are more lucky, since you have detailed explanation of what to do and what to look for, so what left is for you to go on the field and get on the path of liberation and the rest would come.

Of course, while you will receive result here and now, you must be very patient and work very diligently and heatedly, continuously and consistently for maximum result.

It took me a month to open my glands working very intensively, and after two months I saw a dramatic improvement, and was at a time I had severe symptoms, and didn't use the eye drops and products I recommended to you.

So I believe that you guys, would see a substantial result, assuming you apply everything including the Dr. Holly's drops and Tears Again Liposome eye spray (clarymist), in a period of a week !!!

I look forward to hear about your progress, feedbacks and insights after you give it a fair trial for a number of times.

[jenny2008]

I hear the squish sound too! but i have a question--do you sometimes find it hard for the oil to come out-esp on days when your eyes may be more red then usual? If I do the massage and heat 2x daily it seems I do great-then when I skip an evening or two of doing it (only doing it 1 time per day) my eyes seem to get a bit red and I have to start all over again. do you ever experience this as well?

[HOSADOS]

I hear the squish sound too! but i have a question--do you sometimes find it hard for the oil to come out-esp on days when your eyes may be more red then usual? If I do the massage and heat 2x daily it seems I do great-then when I skip an evening or two of doing it (only doing it 1 time per day) my eyes seem to get a bit red and I have to start all over again. do you ever experience this as well?

Hey there Jenny. I'm not sure I undertand you one hundred percents, but let me try. Similar to your experience, if I skip and evening or a morning routine, I feel bad and yes my eyes become red and all that, and if I skip more than one routine this get worst and worst. That imply, that once we pass the challenging aspect of opening the glands, maintenance become issue. However, the longer period I keep my eyes in great shape, the longer it takes for it deteriorate, and that make sense.

I did notice however, that on dry days, when expressing the lipid oil right after the hot compress I have relative nice volumue of oil secretion going out, provided I drink at least half a litter or more of water a few minutes before I start my routine. Whereas on days when relative humidity is high, even if I drink I don't have much oil secretion going out. I think that this has to do to a body mechanism that stimulate the glands to produce more oil when the eye is dry (dry days) and vice versa, and that makes a lot sense to me. Alternatively, on dry days the Meibomian Gland Openings might have a greater tendency to get clogged and blocked and that also in a much faster pace. Of course this could be a combination of those two. That experience taught me how important is drinking in my condition as drinking a lot make a big difference for me.

Also I noticed, that I have a lot of pain just becuase the oil is trapped inside the glands, just by releasing it I feel so much releif and my swollen lids start to look more normal. Maybe the trapped oil is putting pressure on my eyes, and maybe the pain is or partly as a result of bacterias activity, which is being reduced once the oil is being released.

[HOSADOS]

how the routine affect artificial tears

if I don't do this routine for a 2 days or I lose to good effect of the artificial tears, and when I do this routine twice a days the artificial tears seems to be more helpful, and the best feeling is after instilling Freshkote right after I'm done with my routine-it's like heaven

That just shows hom important the lipid layer of the tear film stability, but I suspect there is more to it- I think this also has to do to a pressure from the trapped oil or bacterias activity inside the glands, as I implied in the previous post.

[Stanza]

Interesting stuff, appreciated the effort you took writing this out.

[jenny2008]

Thanks for the prompt replies! I guess I need to do the compress 2x a day for awhile and see what happens. I will also try drinking a lot of water in the morning before doing it...thanks..

[portrgirl]

Another secret is that medidate to deal with body and mental pain (as I explained in the past) and use TranquilEyes while I meditate and while I sleep and that of course help a lot.

This really intrigues me. I tend to hold my breath and breathe shallowly, but days when I focus on breathing regularly and deeply, my eyes feel better. Almost as if they're breathing themselves. I've thought about meditating for various other reasons, and do infrequently, but never thought that it might help my eyes. Could you post a few more details on this part of your routine, or point me to your other posts about it?

[Tomchou]

Hello~

I'm also a sufferer of MGD, My eyes started to get dry from last August, and then gotten worse over months, the cause of my dry eyes was finally discovered by a doctor this May(after countless under-diagnoses by numerous doctors), which is the obstruction of Meibomian glands(with yellowish paste-like secretion upon the very first lid expression by the doctor). With doxycycline for 4 months & regular warm compression(with your cleaning method), my eyes are not dry now(thankfully!), but the oil is still thicker than normal, and often causes inflammation especially in the morning. Apart from that, the overall situation of my eyes is really improving, but in a very slow pace.

It has been 4 years since you've posted this topic, and I'd really like to know about your eyes, are they fully recovered? Does the thickened oil went normal?


Merry Christmas & Happy New Year 2013!!

Tom