confused why i should do compresses

[yoganut]

Hi I haven't posted for a while. Mainly because I became discouraged
about dry eye treatments. I've been to see 3 diff doctors in 2 different practices since 2005 and I've tried the treatments they suggested, and become totally discouraged. Been making do with NutraTear and read with dismay that it's not available?..

Anyway Sunday I decided I'd had it with they dry eye and started doing the warm compresses (rice baggy) and dug out some sterilid I had.

Bearing in mind one of my eye docs suggested I rub my eyelids (he didn't explain it was to express oil - I find my eye docs tell me to do something but don't explain why, which leads me to get discouraged if I don't get immediate relief) anyway...so it's day 4 of the warm compresses followed by sterilid and I'm not seeing any 'oil' come out of my glands.... Alot of people talk about how they can see/feel the oil coming out of their glands, but I don't see/feel anything.. I'm thinking maybe that's not my problem? but then I was told to do this?... I'm also using Zaditor... last eye doc visit I had been given an rx for Patanol, but stopped using it because of the BAK in it..but now I'm giving the allergy drops another try... I'm just concerned about the BAK preservative... how long can someone use these eye drops without long term damage? I mean if the eye doc gave me a script for allergy eye drops, then I must need them just about every day... but is it safe to use them every day?

[mjf79]

I know it is discouraging, but the warm compresses will bring some changes over time. Dr. Latkany in his book said that it can take up to 6 months of constant care to get over some of the inflammation and get things moving again. I have been doing warm compresses for months and am on maintenance now. The compresses are to loosen up any gunk in your eyelids for easy removal and also to help the oil to flow. This is a temporary unplugging and the goal is to go and wash your lids right away and do the "massaging" (which I do very gently with my fingers). Just keep it up!
If you have true MGD, you may want to inquire about oral doxy, which is an anti-infammatory and given for MGD and ocular rosacea.

[yoganut]

Hi thanks fo your reply. I did the warm compresses and lid scrub last night before bed and looked in the mirror and my right eye (always worse than the left) was all bloodshot and sore..could I be doing the lid massage and scrubs the wrong way?

[ALK-O'd]

Hot compresses

Hi Yoga,

Hot compresses followed by proper lid massage will help if you are in the early to mid stages of MGD. If clogged glands aren't your problem then you probably won't get results. The key to finding the right treatment method(s) for your dry eye is to first determine the root cause of your dryness.

I am an MGD sufferer. My O.D. has shown me digital pictures of my clogged glands and "soapy" like tear film. Having seen that visual has really helped me to focus on appropriate treatments. For me, the hot compress + lid massage has been the most effective treatment so far. My method is as follows : First off, I purposely use a thick washcloth. I find using a thicker one is better because it holds more water and thus holds the heat a little longer. I stay at the bathroom sink while applying the cloth to my eyes so that as soon as I feel the heat diminishing I can run more hot water over the cloth and re-apply. As for how hot, well, obviously use some common sense here, but I go for as hot as I can take it without irritating my lids. I find "warm" just doesn't loosen up the oil enough, but like I say, use common sense and find your comfort zone. As for how long, I usually apply the cloth for about 5 - 8 minutes, then do an oil expression, then re-apply the hot compress for a second round of an additional 4 or 5 minutes, then one final expression. I find that the second round is where I really get the oil flowing. I only do the lid expression for about 30 seconds or so each time. Any longer and I find the rubbing irritates my skin. I learned how to do the expression from an online article I read a while back. I'll explain as best as I can but unfortunately I no longer have the link. I have seen others on this site explain it in a similar way though. For the lower lids, I place my index fingers on the outside (ear side) corner of the lid and pull the lids taught towards my ears. Then, I use my middle fingers to massage the lids in an upward motion which squeezes the glands like little tubes of toothpaste which forces the oil out of the glands. As I am doing this upward massaging I also gradually move across the lid from side to side since the glands are located all along the entire lid edge. I purposely don't look in the mirror to try to see if oil is coming out. I've tried that and I find that trying to keep my eyes open to look for the oil actually prevents me from doing the expression properly. But, 1) I can usually feel my fingers getting slippery with oil and in fact I usually have to wipe them clean once or twice or I lose my grip on my lids! And 2) sometimes (particularly with my lower lids) I can even hear a little tiny bit of squishing noise as I squeeze the oil out.

The concept for the upper lid is pretty much the same. Pull the lids taught then massage downward and across (instead of upward) and move across the lids. Also note that it is a good idea to look upward when messaging the lower lid and look downward when massaging the upper to help keep your corneas positioned away from your fingers for safety.

I perform my routine pretty much once daily (in the morning). I’ve found that doing it a second time at night is no more effective and with all that massaging twice in one a day the skin on my lids will get irritated. Again, you have to experiment and find what’s right for you. It’s not uncommon for my eyes to be a little red immediately following this process but the it goes away in a few minutes. As for the level of relief I get, well, it’s no cure by any means but there is no doubt that my symptoms are noticeably reduced on the days I do it as opposed to the days I don’t.

[SallyP]

Thank you for that. I've just started to express the oil, and do manage to get alot out of the lower lids, but only in the morning, and I don't get much out of the upper lids. I also did it in the evenings, but nothing seemed to come out, and it irritated my eyes.

I too noticed a noise on several occasions as it came out, and I think I'll take your advice and stop looking in the mirror. I know there's oil coming out because my vision goes blurry!! It also makes me feel a bit sick actually, so I can do with out the visuals.

Thanks for your time, alot of people will read with interest.

[rp123]

Thank you ALK-O'd for your detailed description of expressing oil. I am trying it. Just 2 short questions. Do you prefer hot washcloths to the rice bag?
Do you wash your eyes with lidcare etc after expressing oil or just leave them. Thank you for your time.

[yoganut]

Hi Yoga,

Hot compresses followed by proper lid massage will help if you are in the early to mid stages of MGD. If clogged glands aren't your problem then you probably won't get results. The key to finding the right treatment method(s) for your dry eye is to first determine the root cause of your dryness.

ALK-O'd

Thanks for your informative post. My next to last eye doc suggested I get a warm washcloth and rub my eyes in circular motions - even though he didn't specifically say I had MGD, I can only assume from his instructions that he was thinking rubbing my eyes with a warm washcloth would help with getting oil flowing. Of course I gave up doing it cos I didn't see any immediate results.

But I'm trying again. I'm going to take a page out of your book and just try the wascloth/expression on the a.m. and not twice daily.

ALK-O'd - do you ever experience itchiness? My eyes have been driving me crazy - it starts in the evening usually - I'm 'digging' at the lids scratching. In fact now that I think of it this itchiness actually preceeded my dry eye symptoms. I've noticed its worse in the summer. Although I'm not a fan of allergy eye drops because of the preservative I have been using the drops the past week and the itching has almost gone.

Also - do you use sterilid or any lid scrub after your washcloth/expression regimen? I've been using it the past week after the warm rice baggy/expression but can't tell if its really doing anything. All those scrubs are expensive!

[ALK-O'd]

Hi rp123,

To answer your questions:

Do you prefer hot washcloths to the rice bag?

I've never tried the rice bag method. Not that I think there's anything wrong with it, but I just have no problem with the washcloth and I find the moisture to be very soothing. I also like being able to quickly re-apply heat by staying at the sink when I feel the cloth beginning to cool off. My advice is to simply experiment and determine for yourself which method you prefer. I myself will probably experiment with the rice bag method at some point. Although I know I'll never hear the end of it from my wife if I need to ask her for a pair of her pantyhose for it...

Do you wash your eyes with lidcare etc after expressing oil or just leave them?

I wash my face and do a gentle lid scrub w/ baby shampoo BEFORE doing the hot compress. My reason for this is that I have oilyskin on my face. I find that any time any minute amount of that skin oil gets into my eyes, my eyes will burn and get very irritated. I have found through my own experience that if I don't wash my face (particularly around my eyes) before doing the compress, some skin oil can get pushed into my eyes and then my eyes burn and get irritated during the process. Besides, I would say in general it's good safe practice to keep everything clean (your face, your hands, and whatever you're going to press against your eyes) before doing this routine. After I finish expressing the oil from my meibo glands I do not do any further lid scrubs. By this point, the skin on the outside of my lids is sometimes slightly irritated and for me, the freshly expressed meibo gland oil feels soothing to my eyes.

One other thing I'll mention here that I've been doing recently. I've been on Restasis for a little over a year now with little to no results. For the last few weeks I have begun administering my morning Restasis drops roughly five minutes after doing my hot compress + expression routine. CAVEAT EMPTOR: I'm not a doctor, nor did my doctor tell me to do this. It's just something I'm trying before giving up on Restasis altogether. My theory here is that since I know I have clogged glands, it's certainly probable that the medicine isn't getting into the glands at all. Since the glands are cleared up a bit after the oil expression, I feel this might be a better time to be putting the drops in rather then when I first get up (which is when I used to do it). I've only been doing this a few weeks and am not seeing any noticeable improvement yet. If I suddenly do, believe me, I'll post loud and clear about it.

[ALK-O'd]

Hi Yoganut,

ALK-O'd - do you ever experience itchiness? My eyes have been driving me crazy - it starts in the evening usually - I'm 'digging' at the lids scratching. In fact now that I think of it this itchiness actually preceeded my dry eye symptoms. I've noticed its worse in the summer. Although I'm not a fan of allergy eye drops because of the preservative I have been using the drops the past week and the itching has almost gone.

The itchiness could definitely be allergies, especially since you mention that it's worse during the summer when there's lots of pollen floating around. I myself was on Patanol for about two years. It neither helped, nor hindered me so I ultimately stopped using it. But I believe it's safe to use long term if it works for you. I am allergic to pollen, ragweed, dust etc... I occasionally had some itchiness in my eyes but my primary symptoms were constant sneezing and runny nose. About two years ago I stopped all allergy medicine and switched over to allergy immuno-therapy shots. I found a good allergist who is located on my route to work. Every other other Tuesday morning I stop into his office for a shot before I head into the office. I have found the shots to help tremendously - and best of all it's 100% natural. No chemicals whatsoever. They basically inject you with very small amounts of what (after some testing) it is determined you are allergic to. Over time the doses are gradually increased and your immune system is "taught" to no longer "over-react" to the pollen, dust or whatever triggers your symptoms. The downside to it is that it does take a very long time to begin noticing results (minimum of 6 months) and you do have to keep regular with them, but it's something you might want to look into. It's helped my allergies TREMENDOUSLY - and as I said, I'm no longer on any allergy medicine whatsoever.

Also - do you use sterilid or any lid scrub after your washcloth/expression regimen?

Please see my above post to rp123 on this.

[yoganut]

Hi rp123,


I wash my face and do a gentle lid scrub w/ baby shampoo BEFORE doing the hot compress. My reason for this is that I have oilyskin on my face. I find that any time any minute amount of that skin oil gets into my eyes, my eyes will burn and get very irritated. I have found through my own experience that if I don't wash my face (particularly around my eyes) before doing the compress, some skin oil can get pushed into my eyes and then my eyes burn and get irritated during the process. Besides, I would say in general it's good safe practice to keep everything clean (your face, your hands, and whatever you're going to press against your eyes) before doing this routine. After I finish expressing the oil from my meibo glands I do not do any further lid scrubs. By this point, the skin on the outside of my lids is sometimes slightly irritated and for me, the freshly expressed meibo gland oil feels soothing to my eyes.

Thanks again. I think you have a good point. I bought some fresh Sterilid. I couldn't find Occusoft and did a lid scrub after the hot washcloth and boy did it burn. It was almost like I got shampoo in my eyes. I'm thinking I'll try the washcloth regimen in the a.m. and do the sterilid in the p.m. Must remember to persevere and not give up as I usually do if I don't experience immediate relief!

[rp123]

Thanks for your reply. It was very helpful.