Dr. Sandra Lora Cremers Recommends Lid Hygiene Routine:
Warm Compresses
Meibomian gland dysfunction (MGD) is due to the obstructions of the oil glands along the eyelids. MGD is becoming a common diagnosis partly related to the use of electronic screens which has been associated with decreased blinking rates and increased partial blink percentages.
These obstructions are often caused by the oil within the glands changing from a liquid to a solid or paste or toothpaste consistency. The goal of warm compresses is to melt these obstructions. Since the glands are located closer to the inside surface of the lids, any heat applied to the outside surface will take time to reach the glands. Therefore, studies have shown that warm compresses must be applied for at least 10 minutes continuously to achieve full efficacy. But who has 10 minutes to apply a warm compress to they eyelid? Not that many people.
Thus the machine Lipiflow was developed to milk out old oil so the body can produce new oil. But Lipiflow is not covered by insurance and can cost $800+. There is no pain and it only takes about 12 minutes, but it is crucial for everyone to still apply warm compresses to their eyes daily and wash your face with warm water at least 2x/day.
Remember, the only way we have to save the Meibomian Glands are:
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Warm Compresses/Lid Hygiene
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Lipiflow
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IPL and/or Meibomian Gland Probing: painful and very expressive & not covered by insurance & not FDA approved. It is considered a medical procedure.
Applying the Warm Compress:
The compress should be at the maximum comfortable temperature in order not to cause discomfort or burning. Water should be hot as you can stand it without burning your finger or skin. Hold the warm compress over your eyes with your hand resting on the bones located above or below your eye to avoid applying any pressure to the eyeball.
IMPORTANT: Really try not to rub or push on the eyeballs.
Bundle Method1 (preferred)
Materials
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5-7 microfiber towels (hold heat longest) or washcloths
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Microwave-safe bowl with lid
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Microwave
Instructions
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Fold towels into long rectangles
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Roll first towel into a tight cylinder
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Continue wrapping remaining towels around first towel to form a large bundle
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Dampen bundle in room temperature water, squeezing out excess water
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Place towels in dish, cover with lid, microwave for 2 minutes
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Allow towels to cool 1-2 minutes before using
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Apply outermost towel, keeping remaining towels in covered dish
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Replace towel approximately every 2 minutes or when no longer feels warm, peeling towels from the outside and working towards center towel last
Dry Eye Relief Mask – DERM. (alternative method)
Instructions
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Dampen a single liner (included), squeezing out excess water
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Place liner on top of mask and microwave for 30 seconds
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Apply mask with liner in direct contact with skin
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May alternate with second mask to maintain heat for full 10 minutes
If you have any questions, or if you encounter difficulties, please talk with a member of our staff.
Dr. Sandra Lora Cremers Recommends This Lash Scrub Technique
Many patients ask what is the best way to clean one’s eyes and eyelashes. Washing your eyes and eyelashes serves the same purpose of washing your hair and body: to remove unwanted debris, mites, bacteria, allergens, and dead cells. Without regular washing, a buildup of dead skin cells, oil secretions, mites, bacteria, make-up, and/or other debris can accumulate along the eyelashes and clog the meibomian gland orifice, which is a crucial exit point for meibomian gland oil called meibum. The most buildup typically forms at the base of the lash, where the hair meets the skin, and can form a collarette (a ring of debris around the lash) which is most often due to microscopic mites called Demodex or a type of bacteria called Staphlococcus. If left untreated, chronic meibomian gland blockage can lead to more significant problems such as redness, burning, itching, irritation, dryness, reflex tearing, styes or chalazia, and in severe cases–chronic, debilitating eye pain.
Thus there are 3 goals of any Eyelid Cleaning Regimen:
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Warm compresses with warm water or a warm hot towel to open the meibomian gland orifice. No one has done a study to say wet heat is better than dry heat, that I know of. I prefer a wet hot towel (see below).
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Scrub the lashes gently by removing any debris.
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Use a cleaning substance, such as baby shampoo if your skin/eye does not dry out with this and you do not have continued crusting, or Tea Tree Oil (which I love & use regularly but can burn like the dickens if not diluted enough in some patients or can rarely cause a skin allergy) or Cliradex (ie, Tea Tree Oil wipes) or Avenova (a prescription, more expensive spray, which does not burn but may not be as strong as Tea Tree Oil in some patients).
Instructions: There is no randomized controlled study to say Q-tips are better than towels or cotton balls. I use towels to scrub. Some prefer Q-tips. The key thing is to avoid a corneal abrasion: so do not poke yourself in the eyeball.
Here is one example of how to clean with a Q-tip
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Moisten the tip of a cotton swab (Q-tip) with a small amount of warm water or very, very diluted Tea Tree Oil (at least 50% to start: 1 drop tea tree oil with 1 drop of water.)
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Close the eye and gently wipe the point of the cotton swab along the eyelid at the base of the lashes (where the lashes meet the skin). Do this by dividing the lid into 3 sections and scrubbing back & forth at least 5 times per section. (Photo 1)
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Next, gently use the side of the cotton swab to remove the loosened debris by wiping downwards from the base of the lashes to the end of the lashes. (Photo 2)
Photo 1 Photo 2
My “faster” washcloth technique also works. See video link:
https://www.youtube.com/watch?v=0TTBsuuZquw
If you have any questions, or if you encounter difficulties, please talk with a member of our staff or your doctor.
1 Original bundle method developed by J. Schubert, Ph.D. and adapted for use at Visionary Eye Doctors