Last updated June 2005
Should I try it, and if so, why? If you have any one of several conditions causing or contributing to "dry eye" or things that feel like "dry eye", lid therapy will DEFINITELY be very good for you. If you have no idea what your eye condition(s) is/are, just the fact that you’re here reading this probably means that you have at least one of the conditions lid therapy could help; in any case lid therapy cannot possibly hurt you (so long as you don't do anything stupid like stick a Q-tip in your eye); and in your state, anything is worth trying, isn’t it? On the other hand, if you definitely don’t have any of the conditions that lid therapy could help, that means you either don’t have "dry eye" at all, or the easy stuff like artificial tears and punctal plugs worked, so what on earth are you doing on this website?
Lid therapy does two really good things that can help your tears directly and indirectly — indirectly, by getting rid of or preventing nasty stuff that gets in the way and makes dry eye conditions worse or makes conditions that feel like dry eye, and directly, by improving some of the really important stuff that goes into your tears.
Specifically, lid therapy will:
Keep those little eyelids nice and clean and healthy: Get rid of and keep away nasty blepharitis (which you may have and not know it but whether you know it or not, lid therapy will help it); prevent infections; shoo away debris; clean up insidious eyelid dandruff.
Improve the secretions from your meibomian glands, which are located in your lower and upper eyelids and are supposed to secrete oily stuff (lipids) into your tears. Remember, oily stuff is what keeps your tears from evaporating and so if you don’t have it, your tears evaporate and you have dry eyes. If the oily stuff has congealed (like olive oil on salad when you’ve set the refrigerator temperature too low) in your glands, it’s not likely to get out of the glands and into your tears where it belongs without help. Lid therapy basically makes it melt again and then squeezes it out. Once you get the glands nice and cleaned out and the oily stuff is running the way it’s supposed to again, you want to keep it that way so regular lid therapy prevents them from getting clogged up again
Do I have to do all three steps? No, of course not. On the other hand, you don’t "have" to do any of this at all — you can simply continue to suffer with severe dry eye and endanger your corneas by permitting erosions and abrasions. The way I figure, the more of a problem you have, the more motivated you will be to do this sort of thing.
Frankly the whole thing really IS a pain in the *ss. At the end of a long day the last thing you’re going to want to do is wrestle your meibomian glands into submission. — Until, of course, you wake up with a corneal erosion and start kicking yourself for not having diligently done your lid therapy. We are sorry. There’s just no way around it. We don’t like it, it’s a major nuisance, but it’s unquestionably beneficial. Make it a habit. I do my little lid scrubs whenever I brush my teeth.
How long will it take to work? Do NOT expect overnight results when you start this for the first time. "They say" you should keep on for three weeks to get the full benefit. Having said that, we know people who DID have immediate benefit.
Here is what we think might happen to you: You will try it out. You’ll notice some change after a couple of days, and that will motivate you to keep at it. You’ll keep it up for awhile, until you get to the point where you think it can’t really improve you any more than it has (which point may be one week, three weeks, three months, whatever), and at that point you’ll slide into "maintenance mode" which depending how motivated and industrious you are may be anything from all three steps every day to daily hot compresses, the occasional lid scrub and expressing the glands only when you get really bad again. Everyone is different. Everyone has slightly different needs for their eyes, and everyone has a different tolerance level for the process. If you are tolerant of the process, make the most of it!
Do I need to follow the instructions exactly? What if I have heard of an alternative method? Please note that there are approximately one zillion variations in the descriptions people give of how to do each of these steps (several of them that I had not heard of are described by the good people over at www.dryeyepain.com). I am simply trying to describe enough to give you the idea, so you won't be intimidated when you read about lid therapy elsewhere.
Warm compresses are good because they make your eyes feel better for awhile. But more importantly, they are good for your eyes and your tears because they start loosening up any congealed oily stuff in your meibomian glands.
When do you do it? Try morning and evening, whether or not you bother with lid scrubs and lid massage.
What do you use for a hot compress? Doesn’t really matter. Here are some ideas:
The "rice baggy in the microwave" approach: (1) Make a rice baggy: Take a piece of muslin about large enough to make a pillow-case shaped thing about the size of a large spectacle case. Sew it up leaving a little hole and through that hold fill it up with rice. Then sew it the rest of the way shut. (Cindy's version of this uses a clean toddler-size cotton sock.) (2) Whenever you want to do a compress, put the rice baggy in the microwave and zap it for, well, it depends on your microwave. In mine the perfect time happens to be 43 seconds. Basically, you want to get it as hot as you can stand without burning your face. Incidentally, please do not add water. You want to cook your meibomian glands, not the rice. (3) Sit back and put the heated baggy over your eyes for 5 minutes. Do this morning and evening.
The face cloth approach: Take a cotton terry face cloth sort of thing and run it under hot water. Hold it on your eyes for five minutes or for as long as it stays hot.
The hot shower approach: Turn the hot water up as hot as you can stand. Let the water run directly over your eyes for a minute or two. (Yes, keep your eyes closed while you are doing this!)
Don’t be surprised when your vision goes a little cloudy after a hot compress. The good stuff is getting into your eyes and there may temporarily be too much of it. It will clear shortly. Believe me, it’s worth it.
NEWSFLASH! "Lid scrubs" does NOT really mean scrubbing your lids! In fact, if you have had LASIK, you really, really do not want to be scrubbing your eyelids, especially not in the sense that you would scrub the frying pan you made your omelette in this morning.
So what DOES "lid scrubs" mean? Carefully, gently washing your eyelashes and the delicate areas around your eyelashes (which are called lid margins), top and bottom.
What thing(s) do I use to wash them? There are several possibilities: (1) Cotton buds are perhaps the most popular. You can dip them in whatever liquid you’ve decided to use (see below). (2) A facecloth may work; it’s a little clunkier, but there’s no risk you’ll poke your eye. (3) Your fingers. (4) If you have a better idea, do tell.
What liquid do I use to wash them? Again, several possibilities: (1) A solution of water a Johnson’s baby shampoo seems to be the most traditional. The proportion should probably be at least 10:1 (water:baby shampoo). (2) One heaped teaspoon of sodium bicarbonate to one pint of boiled and cooled water. — Mind you, I’ve never tried that, but one optometrist’s website that I saw suggested this. (3) Saline (I use Unisol, unpreserved saline). (4) Don’t forget to avoid anything soapy that could get into your tears and seriously mess up the oily lipid layer, because that’s the part you’re doing all this work to try and improve in the first place.
Do I rinse them? Yes, with water.
Whatever you do, find some easy way to do it and do this morning and night for at least two weeks. If you find it reasonably convenient, keep it up now and then even after that.
Now comes the hard part!
I still haven’t been able to talk anyone I know into producing a handy little video of how to do this. Furthermore, I must confess I have never felt 100% confident about the way I do it myself. If using our tips below or consulting your own eye doctor, you are able to do this yourself, fantastic. If not, consider asking your eye doctor to express the glands next time you see him.
Here are some descriptions I have read. See which works for you.
Example #1: The index finger is rolled up the lower lid to the lid margin. Pressure is applied inwards as the finger is rolled up to express the secretion from the gland. Lid massage should be done 20 to 30 times on each eye. There are 23 glands in each eye, running upwards to the lid margin, behind the eyelashes. Ensure that you do 3 rolls to cover the entire lower lid and all of the glands. Research has shown that as few as 2 glands blocked can have a detrimental effect on tear film performance. Think of your finger being like a steam roller. Pressure must be kept in against the eyeball to keep the gland blocked as your finger rolls up the lid and the fluid inside is pushed out.
Example #2: Pinch the lower eyelids between thumb and forefinger to express the meibomian glands and bathe the eyes with saline solution to remove excess material. Squeezing the upper lids is not advised
Example #3: Take a Q-tip and gently but firmly roll it from a position about 1/4 inch below the eyelid upwards until you reach the lash line. Repeat this for different positions on the lower lid.
Good luck, and make sure you consult with your eye doctor about suspected MGD or blepharitis and appropriate treatments for it.