How to know if hot compresses are working

[bostoneye]

Hot compresses have never seemed to do anything for my MGD and blepharitis, but I haven't been very systematic about it. How would I know if it's working?
I've been having a prolonged, severe flareup for a month, after two months when I was really comfortable. I had MG probing last January, with generally good relief until now. My ophthalmologist says he doesn't think the glands would have become blocked again so suddenly after several good months.He thinks the problem is inflammation - but why now? For a week or so I've been on Lotemax 2x a day and Azasite, which help a little, but by evening I'm usually miserable.
I'm making another try with compresses - specifically the soft goggles filled with rice-like pellets, heating them in the microwave. I leave them on a full 15-20 minutes, then massage my eyelids thoroughly. If this is working, should I see or feel stuff being expressed from the glands? I don't see anything at all. My eyelids are a bit sweaty from the heat, that's all. I've done this for a week or so. I would think by now it would have some results if it's going to. Or should I keep doing it longer even though it hasn't helped at all?
thanks
Richard

[Ericska]

Hi Richard,

I was told that for inflammation you should be doing cool compresses not warm and especially not hot.

I do the Therapearl warm mask morning and night and during the day if my eyes feel irritated, i.e. burning or inflamed, I do the cool compress.

My understanding is that if you already have inflammation, the warm and especially hot just irritate it more. My Therapearl mask is only to be left on for 5 minutes and absolutely no longer than 10. I wonder if you're leaving your goggle on too long. How long do you heat in the microwave? Mine is only 15 seconds for warmth.

For the cool compress I use ice and water in a plastic ziplock bag. Not too cold - so usually one ice cube is enough.

[Ericska]

Also, for the blepharitis, are you doing lid scrubs?

[LaDiva]

I have ocular rosacea, and do not use cool compresses because they don't help. It is strange, but warm compressed will bring down the inflammation in my eyes, although not when I am having a full-on, raging bout with rosacea. I found that warm compresses, three times daily really help. I use a warm but not boiling hot rice baggy. I keep my rice baggie on for 5-7 minutes, then do expression with lid scrubs in the morning and at night. You are right. I need to be relentless about doing this three times daily, or the glands plug. Frankly, I find it to be one of the biggest pains about the whole dry eye issue as it is a daily disruption. (Aside from the actual pain.) You might start looking at what you are eating. Try to stay away from sugar, dairy and processed foods for a few days, and see if things get better. Dry eye is weird, but you are a vet so probably have noticed that what works for one person might not work for another. Sending good wishes.

[RoobarbeandCustard]

I think you probably have to experiment with various temperatures and feel which one works for you (and then stick to it).
BW

[bostoneye]

Thanks for your inputs. I really think a lot of the advice is guesswork, and ultimately, it's what does or doesn't work for you at a particular time under certain conditions. At my last eye visit, the assistant swore by the hot compresses and said you should do it as often as possible for MGD. Then when I asked the ophthalmologist, he said heat is bad if you have allergies (not my problem) but helpful if it's mainly inflammation. If the purpose of the heat is to liquefy the gunk in your glands so the oil flows better, that would make sense. I just don't think it's happening in my case, but I"m going to keep going anyway.
The cold goggles (or frozen peas or whatever) are strictly to numb the pain temporarily. I don't think they do any more than that, but they do help me when I'm about to scream. Lately my routine is to come home (with my eyes killing because of computer use and the long commute in my car), put on the frozen goggles, and have a glass or wine...or two... This takes the edge off for awhile. Sometimes when we're having a dinner party at our house I'll excuse myself and lie down in the bedroom with the cold goggles for 10 or 15 minutes. I've also doubled my daily dose of Doxy from 100 to 200 mg, which my doctor said to do for a month, and am using the Lotemax 2x a day although he only prescribed it once at bedtime (which isn't when I need it.) This flare during all of October has been one of my worst, but I'm hoping the extra meds and extra blinking will eventually help me turn the corner. I wish I knew what triggered these things!

[JJdryeye]

From what I've read on this forum over the years everyone is different when it comes to the compresses. FWIW, I'll give you my experience. I have inflammation and burning from poor quality oil / lipid layer. Back when I first started this journey I used a sock filled with rice and heated it in the microwave for a minute, then put in on my eyes for up to 15 minutes, at least once a day, sometimes twice. The first day it felt good, but when repeated every day I found that it was actually making my eyes worse. So after some experimentation I found that just 3-5 minutes every other day works best for me. Then to take that a step further, I stared using moist heat in the form of a mask made by TheraPearl called 'Eye-ssential Mask'. It contains little beads that give off moist heat after heated in the microwave. I bought mine at Walgreens. Finally, to take it up yet another notch, I occasionally use a similar mask that you freeze as a cold compress, this feels awesome on the days when the burning is really bad. I typically don't do the hot and cold back to back though, I separate them by at least an hour or so. Now all that said, this doesn't cure my problem, but it does make it more manageable, and I've had doctors tell me my glands would be plugged by now if I hadn't been doing this all along. So even if you don't feel a big benefit, there seems to be a maintenance benefit that may keep your condition from getting worse.

As to whether or not you know its working...I notice that my eyes get very blurry for 15 minutes or so when the oil is secreted and there's general benefit I feel until my next compress application, usually I won't be reaching for as many drops. You'll know if its working.

Back to why the heat can make things worse, or at least why I suspect it may make things worse. There is an article on this site by a Dr. Sandra Brown (see link below) speaking about how you can actually express several days worth of oil production from your glands and temporarily deplete your supply. I realize she's talking about expression and not compresses, but I have to wonder if the same theory applies to heat application and that over use of compresses could be drying us out and making us feel worse. No idea is this is possible, but if you read her article it seem like a reasonable explanation.

http://dryeyezone.com/encyclopedia/mgcare.html

[Ericska]

HI Richard, are you using regular OTC eye drops during the day? You said computer use and long commute home but I didn't see anything about additional eye drops in between. I too work on the computer all day and I use regular OTC drops every 2 - 3 hours and I find it helps me get through the day along with everything else I need to do. I am also taking Restasis twice a day, Vitamin A and Omega 3 capsules.

[savino]

...............

[savino]

From what I've read on this forum over the years everyone is different when it comes to the compresses. FWIW, I'll give you my experience. I have inflammation and burning from poor quality oil / lipid layer. Back when I first started this journey I used a sock filled with rice and heated it in the microwave for a minute, then put in on my eyes for up to 15 minutes, at least once a day, sometimes twice. The first day it felt good, but when repeated every day I found that it was actually making my eyes worse. So after some experimentation I found that just 3-5 minutes every other day works best for me. Then to take that a step further, I stared using moist heat in the form of a mask made by TheraPearl called 'Eye-ssential Mask'. It contains little beads that give off moist heat after heated in the microwave. I bought mine at Walgreens. Finally, to take it up yet another notch, I occasionally use a similar mask that you freeze as a cold compress, this feels awesome on the days when the burning is really bad. I typically don't do the hot and cold back to back though, I separate them by at least an hour or so. Now all that said, this doesn't cure my problem, but it does make it more manageable, and I've had doctors tell me my glands would be plugged by now if I hadn't been doing this all along. So even if you don't feel a big benefit, there seems to be a maintenance benefit that may keep your condition from getting worse.

As to whether or not you know its working...I notice that my eyes get very blurry for 15 minutes or so when the oil is secreted and there's general benefit I feel until my next compress application, usually I won't be reaching for as many drops. You'll know if its working.

Back to why the heat can make things worse, or at least why I suspect it may make things worse. There is an article on this site by a Dr. Sandra Brown (see link below) speaking about how you can actually express several days worth of oil production from your glands and temporarily deplete your supply. I realize she's talking about expression and not compresses, but I have to wonder if the same theory applies to heat application and that over use of compresses could be drying us out and making us feel worse. No idea is this is possible, but if you read her article it seem like a reasonable explanation.

http://dryeyezone.com/encyclopedia/mgcare.html

http://www.ncbi.nlm.nih.gov/pubmed/19387230

[bostoneye]

HI Richard, are you using regular OTC eye drops during the day? You said computer use and long commute home but I didn't see anything about additional eye drops in between. I too work on the computer all day and I use regular OTC drops every 2 - 3 hours and I find it helps me get through the day along with everything else I need to do. I am also taking Restasis twice a day, Vitamin A and Omega 3 capsules.

Regular OTC eyedrops don't do much for me; but I use the Refresh gel several times a day, depending on how my eyes feel. The relief is temporary, but Refresh works much better than drops for m.

[bostoneye]

JJDryeye - Thanks for that helpful post and the link to the Sandra Brown article, which makes a lot of sense to me. My ophthalmologist who specializes in dry eye along with his cornea work, does press on my eyelids when I see him, but never says whether he's trying to express the glands or what the result is. And he's never recommended that I do it myself. I'm with you on the Walgreen's heatable and freezable compresses - the cold one especially stops the burning for awhile but of course isn't a solution to the problem. From what you and others on this thread say, I'm going to keep up the heated goggle treatment (though not heating it quite as much) in hopes it will at least slow down the gland-plugging process.

I've now been on Lotemax for a week, and although I'm not a lot better, it does seem to make a difference and I"m hoping for better results as time goes on. I had used blephamide in the past, which did help a lot, but my doctor switched me to Lotemax because it's less likely to increase intraocular pressure, and that's reassuring.
Thanks to all of you - one day at a time!

[Minni]

I find that rubbing a tiny bit of White-tiger-balm at my temples helps.
Also alternating warm & cool washcloths while sitting at bath sink.

The rice or flax paks can be irritating to my burnt-lids (AKA rosacea) & spheroid degen.

How do you know you have Bleph. vs. rosacea? And how advanced is the MGD - do doctors know that?

And the reason why many people may have worsened their rosacea is because they apply meds indicated for Bleph. which may specifically irritate rosacea (as does bright lites and acid foods. Furthemore, the term rosacea is misguiding, when it should really be called sunburn or computer-burn or allergy-burn. That's more specific regarding the actual cause.

[Ericska]

Regular OTC eyedrops don't do much for me; but I use the Refresh gel several times a day, depending on how my eyes feel. The relief is temporary, but Refresh works much better than drops for m.

Have you tried HYLO drops and gel? I just started about two weeks ago and I find that the relief is much better than regular drops and lasts a bit longer. I can send you the link if you're interested.

[Minni]

Hycosan did not agree with me. Its just laying around now.
Not sure if its the same as Hylo.