Dry Eye Disease

Over time the glands that supply the lipid component to the tears (essential in preventing evaporation) can develop blockages (See figure 3}. These blockages are usually a result of dried lipid (Meibum) in or around the gland. The purpose of any lid heating treatment is to open the gland orifice and soften or partially melt the Meibum within these glands. Research has shown that continuous heat needs to be applied for 6-10 minutes to the upper & lower lids to be effective. There are three methods (listed below) that can be used to accomplish this.

1. Bruder mask (or generic equivalent): These beaded masks are available at most pharmacies. The great thing about these masks is how well they retain heat. Most masks will retain heat for the required 6-10 minutes with only one re-heating. The down side is this method requires a microwave to heat the mask. Instructions for heating will be on the box. This is my favorite method because of its simplicity.
2. Warm Compress: A washcloth and VERY warm water should be applied directly to the top and bottom lids. Research has shown the temperature of the water needs to be greater than 104°F (40°C) to be effective. Just make sure it is not so hot that it irritates or scolds the skin. You will need to reheat the washcloth approximately every 2 minutes to keep the temperature from dropping below the required level.
3. The Bundle Method: Dampen 4-5 washcloths with room-temperature water. Squeeze out the excess water. Fold the towels into long rectangles. Wrap the first towel into a tight cylinder then continue wrapping the remaining towels around that one until you have a large bundle. Place the towels in a container and cover with a lid. Microwave on high for 1 minute, 50 seconds. Allow towels to cool for 1- 3 minutes until desired temperature is reached. Take out the first (outside) towel for use on eyelids and place the cover back on the container. Once two minutes of treatment is finished, replace the washcloth with another from the container. Continue until all washcloths have been used. The point of this is to not have a ‘gap’ in applied heat by always having a hot washcloth available.

Now that the tear glands have been heated much of the material inside the glands will have liquefied, and the gland opening will be enlarged. This is the optimal time to flush some of that material out of the gland. We accomplish this with lid massage.

On the top lids, massage downwards toward the lid margin putting mild pressure with the ball of your finger toward the globe (ball) of the eye. Your stroke should start on the upper portion of the eyelid and end where you feel the base of the eyelashes-this is the lid margin. Massage 5-6 times on the upper lid (approximately 20 seconds per lid). Repeat on the bottom lid, massaging upward toward the lid margin. This is always done to both eyes.

lf you have done a good job, some of the dried Meibomian oil should now be on the lid surface. (It is too small to see with the naked eye.) We do not want it to stay there and have an opportunity to fall back down into the enlarged gland opening you just created with the hot compress. Clean the surface by diluting Baby shampoo and a Q tip or use Lid Scrub pads that can be found at the local pharmacy. Gently move the Q tip or Lid Scrub pad back and forth over the lower and upper lid margin (by the lash base) for 3-4 swipes. Be sure to wipe along the lid margin itself and not to touch the very sensitive front of the eye (the cornea).