Dr Korb 2016 video: recommends Blephasteam, squeeze lids etc

[MGD1701]

Since warm compress is so so important but hard to master, I would like to share this educational video (for doctors), found yesterday: Dr Korb, world MGD expert & inventor of LipiFlow etc, 2016 in Spain, published May 2018.

Dr Korb considers wet heat is the best so Blephasteam is good. However, the very very very effective is, Bundle method (about 45C (113F), video https://www.youtube.com/watch?v=fpwA76xepa4
I have read/tried a lot and find Blephasem is the best - more importantly, safer.

Allow me to remind - when one has Rosacea/inflammation, be careful with the heat/temperature.
Cold compress or a combination of cold/warm might be better.

My own findings/research:
constant/wet heat, 43-45C, enough time & the best indications: feel oil flowing & feel good afterwards.

I wasted 3 months to figure out all these as all doctors just said10 min which is useless as only 15-20 mins (& about 44C) helped for my thick oil. Even Dr Korb suggests 12-15 min with Blephastem - which really makes a big difference.

Recommendations from doctors range from 4-20 min, microwave 10-20 seconds, hot water/shower, mostly NO reference on temperature/frequency - how we can achieve results with such vague information? No wonder one top American doctor says most people perform compress wrong.

Dr Korb recommends to sequeez lids NOT massage (to avoid damaging cornea)

There are a total of 4 videos (part 2,14:00 about wet heat, bundle menthod etc)
https://www.youtube.com/watch?v=mZyXyQi-5MQ

I can not thank Dr Korb enough for his great generosity to share his knowledge. I admire his result-driven approach.

[Guest]

Since warm compress is so so important but hard to master, I would like to share this educational video (for doctors), found yesterday: Dr Korb, world MGD expert & inventor of LipiFlow etc, 2016 in Spain, published May 2018.

He considers wet heat is the most effective so Blephasteam is good, 12-15min. I have read/tried a lot and find Blephasem is the best - more importantly, safer. I close eyes as it is more effective.

If microwaved masks - he suggests to put a wet towel over it (part 3, 3:38) - to hold the heat longer. I have tried it and it works a bit better.

However, Bundle method (about 45C (113F), change wet towel every 2 min, is the most effective. The study (by his partner, Dr C Blackie and her team) proves it too. There is a video at YouTube.

sequeez lids NOT massage (to avoid damaging cornea)

He also mentioned pain, probing, LWE, lids seal, LLT, inflammation,
expression (done by doctor) - once a month
debridement - this is so interesting as it links to blink (part 3, 4:41)
(relations between blink/MGD &) scleral lens etc.

I can not thank Dr Korb enough for his great generosity to share his knowledge. I always look for his new videos/articles.There are a total of 4 videos. https://www.youtube.com/watch?v=vSShGZfxiFg

I spent/wasted 3 months to figure out all these as all doctors just told me 10 min which is useless as only 15-20 mins (& about 44C) helped for my thick oil.
See, even Dr Korb suggests 12-15 min - which really makes a big difference. Have read an article, posted earlier in the forum too, from Dr Korb team last year in relation to tempearture/duration to support this too - I like evidence-based stuff). I have noticed recommendations from most doctors are ranging from 4-20 min, microwave 10-20 seconds, tape (hot) water, without making any reference to temperature - how to achieve results with such vague information? No wonder one top American doctor says most people perform compress wrong.

My oil has been clear (can see oil drop from 20-zoom mirror) but still do about 12 min - I also use Blephastem to monitor oil status. Best indications, in my view, feel good afterwards & feel oil flowing.

Lipid layer thickness, LLT
one of my eyes has been improved double to 70 nm, per LipiView took in Feb. 2018. I believe now should be a bit higher.

My eyes have been pretty fit - good enough to work again.
Seems the main cause is incomplete blinking and no inflammation issue, confirmed by all +10 doctors in the last 2 years (slit lamp examination only). However, pure HOCL spray, NatraSan I have fouond (one year ago), helped me free from constant watery etc, just in a few days - very keen to know why. I wonder if MMP-9 test will detect better??

When you said 10 minutes is worthless you need 15-20, I agree 100%. I've watched a plugged gland go from milky and hard, to clear and hard, then finally melted. But that was after my 4th application of the compress after 15 mins.

last night for example, my compress was 25 minutes. I applied it 5 times because every time I removed it, my eyelashes were glued together. So last night I just went by feel. It's a very difficult thing to get right...but when you do, it helps so much.

[SirDryEye]

Why is it that some people complain about the blephasteam? Also why would you close your eyes as oppose to opening them?

[dede29]

What did he say about "expression (done by doctor) - once a month"?

[mbperso]

Blephasteam:I have the feeling that temperature of 41C is not enough high. One Dr told me that too.
In order to get wet heat I prefer wet cotton and Meibopatch with microwave 1mn 10seconds (equivalent to bundle method ?)
However I think duration needed depends on the oil quality of everyone. It could be between 5mn and 15mn. I can feel oil after 8mn.

Inflammation: how to see inflammation just with the slit lamp ?

[SirDryEye]

I can imagine that the steam from the blephasteam is very soothing, especially if your eyes are feeling very dry. Sometimes I like fill a plastic bowl with boiling water and put my face over the bowl into the steam. It feels very soothing however the effects is short lived. This is or probably similar to the effects the the blephasteam (probably not as effective though).

After a 10 min warm compress (EyeSoothe) my eyes feel very inflamed - especially after a message/lid squeeze. Has anyone ever felt this following the massage?

[MGD1701]

Hi mbperso

Inflammation
Great question. I always wonder it too. How do your doctors detect it then? Since MMP-9 is only available in USA?? I even tried to do BlephEx but the dr said, ''You could save the money as your lids are so clean & no demodex''.

Blephastem
my booklet from the company indicates 42.5C.

[SirDryEye]

MGD1701 - with the blephasteam, is it better if you open or close your eyes.

[MGD1701]

I find close eyes are more effective
but the company booklet does not suggest so & also just recommend 10 min.

[MGD1701]

My new discovery
*forceful blinking for the last 1-2 min. toward the end but close eyes for the first 1-12 min.
heat + blink = Lipiflow?? not really but kind of?

*I did confirm with my doctor who said if it is ok. But wise to consult your doctors too.
I always explore different/better approach and mostly it works.

[mbperso]

My new discovery
*forceful blinking for the last 1-2 min. toward the end but close eyes for the first 1-12 min.
heat + blink = Lipiflow?? not really but kind of?

Thanks for the advice , I'll try it. How did you discover that ?
Lipiflow is really different because it empties completely the glands and could unclog gland inside (not only at the edge of the lid)

[MGD1701]

of course, such approach will NOT be as effective as LipiFlow
This is only for maintance at home and only helpful when the obstruction is removed by LipiFlow, IPL etc..

The idea is generated from the LipiFlow theory & famous expert in USA, professor Richard Yee, who recommends (8-9/row?) forceful blinkings after compress (but afterwards the heat disappears quick to together is more effective, in my view). Dr Korb and other doctors do not recommend massage so such approach should work more effective/safer.

You may blink a bit longer - the key is you should feel good.

[MGD1701]

My doctor does not recommend 20 min. as it is too long, for info.

[Andrey_V]

However, the very very very effective is, Bundle method (about 45C (113F)[/SIZE], video https://www.youtube.com/watch?v=fpwA76xepa4
I have read/tried a lot and find Blephasem is the best - more importantly, safer.

Blephastem
my booklet from the company indicates 42.5C.

MGD1701 , so, does it matter that BLEPHASTEAM has a temperature less that recommended 45C? And what do you personally use - BLEPHASTEAM, or "bundle method", or something else?

[gilles]

Even if this was posted over 2 years ago, it is still very valuable information.
I learned that wet heat is one of the most effective treatments to do as home treatment against MGD (so I will use my mask with the pearls as cold compress; to help with ocular rosacea/inflammation rather than for heat) and try the Blephasteam again, as it seems it is quite difficult to do the bundle method right (check if the temperature is not too high/low and keeping the temperature steady).
Why wét heat treatment, because water is a good conductor and thus will more efficiently conduct or transfer the heat.
The order of effectiveness for heat treatment seems to be: LipiFlow, Blephasteam, Bruder mask, MiBoFlo (Christen J. Kenrick, Sabiha S. Alloo, 2017).
Eyelid massages should never be done on the cornea (only with tools where a backplate supports the force), so no massages anymore for me (which is a good thing, as it seemed to increase my corneal inflammation) and maybe squeezing of the eyelids against eachother later on. For people who are already doing this, it is suggested to let a practioner do manual expression. This is called 'debridement-scaling' with a golf club spud¹, which dr. Korb also points out in the video which I shared below. As a home treatment, he suggests to do blink exercises; and combining them with heat treatment could have remarkable results (see here how to do them).

Repetitive Lipiflow is suggested for people who have a meibomian gland malfunction (blocked glands) and find no relieve with the home treatment. But first one needs to find out the reason of the inflammation of the glands (eyes that are not sealed well when sleeping, partial blinkers, allergies, screen use as that leads to not enough blinking (lifestyle), bad eyesights, a combination of things, etc.). I put 'not enough blinking' in bold, as this seemed to be the core or essence of the problem as per dr. Korb; seeing screen usage is everyday in our lifestyle and leads to not blinking enough.

In a more recent conference of dr. Korb I learned that Restasis/cyclosporine only helps with the aqueous part, so more water in the tear film; but other than that it does not help with the MGD part. Also the confirmation about the ineffectiveness of supplements (e.g. omega3) was pointed out.
Also, the rule of how you would dry your clothes (keep your eyes moist, out of wind; e.g. with moisture chamber glasses, avoid ventilators/fans, use humidifiers).

Furthermore and as conclusion: it is important to prevent MGD, as dr. Korb mentioned, just as you brush and or floss your teeth to prevent cavities. Meibographies could and should be a standard procedure at an eye check, seeing as our lifestyle does a lot of desiccating stress to our eyes.

For the people who are interested in the conference from 2018 (topicstarter is about 2016): part1 and part2. The introduction is in Spanish but the after that it is all plain English.

^{1 Image of golf club spud:}