Having difficulty cleaning eyelidsHy

[Ted123]

Hi guys,

I am having difficulty cleaning my eyelids. I am using a Q-tip dampened with water and am pressing each of the quadrants on the lower and upper lid to expel pus. However, I do not notice any being expelled and am not certain whether I am pressing hard enough or in the right area of the eye. I am obviously not comfortable with this routine and would appreciate feedback that will enable me to perform this routine more effectively. Thanks, Ted

[Rebecca Petris]

Hi Ted,

First, as regards what goes on the Q-tip: There are a lot of approaches to this. Personally I use saline. I would not use plain water. Distilled maybe, but not plain. The traditional means is with a baby shampoo solution, though personally I don't like the idea of using soap.

Next, as regards stuff coming out: I don't often see anything come out of mine, either. That does not mean what you are doing is not beneficial. One of the benefits of lid scrubs is better eyelash/lid hygiene. Another (I think) is stimulating glandular secretions. Another is actually expressing the glands - that is, getting clogged up or hardened stuff out of them. This can be done more effectively after doing warm compresses. Also, it may require professional assistance or advice. Can you ask your doctor to demonstrate the correct method for you? I worry sometimes about people exerting too much pressure and injuring their eyes. Better less pressure than risk of injury!

For my own part, I do a firm but not aggressive wipe, taking about a third of the lid margin at a time, and applying only enough pressure in a back-and-forth wipe over that third as I am 100% certain I can control, so I don't inadvertently stab myself with the Q-tip.

One of my dreams for future projects this year is teaming up with a couple of good doctors (any takers??? email me) and filming a video of lid scrub & lid massage techniques and making them downloadable from the Encyclopedia.

[Ted123]

Hi Rebecca,

The way my Opthamologist described the process was to pull the eyelid out to the side then to place the Q-tip firmly just below the eyelid at several quadrants to expel the pus. He did not believe in scrubbing but in pressing at different points right below the eyelid. The way he demonstrated this was painful and he indicated that patients have mentioned that they have experienced soreness for a week or two after initiating this process. I don't like this method and find it uncomfortable.

BTW, the Opthamologist indicated that I had a severe case of dry eyes associated with anterior and posterior blepharitis and was stuck with this condition for life. In addition, he noted that I was sleeping with my eyelids open and recommended a special pair of moistened goggles which I purchased. He also noted that I can take fish oils/flax seed supplement. He felt that the various eye drops did not have much use in the long term treatment of this condition.

[Gaye]

eyelid therapy

I have to applaude every one of you out there who manages to do eyelid scrubs without ripping the epithelium off your eyeballs!

[Ted123]

I have to applaude every one of you out there who manages to do eyelid scrubs without ripping the epithelium off your eyeballs!

Hi Gayle,

In fact my initial scrubbing routine resulted in a conjuntiva defect (loss of tissue in the conjunctive) which was treated with ocular antibiotics. Ted

[Gaye]

To Ted

I have done that to myself. The first time was a week of antibiotic ointment and a very uncomfortable eye. Even when I learned to be more careful, I seem to stick the Q-tip into one of them. Even a slight slip means a problem later.

[Cindy]

to all you Q-Tip stabbers

OCuSoft Lid Scrubs http://www.ocusoft.com/eye_htm/fr_eye_oprod.htm (scroll down through a couple of other products) are an option instead of Q-Tips. They are kind of expensive but will allow you Q-Tip stabbers to have more control of the (gentle) scrubbing. I have used them and keep a stash for when I travel. You can wrap the pad around your finger to keep it from coming in contact with your eye.

[Ted123]

OCuSoft Lid Scrubs http://www.ocusoft.com/eye_htm/fr_eye_oprod.htm (scroll down through a couple of other products) are an option instead of Q-Tips. They are kind of expensive but will allow you Q-Tip stabbers to have more control of the (gentle) scrubbing. I have used them and keep a stash for when I travel. You can wrap the pad around your finger to keep it from coming in contact with your eye.

Unfortunately Cindy, it was the use of Occusoft that caused the conjuntiva defect.

[dianat]

Ted,

I'm confused about this "pus" you're finding/looking for during lid scrubs. If you're getting pus, it would seem you're needing more than a simple lid scrub...

Am I misunderstanding something?

Diana

[Rebecca Petris]

It may be worth mentioning here that terms like lid scrubs may mean very different things to different people.

I believe the most common use of "lid scrub" is to describe the techniques used in maintaining good eyelid/eyelash hygiene so as to prevent or treat blepharitis. This is where you get people talking about wiping, cleaning, scrubbing gently, etc.

A more aggressive technique, and what I think Ted is talking about, is where something is expected to come out. This is really expression of the meibomian glands. Some call this lid scrubs, or lid massage, or lid rolls.

But whatever name it goes by, the desired function is to express the meibomian glands, whose secretions can become hardened, preventing adequate flow of the oily glandular secretions into the tear film and resulting in a destabilised tear film. A popular method of trying to keep the passages clear is, for example, to do a hot compress to loosen up the hardened stuff, followed immediately by expression. - I am assuming here that the "pus" Ted refers to are the glandular secretions. If there is pus around somewhere, like Diana said, we've got much bigger worries....

As a safety matter, it should be noted that while lid scrubs in the traditional sense and pretty innocuous, expressing the glands is something best demonstrated by one's doctor before attempting at home.

[Rebecca Petris]

Hi Rebecca,
The way my Opthamologist described the process was to pull the eyelid out to the side then to place the Q-tip firmly just below the eyelid at several quadrants to expel the pus....The way he demonstrated this was painful and he indicated that patients have mentioned that they have experienced soreness for a week or two after initiating this process. I don't like this method and find it uncomfortable.

Sorry Ted - I misunderstood initially about what was being attempted. What you describe here is quite consistent with what I would expect from an in-clinic expression of the glands. I don't know how realistic it is to expect patients to do this at home - if nothing else we worry about injuring ourselves. I had a long talk about this awhile back with an ophthalmologist friend, who suggested that patients who have real problems with hardening in the meibomians ask their doctors to do this for them at every appointment.

BTW, the Opthamologist indicated that I had a severe case of dry eyes associated with anterior and posterior blepharitis and was stuck with this condition for life. In addition, he noted that I was sleeping with my eyelids open and recommended a special pair of moistened goggles which I purchased. He also noted that I can take fish oils/flax seed supplement. He felt that the various eye drops did not have much use in the long term treatment of this condition.

Very sorry to hear it. I would want to hold out some hope for improvement of the bleph though. Goggles = very useful for protection. Eyedrops - assuming meaning artificial tear supplements - quite correct, they cannot treat the blepharitis, but they are still often necessary / useful for maintaining eye comfort when the eyes are dry, irrespective of the underlying cause.

[Ted123]

Sorry Ted - I misunderstood initially about what was being attempted. What you describe here is quite consistent with what I would expect from an in-clinic expression of the glands. I don't know how realistic it is to expect patients to do this at home - if nothing else we worry about injuring ourselves. I had a long talk about this awhile back with an ophthalmologist friend, who suggested that patients who have real problems with hardening in the meibomians ask their doctors to do this for them at every appointment.

Very sorry to hear it. I would want to hold out some hope for improvement of the bleph though. Goggles = very useful for protection. Eyedrops - assuming meaning artificial tear supplements - quite correct, they cannot treat the blepharitis, but they are still often necessary / useful for maintaining eye comfort when the eyes are dry, irrespective of the underlying cause.

Rebecca, unfortunately, I was being monitored by another Opthamologist for another opthamologic issue over the course of twelve years. He identified this condition and provided me with a cleaning protocol consisting of baby shampoo and Systane Eyedrops. However, he failed to inform me of the progressive nature of this condition and its potential impact on my quality of life as well as not being aggressive enough in his treatment. BTW, the substance that causes "hardening in the meibomians" is actually Pus!

The Opthamologist who is currently managing my case is a highly regarded corneal specialist whose practice is primarily devoted to Dry eye/blepharitis syndromes. He has given me special goggles that contain removable pads that can be moistened at night and which keep my eyes moistened throughout the night. He believes this may improve my photophobia, especially when I awake. Unfortunately after one week of use I don't perceive any significant change. I will use them for one month and observe for any change. He stated that although my condtion was lifelong that I would obtain significant improvement of symptoms if I followed the treatment regimen. BTW, he stated that eye drops have no relevance in treating dry eye syndrome.

If this doctor cannot help me with this condition, I will go to the John Hopkins Wilmer eye Institute for followup.

I am not happy about this situation but I always keep in mind that there are much worse sight robbing diseases such as glaucoma and macular degeneration.

Do you suggest that I ask my Opthamologist to "express" the meibomian glands on a regular basis? Does daily "expressing" of these glands cause any deleterious problems to the eye itself? If this does not work or provide satisfactory results what do you believe should be the next step in the treatment process? Thanks Rebecca, Ted

Regards, Ted

[Rebecca Petris]

I am glad you are under the care of a good specialist. Keep in mind that we're just laypeople here... and are not trying to secondguess anyone's doctor, but just like to discuss a wide range of possibilities in case something is suggested which can be investigated to some useful conclusion.

BTW, the substance that causes "hardening in the meibomians" is actually Pus!

Didn't know that.

He has given me special goggles that contain removable pads that can be moistened at night and which keep my eyes moistened throughout the night. He believes this may improve my photophobia, especially when I awake.

That is one of a number of means of protection the eyes from nighttime dryness. Different things work for different people. If you hunt around in previous threads a bit you'll find a lot of discussion about this. Sometimes a simple eyeguard helps. I've used saran wrap in bad spells. Controlling humidity and air movement in the bedroom may help. Personally I find that the product I put in my eyes just before bed makes the most difference (in my own case that's usually Dwelle).

He stated that although my condtion was lifelong that I would obtain significant improvement of symptoms if I followed the treatment regimen.

You know, while this can be discouraging to hear, it can also be very empowering. Many patients with dry eye (and I think this is particularly true of iatrogenic dry eye like from LASIK, or other sudden onset dry eye) pour masses of energy into seeking a cure - energy which might be better spent in a more balanced manner, on the one hand seeking the tools to best manage the symptoms, and on the other learning adaptation and coping skills. No doubt about it, one of the challenges in ocular surface disease of any sort is trying to determine what the goal is!

BTW, he stated that eye drops have no relevance in treating dry eye syndrome.

As with many areas of medicine, opinions vary dramatically even among experts. Among the mainstream, I would have no hesitation in asserting that a clear majority of ophthalmologist or optometrists, no matter what other treatments they might also employ regularly, would have artificial tears either at or near the top of their list in terms of frequency of recommendation when a patient first presents complaining of dry eyes. - Like I said, I don't think of artificial tears in terms of "treating" dry eye so much as helping with necessary daily management of symptoms: making pain levels acceptable, protecting the eyes, and improving vision are all important to moderate to severe dry eye sufferers and often cannot be achieved without eyedrops as a supplement to treatments designed to get at the underlying cause (though overuse of drops may also be a problem).

Dry eye is a funny thing - it's so very difficult to correlate symptoms with clinical findings consistently. And I think it is quite natural for doctors to lean towards treatments they think patients are most likely to be compliant with (if you don't do it, it can't help, if you do, at least it might).

Do you suggest that I ask my Opthamologist to "express" the meibomian glands on a regular basis? Does daily "expressing" of these glands cause any deleterious problems to the eye itself? If this does not work or provide satisfactory results what do you believe should be the next step in the treatment process?

Yes, I'm suggesting the Dr. express your glands when you see him because he's obviously seeing the need for it to be done and you've said you're not comfortable (this is understandable) doing it yourself the way he does. I can't comment on implications of frequency at which this is done... just don't know.

I'm not really sure what to suggest as next steps. If your doctor thinks expression is a very important function for you, I think you might consider doing hot compresses before you do your scrubs/expression, to soften them up, and see whether this improves expression. A doctor can get the stuff out with brute force because his hands are trained for it, but for us laypeople, melting them down makes it a lot easier (and from what everyone's been saying, safer!) I do it with a rice baggy - gets hotter and lasts a lot longer than most other methods.

Another thing you might want to look into - there have been some recent interesting discussions on this BB, and the topic was quite new to most of us - is demodex as a possible cause of or factor in chronic blepharitis. Erik (another member) is very knowledgeable about that.