Pragmatic approach to performing your daily
Eyelid Hygiene on a consistent basis.
Be Empowered through understanding
Hi, I'm Dr Colin Parsloe. I consider myself to be a Professional patient - I work as an Ophthalmologist but live with Dry Eye Disease. I have been studying, treating and teaching on Dry Eye Disease for many years.
After finishing this short video: You will have seen an example on how to perform Eyelid Hygiene in a pragmatic real life setting.
I started off just as the first commercial hot compresses were being developed. I had no understanding of Why or How to apply the heating to the eyelids.
I have watched and been involved in the development of new technologies to heat the eyelids. I have researched the best temperatures required and researched what the limitations are to heating the delicate eyelids.
Knowing the size, orientation and structure of the glands in the eyelids, I have a clear understanding on how to get the "bad" oil out of the glands.
Through years of practice on my own and year of cleaning debris off patients eyelashes, I have a good idea on how to clean them. However I am not an obsessive person and I know how to help you to get a simple approach to performing all these task on a daily basis in a way that can work in your busy routine.
You will need to set aside time for this activity. Unfortunately there is no getting around this. There are, however, exciting new technologies currently under development that may help us in the future to simplify this routine.
So What is Eyelid Hygiene?
It includes the following key steps:
- Cleaning of lashes
- (possibly) eyedrops?
We have a free download video showing the
normal anatomy of the eyelid.
See the Free Champion Dashboard for this and other great free content.
The main cause of Dry Eye Disease is a condition called Meibomian Gland Disease. There is an oil layer that normally covers the tears stopping excessive evaporation.
In Meibomian Gland Disease the oil layer is either a poor quality or poor quantity. The normal oil is thin like extra virgin olive oil. As the quality of the oil deteriorates it becomes cloudy then as it further deteriorates it is more like a butter. In come cases it is as thick as toothpaste and can even completely block the gland and no oil and be expressed.
The heating of the buttery oil melts the oil. Then you need to ‘milk’ this oil out. This invariably involves pressing on the glands, or some advocate squeezing the glands. If you do not perform this while the oils have melted then you lose the advantage of the heating of the glands. In my opinion, heating of the eyelids without milking is a waste of time!
Methods of heating?
There are many options on how to perform this they include using a commercially available hot compress or a flannel (face-cloth).
I definitely Do Not recommend the flannel.
- Firstly the skin around our eyes is very thin and delicate and can only tolerate a certain maximum heat.
- Secondly we need stable heat for sufficient period of time to actually penetrate the eyelid and to heat the oil in the glands.
I have done some unpublished testing my self and found that the flannel was too hot for the first few seconds and then cooled so rapidly and so much that by the end of the 10 minutes the skin of the eyelid was cooler after the flannel ‘heat treatment’ than before we had put the flannel on.
Types of hot compresses:
Electric - these are usually battery powered. They are more expensive but have the advantage that you can walk around with them an do tasks during your treatment. They also produce a fine steam to moisten the environment around they eyes.
Microwave - This is the most common option, there are numerous varieties of the available. The first ones developed were filled with natural grains. Then the later versions were fill with synthetic ‘beads’ that absorbed and slowly released the heat.
Oven - some can be heated in the oven for people without microwaves.
Exothermic - some have chemical sachets that when activated they release heat. If you have ever been skiing then you may have come across these instant hand warming devices.
Antibacterial - this is the latest development. We know that the higher the bacterial load in your eyes the worse your symptoms of Dry Eye Disease will be. The older hot compress can not be washed especially the grain filled ones. By applying any hot compress to the eye it gets contaminated with bacteria. Then during storage the bacterial multiply. Then we put the hot compress onto our eye again the next day.
Companies are all aware of this problem and are looking at ways around this including heating the compress then letting it cool before needing to heat it again order to use it
One of the companies that I consult for have developed an innovative solution and this is an antibacterial cover that actively kills 99.9% of bacteria while it is kept in storage overnight. Each day you are using a safe clean hot compress.
The next step is milking out the glands also known as massage.
The glands lie in the upper and lower eyelids.
They are around
- 5.5mm tall in the upper eyelid and
- around 2mm tall in the lower eyelid.
Their openings are on the eyelid margin.
Most people advise:
- Using pressure of your finger in an upwards motion on the lower eyelid
- Then a downward motion on the upper eyelid.
This is correct, I have found - pressing the lids of hundreds of patients in clinic - that direct pressure against the eyelid is enough to express the oil in many cases.
For very thick oil, pinching the eyelid so that it folds can also help but can cause some discomfort and is rather a tricky technique to master.
I divide my upper and lower eyelids into 3 horizontal portions.
For regular maintenance eyelid hygiene I apply firm, almost uncomfortable pressure, onto each third for around 15 seconds.
Cleaning of lashes
This is essential if you have Anterior Blepharitis. Not everybody has this and so hot compress may be all you need. Similarly not everyone has a problem with their oil glands and may only have Anterior Blepharitis requiring eyelid cleaning.
In Anterior Blepharitis there is an abnormally high number of Bacteria or Fungi or Parasites. They feed off debris at the base of the lashes and eyelid.
Cleaning will get rid of their food supply and the physical cleaning can also directly remove the bacteria. We have a blog post regarding the Parasites (Demodex) - see the Free Champion Membership Dashboard.
So how to clean?
There are 4 options
Household products -
please do not use these!
Secondly is commercially available cleaners they come in
Wipes, Gels, Cleansers and Gadgets
Thirdly there is a spray that can be applied
Fourthly you can use Antibiotics in the very short term.
Regarding cleaning of the lashes, we address the how and with what in another blog post.
I loosely include eye drops as part of the routine.
I prefer to use them after the heating, massaging and eyelid cleaning.
There are 2 options with eyedrops:
- Medicated drops
Watch video for my stable technique to instil eyedrops.
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