Hot compresses - including Blephasteam - only make eyes feel worse. Anyone else?

[Jenny43]

After having four-day flare-ups every time I used a hot compress (microwaveable bags and hot flannels), I bought a Blephasteam with high hopes. Used it yesterday for the first time - and began a flare-up afterwards, with eyes feeling dryer and more uncomfortable and needing drops more often. So it seems that my corneas cannot tolerate heat of any kind. I was on 50mg doxycycline for two months which helped and my oils expressed reasonably clear afterwards with no blockage. But without the application of heat I have a problem with managing my MGD in the future. I do blinking exercises - but don't think this helps much without heat.

Does anyone else react badly to heat in this way? Or have any ideas for getting around the problem?

[anteloper]

Does anyone else react badly to heat in this way?

Hi Jenny43. Just from reading your post I of course don't know a ton about your particular case of dry eye. So I'm not sure if it's at all in the same way. But heat seems to exacerbate my ocular rosacea and its symptoms-- burning, irritation, pain, increased blood flow and very visible red veins in eyes-- so I do not use warm compresses any more.

I did use them for about 6 months initially after my dry eye started, and they did help with my MGD but the impact on my ocular rosacea was worse overall than any MGD improvement. I have very sensitive skin. At the time I couldn't differentiate MGD symptoms from ocular rosacea symptoms so I didn't catch on that the compresses were hurting as well as helping.

IPL has helped me a ton, though of course I don't know if it would work for you.

Re: healing MGD with less heat, I have tried doing warm compresses less frequently but putting more effort into manually expressing the glands each time. I bought a paddle (https://www.amazon.com/gp/product/B01LW7SJMP/) and have done manual expression in front of the mirror similar to how the doc does it in the office. For me, doing this once every 1-4 weeks is better than doing warm compresses every day but I think it depends a lot on your particular kind of MGD. With manual expression it's extremely important to be gentle. A few times I've done it I didn't see any meibum coming out so I panicked and pushed harder, which I have always regretted. If the meibum doesn't flow the only solution is more heat, too much pressure can damage the glands.

Of course, anything else you can do (e.g. fish oil, diet, stress management, etc.) to reduce inflammation will help improve the consistency of your meibum.

I still have MGD so I have basically ended up getting Lipiflow every 6-8 months and not doing any warm compresses. Sadly, it's expensive but this is the best solution I've found for my dry eye.


What makes you think it's your corneas that can't tolerate heat? (And not, for example, your eyelids?)

[drydm]

Does anyone else react badly to heat in this way? Or have any ideas for getting around the problem?

Hi, for me warm compresses made my eyes worse as well. It created more permanent delighted vessels in my eyes. So I stopped doing that at all.

[lipino]

I find that heat helps me. I do eyelid pinches afterwards, and it's kind of like when you take a bottle of olive oil out of the fridge and starts to thaw and if it was a plastic bottle you could squish it. That's how my glands feel.

Maybe try using a cold compress afterwards to calm things down? Also, have you tried Azasite/Azyter? I squeeze out a tiny drop and rub it on my lid margins every night, and I find it helps the glands express more easily. I've also read you can stay on 20 mg doxy twice a day long-term without any gut bacteria consequences, although you should take probiotics just in case.

[Jenny43]

Thanks, Lipino. I haven't tried a cold compress after a hot one. I suppose it might work but I'm wary of the 4-day flare-ups which always come after heat. I have a x15 magnifying mirror but still can't see my glands. Azasite doesn't seem to be prescribed much here in the UK but I'll ask my ophthalmologist when I next see him in January - thanks for the heads-up. And it's nice to know that low-dose doxy can be used long-term. I took a probiotic drink every day while I was on doxy and had no problems. I feel so lucky in finding this forum - for both help and support. Thank you for yours - and good luck with your own eyes.

[alex123711]

I find warm compresses make things worse too and stopped doing them