I think warm compresses are pointless in many patients...

[poppy]

Just thinking back to my last eye doc visit and one of the registrars was interested in dry eye and wanted to try to express my glands. He was a big believer in warm compresses, and suffered from blepharitis himself. He used numbing drops and applied a great deal of pressure to my lower glands, still hurt quite a bit so I knew he was trying hard, but he was unable to get anything to come out. This is the only time I have had a doc try to express my glands like this, and I know this guy was just a registrar but I've had other very experienced dry eye docs who have also noted that they cannot get any oil to come out after pressing on my glands.

I feel that in cases such as mine warm compresses are useless and are being used as an excuse by crappy eye docs to blame our conditions on our own laziness etc. Of course I have tried warm compresses several times for lengthy periods, and lid massage, it has done absolutely nothing and I feel it's pretty crappy that docs are telling us that if something isn't working, doing more of the stuff that doesn't work is the right idea?

[kitty]

Much depends on the cause of the DES. If the DES is caused by an inflammatory process, as one doctor told me, "why put something hot on something that is already hot?" He did not believe that warm compresses would help my inflammatory dry eye. He expressed my glands with a cotton swab, no pain at all. I did not notice much difference in how my eyes felt as a result. Just my observations and two cents worth.

[Rebecca Petris]

Like everything it's patient specific and results vary a lot with the specifics of the method. I would definitely agree that there are a lot of people doing compresses that are unlikely to benefit, and plenty doing compresses that might be making them worse. It's the whole problem with boilerplate one size fits all treatment. For any treatment, if you don't have a way to monitor results objectively and subjectively over a long enough period of time, frankly, it's a crapshoot.

I feel it's pretty crappy that docs are telling us that if something isn't working, doing more of the stuff that doesn't work is the right idea?

Well yeah. That was always my biggest beef with the Restasis bonanza. Doesn't work? Keep doing it for another few months, or years, or let's increase the dose. On the blind faith that it will, eventually, work, period. Logic at its finest

Speaking of the varieties of doctor-patient attitudes, I have to share a funny anecdote from my recent appendicitis adventure.... Tuesday last week....

3pm My gut starts hurting and I lie down on the sofa at my office for awhile. Classic pattern. Starts at the belly button, moves to the right. Feels like an endless contraction.

5pm I'm chewing through my lip at every pothole of our long dirt lane on my way home.

7pm I'm in ER having a quick chat with a triage nurse and one or two other staffers in the room. I explain what happened. Then... ugh. Some people when asked where their pain is on a scale of 1-10 say "TWELVE DAMMIT!" Me, the assertive-aggressive type who coaches people on how to communicate pain to doctors, surely I'll get this one right? Nooooo. I say well, gee, I dunno, I hate those numbers things, I guess maybe a 5? Then I make some tentative brief comment like "I'm not trying to self diagnose or anything, and I know there's a lot of potential explanations for right side abdominal pain but... from everything I've read, this sure seems pretty classic textbook stuff...." They IMMEDIATELY jump down my throat scoffing at all the bad information on the internet (and me for believing any of it). I stop talking, not motivated to argue.

11pm or so I finally actually see a dr. (walked into an empty ER and thought great! then a city full of heart attacks and whatnot walked in on my heels, so got bumped back down the priority list. I think that's when I figured out I should have said 12.) Great guy, clues in immediately. Asks a few pertinent questions, feels around, smiles and says, "You know what this is don't you!" and I said "Well... yeah... but... shoot... is it really?" "Yup. Clear your calendar for a few days."

Anyway the whole episode made me think a lot about all you folks here. I was so, so fortunate that I had a really easy straightforward obvious case. Diagnosis obvious, treatment equally so, no issues. But with dry eye diseases, sadly, so frequently it doesn't work like that. They tend to throw the cookie cutter treatments at you (be it Restasis or compresses) without any more thoughtful detailed observation, case history, ongoing monitoring, etc. All on faith that it will eventually work because it's conventional. In what's supposedly an age of science, many doctors really act on faith an awful lot of the time. Not necessarily bad in itself, but faith in what? Merck marketing machines?

Pardon my midweek ramble I'm still not quite 100% ready for work today I guess