Warm Compress Issue!

[Mohit]

Hello everybody,
I came here, asked for help and started warm compresses. Once a day for 5-10 minutes, with a cloth.

On the third day i felt that there is some oil secretion type of thing going on and felt very good, but it was only for 2 hours.

The problem that arised is that since that day the water in my eyes kept reducing(aqueous tears), on the fifth day it became almost zero. Also 4th and 5th day also had no oil secretions either.

Aqueous Tears before starting compress were normal, only excessive computer use reduced them.

They came while yawning etc but never stayed and evaporated, so i'm thinking I have the MGD thing.

Also i changed the cloth yesterday from a colored to white one, as the colored was dyed and some color came out of it, yesterday was the worst after warm compress.
Also my dry eye was caused by LED monitor.


Now today is the 6th day, I'm scared and thinking of quitting warm compresses, any thoughts?

[Tankie]

I have a few thoughts. Personally, I have never been a huge fan of the conventional methods of doing warm compresses because of the following reasons:
- It's difficult to get the temperature right
- It's difficult to apply the heat in a uniform manner to the areas that need it
- The temperature of the cloth changes so rapidly that even if you do get the temperature right, you will only have a minute or two before it cools too much
- If the temperature is too high, you can burn yourself and cause wrinkles (although you can get rid of them with a few weeks of healing time and moisturising).


What I prefer to do instead is to stand under a hot shower spray for several minutes with my eyes closed. I like this method for the following reasons:
- The temperature is constant
- The heat distribution is uniform
- It is reliable, and I can do compresses as much or as little as I like

The downside of course is that you need to have a shower to do this.

Anyway, with regards dryness, I'm not certain of the reason, but I have definitely experienced dryness after hot compresses sometimes too. However, there is a way around this. As soon as you are done with the hot compress (be it with a cloth or in the shower), as soon as possible, sit back on a couch, or lie back on a bed, put a lubricating eye drop in each eye, and blink with your eyes closed for 5-10 minutes. The idea here is that the lubrication from the eye drop will help prevent dryness, and the blinking with your eyes closed should release meibum (the oil from the meibomian glands) into your tears/artificial tears since the oil has been melted by the hot compress.

The major downside to my advice is that it requires a commitment. If you're in a rush to get to work, or you don't have patience and you just want to immediately go about your day and don't have the time or don't take the time to spend that 5-10 minutes lying back on the couch or in bed doing the blinking after the hot compress, you won't experience the benefits. It's definitely a situation where you get out of it what you put into it.

I hope this helps. It certainly isn't a cure, but hopefully it will help you get through the day. If you're interested in hearing about what eye drops I found help dry eye I would be happy to share that with you and explain how they all work (or at least how they worked for me).

[Mohit]

Thanks a lot for taking time to reply.
What i want to know is that warm compress will only secrete oils for 2-3 hours? The duration and the amount of secretion will not increase day by day? Amount specially matters otherwise its useless.

About dryness, i can say its very stable, after warm compress, no tears/water from lacrimal glands, no tears while yawning etc I mean to say it will surely happen, so warm compress is probably not for me.


Another thing i would like to ask about eye drops is that i used to abuse drops with Carboxymethylcellulose+preservative and also sleep with it, i did not know what i was doing.
So, it gave me redness/inflammation, bad stuff. My doc prescribed me Flurometholone Acetate drops for 10 days + Systane Ultra.
What i would like to ask is if you know is it safe to use Flurometholone Acetate for more than 10 days as the redness didn't go, even shifting to Systane ultra didn't help much.

I know i should try preservative free but they are not available here, never saw them anywhere and HPMC one does not suit me.

Other salts are not available here, only PVA+POVIDONE, but they were really cheap, i do not want to try that cheap stuff.

[Tankie]

Sounds like you've got a lot on your plate. I think we'll have to call in the DEZ Pro's on this one . I'm sure they'll make an appearance soon. Until then, I'll help you as much as I can, but I can't answer all of your questions.

With regards taking FML (fluoromethalone), I would not recommend going beyond the 10 days your doctor recommended. The reason for this is because it will increase the pressure of your eyes to unsafe levels if you take it for lengthy periods of time. If your eye pressure climbs too high, you can/will develop cataracts and glaucoma. Cataracts aren't the worst thing in the world, but definitely worth avoiding if possible, but glaucoma leads to blindness, so it's not worth the risk!

I once abused FML myself, and my pressures climbed to 20 mmHg (20 millimetres of mercury). This is considered an unsafe level. Really anything at or above 20 is too high. I've heard of people climbing to 30 before, which is REALLY dangerous, and the pressure needs to be taken down immediately. Safe levels are usually considered between 9-19, and generally speaking, I myself hover around the 11 to 12 mark.



Now to discuss the warm compresses. One thing you need to understand is that you suffer from meibomian gland dysfunction. What this means is that for some reason your meibomian glands are unable to keep your oil in a liquid state in sufficient quantities that can be used to prevent the evaporation of your tears. So even if you do the warm compresses, all you're doing is allowing some of the oil to get through, but eventually the oil will harden up again.

So how do you fix it? Well that would be a multi-billion dollar question (million dollar question doesn't cut it here).

Some people (including me) have tried lipiflow to fix the problem. However, I found that all lipiflow did was a really good hot compress. It might have helped a bit, but ultimately I still have the dysfunction, and so the problem was never truly fixed and I didn't find relief. If there was a way to get lipiflow done on a daily basis, maybe then it would work, but to do that you would need to spend about $500,000 per year haha =)

It's unfortunate, but as far as I know there is no cure for meibomian gland dysfuction. All we can do is circumvent the symptoms by keeping our eyes as lubricated as possible.

The good news is that new eye drops are being researched, and hopefully one day in the next few years something will get released that acts as artificial meibum, so we can just put a drop or two of that in every couple of hours, and that will keep our tears from evaporating. Until that day comes, however, we've just got to cope the best we can.

[spmcc]

Hi Mohit,

To build on what Tankie says about drops... just remember that if all your puncta are open, the drops may drain out quickly. So, when you apply drops, push on the puncta to hold them shut. That will keep the drops on your eyes for longer.

Also... just an idea... you could try cold/cool compresses to see if that helps. Unfortunately, it's all about experimenting to figure out what your eyes need.

Wishing you relief.
Sheila

[Mohit]

@Tankie thanks for taking time to reply, what you said about the drops sound really bad, will have to stop them. Also just noticed the FML (fluoromethalone) drops i'm using has the preservative BAK.

So how do we measure the mercury pressure? why will my doctor do it? what should i tell him so that he will do that test?

I wonder where are the pros you speak of.

@Sheila After 6 days I skipped warm compress today and my drops are drying really fast while on computer. So i understand that warm compress closes my puncta and the lacrimal glands
Thats why drops didn't drain and stayed better on the days of warm compress. Will have to start warm compress again maybe, i'm confused. Am i thinking right?
Will maybe try cold compress.

Also i have another question, how long is it safe to use a lubricant with preservatives, after opening it. With systane which is costly here, on the 13-14th day, it increased my reddishness badly.

[Tankie]

As long as you keep the dispenser clean (the tip of the bottle where the eye drops come out) and put the lid back on after you've finished putting the drops in, I wouldn't worry about preserved eye drops going off for at least 30 days, maybe even longer, like 60 days. 30 days for sure would be safe though. If you put your eye drops in a refrigerator, this can keep them from going off for an even longer period of time.

One of the first things you aught to try if you have MGD is getting punctal plugs put in all 4 puncta. This way you can very quickly determine whether or not you have MGD or aqueous deficiency dry eye. If you do not have the aqueous deficiency, then with any luck the plugs will keep enough tears in your eyes that it will eliminate the pain you feel. This would be my advice to you, and I'm sure many others would agree with me. Hopefully it will help, and then you'll be at least on your way to feeling better.

One other piece of advice I would give you is to get an eye drop that is more like a tear eye drop. Systane Ultra is good, but it's a thick eye drop. It's good that you have this, you will need it. However, you should also get an eye drop that isn't as thick. If you like Systane, then perhaps try getting the Systane Original eye drop.

[littlemermaid]

So i understand that warm compress closes my puncta and the lacrimal glands

Hello Mohit, My understanding is that warm compresses help to keep the meibomian glands in the eyelids good and help keep the eyelid functions good, especially the parts that supply the tear film. Especially with hygiene like careful warm-water eye cleaning afterwards. Also when these oily glands, and other glands eg at the base of the eyelash follicles, get clogged, bacteria and other bugs can take advantage. This is what people mean by meibomian gland dysfunction (MGD). Many people get blepharitis and styes and chalazia, and these are cured by warm compress and careful cleaning, plus antibiotics if needed if there's infection.

So it is not that the warm compress closes the puncta (tear drains) and lacrimal glands and you get reduced tear film. It's that the meibomian glands need a warm compress to keep the oils moving, especially with obstructed MGD, and you are probably noticing less tear film when you skip because the oily glands contribute to the viscosity and osmolarity of the tear film and help it cling to the eye surface, don't you think?

The only time we don't use warm compress, or warm shower and eye cleaning, is when my daughter has a red (inflamed) eye surface, then we use cold compress and careful cleaning and even put tear substitute eyedrops in the refridgerator to use cold, which seems to help. If a treatment is giving you a red eye, there's a problem. Sometimes she has reacted to eyedrops, for example.

http://www.nhs.uk/conditions/Dry-eye-syndrome UK NHS summaries on dry eye and blepharitis (and Clinical Knowledge Summary on blepharitis) are good. Also search the American Academy of Ophthalmology Preferred Practice Guidelines on dry eye, blepharitis, and conjunctivitis.

Mohit, Can you use wraparound sunglasses or similar while you are on the computer to protect your eyes and keep them moist? Also my daughter uses a humidifier that produces cool steam while she is studying. The eye doc should test your intraocular pressure (IOP) as standard, especially if s/he has prescribed steroids. Most people try a few tear substitute eyedrops until they are happy - hope you can find one that keeps your eye surface comfortable.

Are you getting punctal plugs? If you want to post up your region in India there are people here who might have experience that will help on finding treatments.

What do you think has happened to your eyes? Do you think you would you have dry eye without the computer use?

[Mohit]

@Tankie Ok, but in my experience after 15 days or so it gets really thick and increases my redness, had to throw it and get new.
Yes I'm going to see a new doc soon(as soon i get hold of money to do that) who will probably know of plugs, all docs i've seen didn't even knew of warm compress. I'll keep in mind what you said. Also thanks man blink with your eyes closed after hot compress is good stuff.
Any advice working on computer?


@ littlemermaid Thanks for the detailed explanation. Yes, i want to try onion glasses/ moisture chamber glasses but i'm finding it hard to get hold of them, they seem to unavailable. I can't get them shipped, way too costly. I will try punctal plugs if the new doc(yet to see him) knows of them and if they're available.

I'm in Chandigarh region, its a major city, help is welcome. A dry eye specialist is what i need and I haven't found one yet.

My dry eye was caused by a new LED monitor, it gave me problem and i thought i will adjust to it in few days, i did not know what i was getting into.
I'm doing a university degree in animation, i know i should quit it, but that was not possible due to other reasons.

What i think has happened is my lacrimal glands produce water but not enough, lot of water when yawning etc but dry and evaporative otherwise. I also think i have the MGD thing. What warm compress does is improves a bit on MGD and closes lacrimal glands for the day, i can feel it(I don't know about puncta). In the morning they open up and I get a lot of water for half an hour flowing out of my eyes. I also think that water from lacrimal glands washes out my eye drops and then eyes get drier.

Yes I'm uncomfortable without the drops be it computer or not, it was worse in the summers. In summers drops gave me dryness in the back of the eye, so i kept on without drops all the time, that damaged my eyes more, now i cannot look at screens at normal brightness, no CRT TV/monitor, gives me headache. Also i abused CMC+purite drops a lot, working on computer a lot, also sleeping with them, gave me reddishness which hasn't gone since then. Haven't used CMC since then, HPMC doesn't suite me, using Systane ultra now, its the costliest I know of.

Thanks for your time, may god bless you and your daughter.

[littlemermaid]

In the morning they open up and I get a lot of water for half an hour flowing out of my eyes. I also think that water from lacrimal glands washes out my eye drops and then eyes get drier.

Mohit, My daughter had this overtearing (epiphora) in the mornings in the early stages when, looking back, she had started with blocked meibomian glands and we did not know about using warm compresses to clear them either. This tearing up (lacrimal glands overproducing just as you describe) was the eye trying to compensate for the dryness on the eye surface caused by lack of oily layers holding a good tear film on, as you say. But that doesn't necessarily mean MGD is your main problem, just that maybe there's a similar overtearing with the eyes being stressed.

Looking back, there must then have been eye surface changes because eventually the overtearing (epiphora) stopped and she had a chronic dry eye with neovascularisation started. The eye surface changes must have been partly caused by prescription eyedrops she was given to try by random ophthalmologists and general practitioners: anti-allergy, anti-bacterial, different steroids. All of these had preservatives in, which are now proven to cause eye surface damage. So please be very careful to use drops that are not causing you further problems.

Similar to you with the animation screens, she couldn't look up at the classroom boards and computers, especially in the morning (photophobia). Now she is very comfortable but we have to keep up the regime we have worked out and treat the eyes as very sensitive to chemicals, and keep the tear film good with drops and other things keeping the environment humid like wraparound glasses and humid air, so hopefully you can do this too and bring about a spiral of healing when you work out what makes things better/worse for you. The cornea is very fast to heal if the conditions are good.

I dearly hope you can find eye doctors - maybe ask if it's 'computer vision syndrome' because I think that may be more easily recognised in India and Pakistan as a condition. Ask if they can see signs of allergy underneath the eyelids (cherry red, bumps - papillary conjunctivitis) - could be allergy to external factors or to the eyedrops.

Any wraparound sunglasses would be a good thing - many people manage this way, even with swimming goggles, and some people make their own foam pads to provide a moisture chamber.

How many FML/day did the doc prescribe? Would it be more helpful to use a drop first thing in the morning rather than at night?

If you want to test for meibomian gland dysfunction, try pressing with 2 fingers gently upwards underneath the bottom eyelash line while standing close up to a wall mirror in very good daylight. You might be able to see tiny drops of oil along the eyelid margin where the eyelid meets the eye surface. If it's tiny clear drops, the meibom is good. If it's whitish, you can improve that with warm compress or even antibacterials. The eye doc should do this, but even now, they don't all know how or what it means.

Dr Latkany's book 'Dry Eye Remedy' is very good and simple with advice. He mostly feels a warm shower is enough to keep the eyes good with most MGD.

I just keep wondering if your eyes would get better with less chemicals and more gentle treatment to reduce inflammation, as Tankie says, cold compress sometimes, even, and this sounds crazy, cucumber slices or similar as a cool compress. It's a worry that the FML doesn't control inflammation and it sounds as if you are sensitive to it. I'd also be very careful with hair shampoo and detergents etc.

As Tankie says, can you keep the Systane in the refridgerator? We use drops this cold sometimes when there's inflammation. Check the leaflet inside the box or look online at the USA drug guidelines for the temperature range. Should last more than 10 days and not thicken. Is this part of the problem, that it got too warm and went bad? Also we must not let the nozzle on the eyedrop dispenser touch the eye or anything else. Or do you think you are sensitive even to Systane?

We use something similar, Hyloforte or Hylotears, but we also use normal saline 0.9% Minims individual preservative-free vials because she is in such frequent use, especially studying on the computer. It is good straight from the refridgerator. This normal saline might be easily available because any medic or nurse would use it to flush the eye. Yes it does wash off the tear film to some extent, but it provides short-term relief without too many chemicals, just as an extra option to the Systane.

Can you adjust your seat or monitor so you get absolutely minimum eye surface exposed while you are working? And take the breaks with closed eyes that you need? It is very helpful to look down on the monitor rather than eye surface wide open staring for hours. Have you adjusted the brightness right down?

What do you think is helping you so far? Sensitivity and exposure sound like the worst problems. I am so sorry this has happened. I can only say if you do have to give up the course because of the screens, as one door closes another will open for you with your skills if you search for it. But hopefully you can try punctal plugs, as Tankie suggests. These were a great help for us.

[Tankie]

Working on a computer is a tough one. For me, the secret is to have moisture in the eyes at all times. Prior to my recently plugging all 4 puncta, I would use eye drops very frequently when using a computer. I would also coat my eyes with Systane Gel before using the computer. Beyond that, the only other tip I can give you is try to make it short and sweet. The less time you're on the computer the better.

Sorry I couldn't be of more help.

[Mohit]

@littlemermaid sorry for the late reply, went busy with some stuff.
Thanks for the information about eye drops doing bad, can you name a few preservatives that are bad? We all know of BAK i guess, but i didn't knew others can do bad too. I'm glad shes ok now. I will keep in mind about allergy underneath the eyelids, when I see a doctor.

About FML, i was prescribed once a day for 10 days. I used to sleep with CMC+purite drops at night, that gave me redness/inflammation. So, i think never use any drops at night because eyes are closed. In daytime, we blink, come contact with air, so the chemical cannot do that bad as compared to night, just my opinion.

I'll do your test tomorrow, its evening now, totally new to me, sounds good.

I just keep wondering if your eyes would get better with less chemicals and more gentle treatment to reduce inflammation,

I think the same now. Specially since tankie talked about Intra Ocular pressure. Thanks.

Yes i also used to keep it in the fridge, but its winters now and still gets thick like on the 8th day. Also at school i couldn't keep it in the fridge and it used to heat all day in my bag, maybe that gave me redness, summers are very hot here. How do you manage when shes at school?

So, Sodium hyaluronate is a better option than Systane(poly glycol)?, I haven't tried that yet, availability issues. Also saline means water+NaCl, how can one put that in the eye, I must be wrong, my information comes from wiki http://en.wikipedia.org/wiki/Saline_(medicine)

Can you adjust your seat or monitor so you get absolutely minimum eye surface exposed while you are working? And take the breaks with closed eyes that you need? It is very helpful to look down on the monitor rather than eye surface wide open staring for hours. Have you adjusted the brightness right down?

Thanks, totally forgot about eye surface exposure. I can only use screens at lowest brightness.

What do you think is helping you so far? Sensitivity and exposure sound like the worst problems. I am so sorry this has happened. I can only say if you do have to give up the course because of the screens, as one door closes another will open for you with your skills if you search for it. But hopefully you can try punctal plugs, as Tankie suggests. These were a great help for us.

Due to Warm Compresses, Oil has improved a bit but lacrimal glands have gone bad I think. No excessive tearing in the mornings, been 2 days, less, very less watery tears. Thanks for the hope.

@ tankie Its ok, you have been helpful man.

[Storm]

I have used heat for may years. Yes it only gives benefit for a short while (maybe only 30 minutes for me); but it the best thing to relieve pain.

If I use them too much, it makes my eyes dry. I only use them once a day in the evening.

I use the little heating pads ( made by 'Heat In A Click' or 'Bodycomfort' ). I use a wet pad on them and heat one eye at a time so I can watch TV at the same time. I have a whole box of them and boil them once a week to reset them.

[littlemermaid]

Hello, Mohit ~ Thanks for your reply, it's very good to hear that you are thinking attentively about what is making your eyes better/worse and how to bring about careful healing.

We have had to use FML on/off for flareups - but without raised IOP so far, but the eye pressure was checked maybe every 2m, now it's more like 4m interval. Also IOP needs checking within a week or two of starting steroid eyedrops, as far as I know, in case there's a problem reaction. Of course, long-term steroids is not good (cataracts etc) but they have prevented further damage in the short term when the inflammation's been bad. We have been able to taper and reduce to a minimum, even less than 1/wk, but not been able to get off them yet because her low-level inflammation appears to be chronic from systemic causes like an autoimmune/allergic condition. But this is not like you, so the multifactoral damage to your eyes should heal with careful attention.

It's best if you can find a good and honest Pharmacist to talk about your eyedrop questions if you can. People like different tear substitutes and we've needed thick ones or light ones, and more or less, depending how her eyes are. Also, I use the US FDA (Federal Drugs Administration) website information. Don't know why the Systane's going thick but it's an important question - maybe email the supplier/manufacturer for advice?

http://dryeyezone.com/ has a lot of information you're seeking too. Maybe think about a sleep mask for night?

Have you noticed that some people get improvement when they have a healthier vegetable-based diet and take more oils - omega 3 fatty acids? http://en.wikipedia.org/wiki/Omega-3_fatty_acid Certainly I have seen that diet affects the meibom and some docs say they have seen improvement to the eye surface. Drinking much more water helps some people (no cola/soda). Again we have to experiment on this for ourselves.

It's difficult to keep eyedrops cool in the schoolbag. We have another problem in the winter with the heating systems. There is a big danger of bugs developing in the warm fluid. After looking up the exact drug information on safe temperature ranges, I would ask the Pharmacist for advice, or even consider sending PM to Indrep for more advice.

I would click on Indrep's name and read all the posts to research the threads on eyedrops.

She carries a small insulated bag with a cool-pack insert - we bought it from a Pharmacist (it's designed for carrying insulin for diabetics), if you can find something like that. The cool-pack goes in the fridge overnight to chill for the next day. Another thing we use is an insulated lunchbag with a small freezer pack. Again the eyedrops must not get too cold either so you're looking for something small for drinks, food or meds. Is there something like an insulated flask for cold drinks?

That is good experience from Storm. It's important to work out what makes it better/worse for ourselves. Maybe think about what is preventing your eyes from healing themselves. It sounds like making a moist environment (wraparound glasses, humid room) and reducing allergens and drops you're sensitive to might be a big help.

When you see the next Eye Doc, I've found it's very important to write up a history of symptoms with dates, and to make a list of questions, and to make notes of exactly what they've said afterwards. We get so nervous - this is a very big help to get a good consultation - especially if it's an expensive doc we need to get the most out of these guys.

Anyone from India/Pakistan got advice on keeping eyedrops cool through a long day? I'm thinking if you were eg diabetic the College would help you keep your meds cool. Is there eg a Student Counsellor or Admin who would know about this?

[Mohit]

late reply again my bad, insulated bag is a really good advice, thanks a lot littlemermaid, you have helped a lot.