Lid Hygiene and Using Drops or Ointments

[regularjoe]

Regarding Eye Lid Hygiene:

My dry eye doc told me to use an eye scrub daily, called "i-lid n lash". It has tea tree oil and a bunch of other things.

The doc said to close my eyes and just wipe my eyelashes outwardly. The directions on the wipes say to wipe my lids and eyelash roots in a circular fashion until debris is gone. Does not say with eyes open or closed, but figure they need to be open to hit the lid margins, right? Furthermore, I have heard of people using baby shampoo on a Q-tip, and running it along their eyelids to clean them...

All of these different methods have me confused about "eye hygeine" and how to do it? Am I targeting the lashes, or my eyelid, where the Meibomian glands are? Eyes open or closed? As for debris, I have never noticed any.


Regarding Drops and Ointments:

I am using Tobradex oitment. Pharmacist said to squirt one ribbon in the pouch of each eye. Easier said than done!! The little squeeze tube is squirting gel out as soon as I open it, and trying to get it in place, holding an eye open, judging distance in a mirror, means I never get a proper ribbon in place. I am resorting to squirting some gunk on a q-tip and trying to dab it in place.

Do you have nay advice on getting this done?

I feel like using eye drops would be better, or at least easier, but maybe they are not as effective?

Advice is very much appreciated. *smiley icon*

You can read my intro story here: http://www.dryeyezone.com/talk/forum...lazions-galore

[PhoenixEyes]

The doc said to close my eyes and just wipe my eyelashes outwardly. The directions on the wipes say to wipe my lids and eyelash roots in a circular fashion until debris is gone. Does not say with eyes open or closed, but figure they need to be open to hit the lid margins, right?

This "Instructions for Use" guide for i-lid ‘n lash show the eyes closed:
http://imedpharma.com/wp-content/upl..._8.5x11-EN.pdf

You have to be careful what you're getting inside your eyes so I'd keep them closed. The meibomian glands are very close to the base of the eyelash and so even if closed, the wipe will seep there.

Furthermore, I have heard of people using baby shampoo on a Q-tip, and running it along their eyelids to clean them...

I've heard from this forum that baby shampoo should be diluted or an alternative used:
http://www.dryeyezone.com/encyclopedia/babyshampoo.html

http://www.dryeyezone.com/talk/forum...dilute-it-more

This blog post also makes a good point about checking shampoo ingredients, a lot of preservatives do irritate dry eyes.

https://www.weloveeyesxo.com/blogs/n...lids-heres-why

As for debris, I have never noticed any.

I think cleaning the eyelid is also good for killing off bacteria etc. that aren't very visible. I guess in a normal healthy eye such crap is gotten rid of naturally as the oils flow away but when the oil isn't flowing well I imagine it sits on the eyelids. That's just my guess, best to ask your ophthalmologist for a proper answer!

Do you have nay advice on getting this done?
I feel like using eye drops would be better, or at least easier, but maybe they are not as effective?

Is it supposed to be so runny that it comes out without even applying pressure on the tube? Maybe ask the pharmacy or check the instructions to see if you're storing it OK. I have no experience with Tobradex so I can't say, sorry. You could position it horizontally then turn it when ready. Personally I don't use a mirror, I just tilt my head back.

If you find you aren't getting enough dosage with an ointment then you could ask for antibiotic and steroid eye drops separately. Tobradex is perhaps more convenient as it combines the two in one, but I imagine eye drops could be just as effective if you don't mind having to leave some time between the antibiotic and steroid drop.

Best of luck.

[MGD1701]

Hi
Lid Scrubs: Baby shampoo/*soap is BAD for eyes, many doctors do NOT recommend it but
Avenova, Cliradex (with tea tree oil), Ocusoft, ILAST (can moisture skin?), or Blephasol etc.
Bacteria + oil= *soap (simplest explaination) - what I have read.
We do NOT have Avenova nor Cliradex so I use soap-free tea tree oil shampoo but hard to judge % diluting is effective.
Dr Cremers puts 1 drop pure tea tree oil in a wet towel (details refer to her viedo below) - I tried seems ok.

Viedos on Lid Hygiene & gland expression
1) How to Wash Your Face by Dr. Sandra Lora Cremers
https://www.youtube.com/watch?v=srfWtLRWdh8
Use warm compresses and diluted tree oil (or Cliradex or Avenova) to clean your eyelids
More info http://eyedoc2020.blogspot.com

2) https://www.youtube.com/watch?v=gNFQ3s1VXas by Virginia B. Petitto, M.D.A

3) How to do Meibomian Gland Expression Safely, Dr. Jenna Zigler
https://www.youtube.com/watch?v=nYYQrMiebV0

-----------------
Ointment: it creates more problems than benefits, especially next morning.

Before bedtime - a MD posted the following in 2016 which I find logical/helpful! I wear swimming goggle which helps.
Quote
Trying to keep "dry eyes" moist during sleepwith the thickest or smoothest ointment/gel likely will not help and may worsen the problem.
The underlying cause is generally not due to excess evaporation or inadequate water/aqueous production.
It's the oil secretion along your lids during sleep that leads to the cascade of inflammation that cause dry eye symptoms.
Ointments will block the flow of inflammatory components that must drain through the lacrimal system, since they won't clear by evaporation like water to any great degree.

Try letting warm water run across your closed eyelids for 2 minutes at night and
scrub the lash line of the closed eyelids for 15-20 seconds with a mild shampoo.
The running warm water removes the dirt, oil residue, and bacteria on your eyelids in addition to warming them. Heating pads just warm the lids.
Unquote

[regularjoe]

Thanks for the replies and links, MDG1701.

I found another video that show Meibomian Gland Expression in a different style: https://www.youtube.com/watch?v=Rbdn4ezJL4U

I think you mentioned that you have a 20x mirror you use to express. Can you explain how you do it, or show a link if you have already done so?

[MGD1701]

20x mirror - I use it to monitor gland status - I can see (oil) drops for upper glands. It also helps find (falling) lashes and (small) stye etc.

Expression/massage:
Different doctors have different views - hard to know which one is safer and more effectiver.
I squeeze glands as recommended by Dr Korb, inventor of LipiFlow, to avoid cornea deformation.
I think the one you show - takes longer and hard to do for upper lids. Some doctors say:
do NOT do more than twice a day, do not press too hard (so as not to empty oil),
do NOT massage right after warm compress (so as NOT to damage conera but do not specify how long to wait)??

[regularjoe]

20x mirror - I use it to monitor gland status - I can see (oil) drops for upper glands....

You mean you can see oil drops from your upper eyelids?

With your 20x mirror, can you see Meibomian glands on both lower and upper eyelids? Can you literally see if oil is expressed, when you express it?

Do you think a (much more common) 15x mirror would be sufficient?

Some doctors say:
do NOT do more than twice a day, do not press too hard (so as not to empty oil),
do NOT massage right after warm compress (so as NOT to damage conera but do not specify how long to wait)??

Yes, and most doctors say nothing, as well. There is a lot of misinformation out there. And contradictory information. Makes things very difficult. But, I like your scientific approach, especially using a magnified mirror.

Warm Compress: Do you use Blephasteam/42.5C?

I don't use Blephasteam. Do you highly recommend it? Currently, I do warm compresses for 8-11 minutes with a rice sock (home made) and then wipe away closed eyelids/lashes with warm water. Then I either use lid scrubs ("i-lid n lash" with tea tree oil) or use eye ointment (Tobradex, a steroid and antibiotix mix), I cannot use the wipes and ointment together because it is all just too much for my eyes. So lately, it is:
Round 1 (morning): compress, wipe, lid scrubs
Round 2 (before bed): compress, wipe, ointment

For the record, I somehow have only mild dry eye. My main issue is inflamed eyelids and recurring chalazions, the latter of which I have had over a dozen over the years. (I do expect, with my MGD causing less and less functioning glands, my dry eye will only worse. Hence me joining this forum and redoubling my efforts to get this under control and not keep losing ground.)

[MGD1701]

Mirror: x20 is the best (brand I use: Zadro). Tried 15x but no useful. It can help you detect/remove stye sooner too.
Yes, I can see oil drops only from upper eyelids. Some drops are bigger than others. Some of lower glands are gone/short (for good).

Can you feel oil secretion with rice sock? If not, it is useless. Or perhaps should try longer, 15 min.

[regularjoe]

Mirror: x20 is the best (brand I use: Zadro). Tried 15x but no useful....
Can you feel oil secretion with rice sock? If not, it is useless. Or perhaps should try longer, 15 min.

Thanks for all of your info. I will buy a 20x mirror.

I cannot "feel" any oil secretion. Maybe I am not trained enough? The reason I want to get the mirror is so I have concrete proof that something is working. I agree, if I don't have proof, I need to change my approach.

Have you always been able to "feel" when things are moving?

[MGD1701]

It is NOT because you are NOT trained enough, rather the problems are:
insufficent heat/time, your oil is too thick or your glands are too clogged so oil can NOT come out.
Some people oil are toothpaste like. Normal oil should be clear like oliver oil. What are yours?

Here is an interesting/useful case report (Jan. 2017), comparision of: LipiFlow, Blephasteam, Bruder mask, MiBoFlo
title: ''The Limitation of Applying Heat to the External Lid Surface: A Case of Recalcitrant MDG''

I have tried three of above except MiBoFlo.
full text https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301113/

this can help you understand more why heat is important for results!!

[regularjoe]

This is the item you are talking about, right: https://www.amazon.co.uk/Blephasteam.../dp/B00ARUI3WK

It does not ship to Canada, where I live. If I was sold on it (I need to investigate more) I would figure out how to get it.

Could you ever feel your oils running before using this product?

[MGD1701]

Yes. that is correct. You need to buy rings too.
With (microwaved) Bruder Mask I can also feel oil but Blephasteam is much better due to its steam/mist.

Actually what helped my thick oil running is facial steamer.
(but 15 min. of Blephasteam instead of 10 min. should reach similiar results - this is safer)
Afterwards each time I use Blephasteam or Bruder mask, I can feel oil each time.
Like the article I shared, my oil is so thick and higher heat is needed.

[regularjoe]

With (microwaved) Bruder Mask I can also feel oil... Afterwards each time I use Blephasteam or Bruder mask, I can feel oil each time.

But for comparison purposes, did you ever feel the oil running before using these products?

(Maybe they make it run a lot, but other things made it run a little, and you didn't notice?)

[MGD1701]

No feeling of oil running before with boiling gels.
I first realized such feeling is when I did LipiFlow.
Just think if you want to melt butter, you need enough heat.
The article (case report) I shared, explained very clearly WHY HEAT is so important for results!!

[regularjoe]

I hear you, MGD1701. And I do respect, and agree with, your evidence-based approach!

That said, it is possible that there is a therapeutic benefit to using warm compresses, even if you can't feel the oil running. My guess is, it is even possible the oil is running, just not enough to feel it. (You can turn on a faucet a trickle and hardly hear it, or blast it and make it roar.) I am not discounting what you say -- I appreciate it -- I am just pointing out there are nuances to many things.

I did read the study that you linked. Thank you!

In the study, they do not mention measuring oil gland secretions, only the temperature of the eyelids. Yes, Lipiflow provided the most heat. That said, maybe, as I say above, there is still benefit in less heat.

[regularjoe]

This "Instructions for Use" guide for i-lid ‘n lash show the eyes closed:
http://imedpharma.com/wp-content/upl..._8.5x11-EN.pdf

You have to be careful what you're getting inside your eyes so I'd keep them closed. The meibomian glands are very close to the base of the eyelash and so even if closed, the wipe will seep there.

Thanks for the link and info. I have been doing my wipes, as described in the PDF, for over a week now. I think I get it now.

Regarding the ointment, that still is going poorly. I think it is an air pressure thing (or heat/humidity thing) that causes the ointment to ooze out as soon as I uncap. I have never perfected the application. My pharmacist also told me I could rub the ointment around my eyelids, which I do, but I am worried this may itself plug up the glands. I try to put a ribbon in the pouch of my lower eyelids, but it is hit and miss and I usually resort to q-tips.