The Dry Eye Compress: Warmer is not Always Better

Meibomian gland disease (MGD) is a progressive disease and the leading cause of dry eye. In fact, up to 86% of all dry eye sufferers have MGD. The prevalence of MGD in several large general studies has been found to be as high as 70%. Our modern lifestyle, decreased blink rates, cosmetic use and chronic tear film evaporative stress are a few things that place us at risk for MGD.

I recommend at-home warm compress use for both preventive care and supplementary therapy for my patient’s with MGD. Warm compresses can be thought of as the brushing and flossing of your eyes. Just like consistent brushing and flossing can help prevent cavities and other dental problems, warm compresses help keep the openings of Meibomian glands functioning properly to help the eye see clearly and comfortably.

The ultimate treatment goal for MGD is to stabilize the tear film and provide the eye a better barrier against the environment. The therapeutic goal of adjunctive warm compress use is to heat the eyelids to help soften and partially melt any remaining material obstructing the glands.  In terms of supporting gland function, it has been established that warmer is better when it comes to warm compresses. This is especially true for more advanced disease.

However, warmer is not better for the ocular surface. The challenge with any form of front surface lid heating is to transfer therapeutic levels of heat to the Meibomian glands (110°F), while not risking thermal injury to the ocular surface or the skin. 

A 2008 study determined the following key features to increase the effectiveness of a warm compress without compromising eye safety. Warm compresses applied to the outer lid surface must maintain a consistent 110°F in order for the therapeutic heat to reach the oil glands. 110˚F, when properly handled, can be applied safely against the external eyelid skin without risking thermal injury for the duration of a treatment. Heat needs to be applied for a minimum of 10-20 minutes in order for the heat to pass through anatomical barriers that naturally shield the glands, e.g., skin, fat, the tarsal plate, and vasculature of the eyelids.

In addition, because the cornea is more susceptible to corneal warpage when it is heated, patients are typically advised not to massage their lids during or immediately after warm compress application. Safer lid massage techniques do exist. Talk to your Spokane Eye Doctor to learn more.

The use of warm compresses

Many methods have been suggested to provide consistent heat to the eyelids. Unfortunately, many patients performing these methods find themselves unenthusiastic about the procedure due in part to the lack of personal results, the laborious nature of the application, and/or the lack of instructions about how to optimize their efficacy.

Traditional warm compresses such as a warm wash cloth held over your eyes for a few minutes or an at home rice bag is generally ineffective. A wash cloth cannot sustain the proper temperature as long as necessary and a rice bag has a dry heat which the Meibomian glands poorly respond to. These types of methods can feel like a waste of time and effort since no real effect is being produced. My favorite mask is the Bruder warm compress because I find it is both cost-effective and delivers effective moist heat treatment.

The Bruder Moist Heat Eye Compress opens oil glands and allows natural oils to flow back into the eye. Simply microwave for 20-25 seconds and apply for 10-20 minutes, or as prescribed by your doctor. The mask may be reheated in 5 second increments to allow for longer wear.

The compress improves oil gland function, helps stabilize the tear film and slows tear evaporation. Properly hydrated and lubricated eyes can expel bacteria and debris more efficiently. Many of my patients note their eyes will feel refreshed and rejuvenated after consistent/regular compress use.

  • Safe for frequent use
  • Self-hydrating – no need to add water
  • Anti-bacterial and non-allergenic
  • Washable and reusable.
  • Available in a single eye model.

Although the Bruder mask is my favorite form of a warm compress, I recognize it is not the best option for every patient. If you are having trouble with your warm compress, further evaluation is recommended.