Just diagnosed with MGD at 39, natural options?

[jennifermd2015]

So I have always had on/off problems with dry eyes when I wear my contacts and recently I had some dry eye when I was wearing my glasses, traveling for 10 hours on a plane. I have always wondered about my tear film because it doesn't feel "right" and I notice that I get frothy film in the outer corner of my eyes which the internet says is a definitive MGD sign. I guess I am wondering what to do. The opth is so vague, he just says yes you have dry eye from MGD and then offers my cauterization or plugs. I really don't feel that my problem is bad enough to do cauterization or restasis but he claims it will just get worse and worse over time. Im already taking NAC supplements and flax seed oil (2000mg /day) and have been for years. I guess Im wondering what else I can do that is not medication or weird plugs/surgery.

I'm considering having PRK because I am very active and if I can't wear my contacts that is going to be a big problem for me when camping/traveling/scuba diving etc. Things that are not glasses friendly I'm really bummed about this diagnosis but I also question this diagnosis. What are the glands on my lids supposed to look like? I can't tell if they are plugged or capped or just not producing anything at all? I don't see white goo or caps or anything but the inside of my lower lids look like whitish rows with capillaries around them. I honestly don't usually have any discomfort with my glasses, only when I wear my contacts at this point or when I am traveling on a plane with super dry air. Should I find someone to do more definitive testing? Any info appreciated from those who have more experience.

[jennifermd2015]

I should also note that I tried warm compresses but found that they were making my eyes look "older" and wrinkly so I stopped. I mainly just apply pressure to my lids when I'm in the hot shower. I also rinse my eyes with salt water when they are bothering me and apply castor oil to my eyes nightly for moisturizing and because I have heard it is good for dry eye at night and to help if bleph might be the problem. I have not formally been diagnosed with bleph or rosacea but I am of Irish/Scottish, Northern European descent so I guess that is probable? I guess I am just surprised that when I went to the eye doc for contacts lens checkups for so many years that no one ever noticed anything or said anything if my eyes were looking dry or irritated. I currently use Zaditor on a regular basis to help alleviate my allergy probs (dust, pollen, mold, everything )