A better way of doing warm compresses (personal experience)

[Milo007]

Hello everyone once again,

I am writing a short post to share a trick based on my personal experience and thoughts that may improve the efficacy of warm compresses. Conventional methods of warm compresses typically involve using one or more washcloths soaked in hot water (~45°C) and applying them over closed eyelids turn wise (alternated every 1-2 minutes) in order to transfer heat to the inner palpebral surface of the eyelids where the meibomian glands are located. A CONSTANT external temperature of 45 °C applied to the outer surface of the closed eyelids results in an increase in the temperature of the inner palpebral tissue of the lower eyelids from 35.5 °C to 40.1°C in 6-10 minutes according to Dr. Korb. The goal of warm compresses is to liquify the stagnant and solidified meibum within the glands that creates a blockage. But the most essential part is to milk the liquified secretions out of the glands BEFORE they start getting more viscous again. Most of us are instructed to complement a warm compress with a lid massage after the compress. The downside of this practice is the secretions start to get more viscous as soon as the source of heat is withdrawn and by the time you can milk the secretions of some of the glands the secretions in the other glands have already hardened again. So an effective practice would be to SIMULTANEOUSLY milk the glands while the source of heat is still present over the outer eyelid surface. This is exactly what lipiflow does in an assisted way. The combination of simultaneous heating and milking of the glands can be achieved only if we complement warm compresses together with blink exercises. Blinking is the natural process that milks the glands through complex muscular contractions within the eyelids. It's both safer and more effective than eyelid massages. So the idea is to perform blink exercises (squeezing the closed eyelids hard) simultaneously while applying warm compresses over the eyelids.

I would love to have your thoughts on this. It would be very interesting to see if it makes a difference to them who have had limited success with warm compresses earlier.

[Topher3]

I do believe blinking with compresses can help, and have the potential to excrete the liquified oil. Definitely do blinking exercises under heat that’s a great idea. The main problem that I can see with people having this MGD is that yes some could have just solid meibum however a lot including myself have malfunctioning glands. So even if the oil is expressed the malfunction whatever it may be (so many reasons) brings people back to the same place.

[Milo007]

I do believe blinking with compresses can help, and have the potential to excrete the liquified oil. Definitely do blinking exercises under heat that’s a great idea. The main problem that I can see with people having this MGD is that yes some could have just solid meibum however a lot including myself have malfunctioning glands. So even if the oil is expressed the malfunction whatever it may be (so many reasons) brings people back to the same place.

I am sorry to hear that your glands are malfunctioning. Assuming that your glands are not blocked with stagnant meibum have you contemplated the reason behind the glands not producing enough lipids?

If you have enough glands visible in meibography and they aren't secreting enough lipids then there's a big chance that your glands are internally blocked with hardened meibum or fibrotic tissue or keratinized epithelium. Your only option to save the glands is to clear the blockage (probing, heating/IPL followed by manual expression or lipiflow).

Even after the blockages are cleared up it must be ensured that there's no recurrent blockage due to inflammation (inflammation from dessication stress due to low LLT in most cases) to give the glandular acini enough time to start working again. This is where I believe most treatments fail since treatments are aimed at clearing the blockage initially but they get blocked again due to consequent inflammation. Unless you are on a very effective protocol of anti inflammatory treatment or you remove/manage the source of your inflammation for LONG ENOUGH so that your glands have enough time to get back to a working condition again all current modalities of treatments are likely to fail ALONE. So I believe a strategic protocol of treatment is far more important than a single procedure with short term efficacy.


Remember you have to break through the cascade of dry eyes which is not a single day affair but might take months or years of careful management with drugs and lifestyle modification.

[hopeful_hiker]

Yes, I use a similar method. I have to reheat the mask a few times anyways so I blink in a pronounced fashion then. After 8 minutes or so I apply light pressure and check what is happening in the mirror. Often I can see clear oil in some glands and an oily margin. Plus I can see oils in the eye and feel the grittiness. I wipe gently my eyelid margin and then do a bit more of warm compress for another 5-8 minutes.

[Topher3]

I am sorry to hear that your glands are malfunctioning. Assuming that your glands are not blocked with stagnant meibum have you contemplated the reason behind the glands not producing enough lipids?

If you have enough glands visible in meibography and they aren't secreting enough lipids then there's a big chance that your glands are internally blocked with hardened meibum or fibrotic tissue or keratinized epithelium. Your only option to save the glands is to clear the blockage (probing, heating/IPL followed by manual expression or lipiflow).

Even after the blockages are cleared up it must be ensured that there's no recurrent blockage due to inflammation (inflammation from dessication stress due to low LLT in most cases) to give the glandular acini enough time to start working again. This is where I believe most treatments fail since treatments are aimed at clearing the blockage initially but they get blocked again due to consequent inflammation. Unless you are on a very effective protocol of anti inflammatory treatment or you remove/manage the source of your inflammation for LONG ENOUGH so that your glands have enough time to get back to a working condition again all current modalities of treatments are likely to fail ALONE. So I believe a strategic protocol of treatment is far more important than a single procedure with short term efficacy.


Remember you have to break through the cascade of dry eyes which is not a single day affair but might take months or years of careful management with drugs and lifestyle modification.

Yes I have recently done lipiflow, I have done 4 treatments of ipl. My inflammation has been considerably lower since recently starting using moisture chamber goggles. They have helped so much. You’re right I believe it will take some time to heal. As I’ve said in pst posts I do have atrophy in my glands however more oil should be coming out then what is. My diet is absolute trash and I believe the single most important thing I need to clear up. I also have eczema on my eyelids too which needs appropriate action as well (diet should help as well.) I use blephasteam to help with my glands, but recently I have learned that I should be doing it for at least 20 minutes for it to actually help melt the meibum. I don’t know if blockages and scar tissue is the issue. It’s most likely malfunctioning glands due to atrophy I’d assume.