MGD and gland expression/lid massage

[Charon]

So I have pretty severe MGD/posterior blepharitis. No flakes on eyelids or anything, just glad dysfunction. I do warm compresses a few times a day, and sometimes do lid massage/gland expression. When I do the lid massage, if I put gentle pressure on my lids, nothing happens. I think because the glands are so inflamed, that pressure isn't nearly enough. But when I use a lot of pressure, my lids get even more inflamed after I press on them because they are so irritated and sensitive. Does anyone else have this experience?

Is there a subset of people (i.e., some of us with severe ocular rosacea/MGD/posterior blepharitis) for whom lid massages are ineffective or counterproductive? After doing an "aggressive" lid massage my eyes will be burning for at least a day and the lids will be even more swollen and red than they were before. Should I just stick with the compresses and a light massage? Or do doctors advise being aggressive? I have yet to get a straight answer from my opthamologist.

[unicorn]

Charon, I have similar experiences, in that after a warm compress I can't seem to get much oil at all out of my right eye, even if I put quite a bit of pressure on. (I'm not seeing any 'toothpaste-like' secretions, just nothing at all; my left eye, on the other hand, seems to produce oil as my vision goes cloudy in that eye). I'm scared to press too hard - firstly, it makes my eye ache and my lids feel sore and swollen, but obviously I'm also scared of doing some damage!

It doesn't seem to have improved even though I've been on Doxy for nearly 3 months.

I would also be very interested to hear if anyone has any advice on this.

[ALK-O'd]

Hi. I'm an MGD sufferer as well and it took quite a bit of experimentation with warm compresses & lid massages before I figured out what benefits me. The two key things I've learned (at least for myself) are:

1) Less is more:

I do warm compresses a few times a day...

You might be overdoing it. Personally, I generally do the warm compresses once every other morning, sometimes even less often. I find if I start doing it every day or especially multiple times daily, my lids get swollen and my eyes absolutely feel dryer than normal. I'm not saying that is how often you should do it, but maybe try backing off a little on the frequency and see if that helps.

After doing an "aggressive" lid massage my eyes will be burning for at least a day and the lids will be even more swollen and red than they were before.

Yep. If I go at it too hard, I get the same thing. Again, you might be overdoing it. You have to find the "sweet spot" in these applications. Too aggressive, too often, too hot, too long etc... all will make things worse. Not enough is no good either, but it's better to start off on the light side (less frequent, less aggressive, lower temps, shorter individual applications) and gradually adjust those variables until you see some benefit. It does not take an excessive amount of heat or an excessive length of duration of heat application to loosen up the oil in the meibo glands. I find for myself, 3 to 5 minutes of application at the right temperature is plenty to do the trick. Which brings me to my next point:

2) Use the right temperature. Too hot is NO GOOD. I have to admit that I still accidentally do this to myself every once in a while. I don't necessarily notice until a few minutes after I'm done with my compress that I begin feeling my lids swelling and then I realize I just did myself in for the rest of the day. Remember, its "warm" compresses, not "hot" ones.

The last thing I will say is don't look for miracles from warm compresses and lid massages either. The goal should simply be using the least amount of application to get your glands unclogged in hopes of having a "better dry eye day". Remember, with MGD, the root of the problem is the meibo glands are not producing oil properly. Even when unclogged, you may still not produce enough or the right type of oil. Doing warm compresses properly should hopefully provide some benefit in unclogging blocked glands, but they won't make you feel "cured". Again, look for "better" days and DON'T burn the crap out of your eyelids with the expectation of getting back to 100% normal.

[Charon]

I think my confusion started when I saw some posts in this forum where people were talking about how they were actually pinching their eyelid with their finger and a q-tip or in between two fingers to squeeze something out. That seemed far too aggressive, so I was wondering if anyone else had the same experience as me. I'm by nature an impatient person so I like seeing RESULTS from things, so I was tempted to keep trying the aggressive technique. But it seems like a bad idea that will only increase inflammation.

[hankm9]

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[Charon]

how do they do that? Do most opthamologists do that? My previous two opthamologists didn't even mention this as a possibility.

[hankm9]

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[farmgirl]

Gosh this is interesting, I wonder how many people on this forum are suffering and not responding to treatment because of these mites???

[bunnyrabbit123]

Charon,
Yes, I've had the same experience- after reading posts about using q-tip after warm compress to express your glands, doing it and really regretting it. I'm in the camp that's stopped the warm compresses and massage. It just inflammed my eyes and made things worse. My glands were so badly blocked anyway that the only thing that helped me was IPL- You might look into that or lipiflow, which seems to be gaining ground. It's now offered at several practices around me (and I live in the middle of nowhere!) then go from there in terms of home treatment.

[hankm9]

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[Charon]

I mentioned demodex as a possibility to my opthamologist, and he just said that it was possible, and some doctors do treatments for it. I don't think he does. I have no clue how to find an opthamologist who tests or treats for those.

Also, I doubt I have it, because sometimes my eyes feel completely fine (usually on the weekends when I am not stressing about work or looking at a computer for 12 hours straight). If I really was infested, the symptoms wouldn't just disappear like that.

[spmcc]

I mentioned demodex as a possibility to my opthamologist, and he just said that it was possible, and some doctors do treatments for it. I don't think he does. I have no clue how to find an opthamologist who tests or treats for those.

I say get a vet to check you for demodex. Vets check dogs for demodex all the time (one example is mange)... and they don't charge horrendous amounts to do this. The ophthalmologists who check for demodex charge ~$450 to pluck some eyelashes and look at them under the microscope. Cheaper to buy your own microscope... demodex are easy to identify.

[chamby1]

One of the articles above mentions a treatment for demodex mites is a lid scrub with tea tree oil. I found one at my local drugstore, and I am supposed to use a lid scrub anyway, so why not just use one with tea tree oil in it? Be much cheaper to just do that instead of going through all the testing, I suppose. Plus much easier.

[Charon]

I say get a vet to check you for demodex. Vets check dogs for demodex all the time (one example is mange)... and they don't charge horrendous amounts to do this. The ophthalmologists who check for demodex charge ~$450 to pluck some eyelashes and look at them under the microscope. Cheaper to buy your own microscope... demodex are easy to identify.

Good lord. This becoming even more of a nightmare. I can't imagine going to a vet and asking them to check me for demodex. I also doubt that they would do that. Anyway, I started using a tea tree oil-based face wash and pads with a solution made up of tea tree oil (as well as other things). I think i was too aggressive about washing near my eye, because my eyes are much worse now than they were before and seem very irritated. You can't win! If I have demodex, it needs to be treated with tea tree oil, but the treatment is causing massive amounts of irritation and inflammation. Sigh.

[HYPERHEAD]

Alkod amazing posts.. I totally agree with the less is more attitude and finding your own sweet spot .

I have tried so many things to realise that simplicity is the key..no harsh chemicals,no extreme heat,light but firm massage technique otherwise aching eye syndrome. You have to find balance or you will suffer! Too much heat causes dry crepid eyelids!