If a non-preserved drop is necessary, clinicians must emphasize to the patient that the extra cost is warranted. Most patients are aware that their sensitive eyes need special care.

Chill it in the freezer or fridge or pop it into the microwave. Place it over your eyes and sinuses, or slide it up to your forehead. Its pliable, face-hugging shape stays put without drips or leaks. The therapeutic temperature lasts approximately 20 relaxing minutes and feels very comfortable on your eyes. Patients were instructed to use the goggles in accordance with guidelines from the manufacturer. First the goggles were to be preheated for 15 min before a wet cotton ring was placed inside each chamber. When placed over the eyes, heat was delivered as steam to the eyelids. The device was used once daily with each treatment session lasting 10 min. TheraPearl Eye MaskPatients are confronted with a multitude of lubricating drops at the drug store. It’s the OD’s job to help them narrow their options. For effective treatment of MGD, temperatures of warm compresses need to exceed 40 °C 26, 27, 28, setting the basis for treatment with heating devices. Several studies have shown that Blephasteam (Spectrum Thea Pharmaceuticals LTD, Macclesfield, UK), a steam-based system, is effective at delivering heat to the eyelids and treating MGD 19, 29, 30, 31. Only one other trial has compared Blephasteam to another device 32. Preservative-free artificial tears to use as needed, especially if the temperature is changing or varies in the environment you are in.” Miller, K. L. et al. Minimal clinically important difference for the ocular surface disease index. Arch. Ophthalmol. 128(1), 94–101 (2010).

Lacroix, Z., Leger, S. & Bitton, E. Ex vivo heat retention of different eyelid warming masks. Cont. Lens Anterior Eye 38(3), 152–156 (2015). Lids. Evaporative dry eye is the most prevalent form of DED, and MGD is one of the most common causes. Researchers have studied the prevalence of MGD outside the United States and have found it as low as 30.5% in Spain and as high as 68.3% in China. 10,11 Badawi, D. A novel system, TearCare(®), for the treatment of the signs and symptoms of dry eye disease. Clin. Ophthalmol. 12, 683–694 (2018).FBUT is one of the most common tests used to diagnose and monitor DED and was chosen as the primary objective efficacy measure in this study. FBUT improved significantly for both groups from baseline, without any difference detected between the treatments. Additionally, our findings indicate that males generally experienced a greater increase in FBUT after 3 and 6 months of treatment (mean 1.33 s and 2.68 s respectively relative to females), suggesting that treatment may be more efficacious in males. FBUT has some limitations 49, 50, 51, 52, 53. Fluorescein itself reduces the stability of the tear film 54, 55 and the scoring of FBUT is not always exact. To this end, a standardized amount of fluorescein was instilled into each eye using a pipette, and the same observer performed measurements at each visit to eliminate the possibility of inter-observer bias. In addition, all measurements were repeated three times during each visit, with the mean value being recorded. As DED is one of the most common reasons for seeking ocular medical attention, it is important for ophthalmologists, general practitioners, optometrists, and opticians to have readily available, effective, and convenient treatments to recommend 60. It is well established that treatment compliance in MGD-related DED is a major obstacle as the treatment is time-consuming and needs to be repeated every day for weeks to years 25. Well documented treatments will motivate the patients and increase compliance.

Department of Optometry, Radiography and Lighting, National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of Southeast Norway, P.O. Box 235, 3603, Kongsberg, Norway Bilkhu, P. S., Naroo, S. A. & Wolffsohn, J. S. Effect of a commercially available warm compress on eyelid temperature and tear film in healthy eyes. Optom. Vis. Sci. 91(2), 163–170 (2014). Oral supplements. For years we have prescribed omega-3 fatty acids (FA) for MGD and dry eye. Recently, the DREAM study has changed how we see this practice. 15 Basically, the study demonstrated that the particular FA supplements used in the well-designed trial did not help MGD any more than the sham pills that contained small amounts of olive oil determined to be easily met by most North American diets. With the heart community also finding little benefit to omega-3 supplements, many practitioners are discontinuing that recommendation. 16 Patients probably won’t complain, considering the high cost of these supplements. To get to the bottom of a patient’s dry eye symptoms, clinicians should follow the TFOS DEWS II essential diagnostic test recommendations: a dry eye questionnaire followed by tear break-up time (TBUT, noninvasive diagnosis <10sec, F-BUT diagnosis <5sec), osmolarity (diagnosis ≤308mOsm/L) and ocular surface staining (diagnosis >5 corneal spots or conjunctiva >9 spots). 5 Not all testing is available to each clinician, and only one of these tests needs to be abnormal to move the diagnosis forward. Dry eye disease requires a concerted effort on the patient’s part to modify their external and internal environment to help encourage ocular health. It also requires regular use of lubricants and lid care. Optometrists serve their patients well if they diagnose, and then educate them about the type and degree of dry eye that is present. Time spent explaining the options for treatments that include less expensive forms, is time well spent to improve patient outcomes.

Contact Lenses

Matsumoto, Y. et al. Efficacy of a new warm moist air device on tear functions of patients with simple meibomian gland dysfunction. Cornea 25(6), 644–650 (2006). Thera-Pearl Eye Mask offers a therapeutic spa-like treatment for a variety of eye conditions, from the comfort of your own home. Developed by eye care professional Bausch & Lomb , the eye-ssential mask is perfect for treating dry eye, blepharitis , sinus headaches, irritation and relieve puffy eyes. Application of heat and eyelid massage are considered mainstay treatments for all MGD patients. Several methods exist for heat delivery to the eyelids, including a heated wet towel placed over the eyelids, in-office modalities, steam-based systems, and dry-heat eyelid masks 10– 19. In addition to heat therapy, other treatments, including lubricating eye drops, topical cyclosporine, antibiotics, and manual meibomian probing and expression, should always be considered 10. Despite heat therapy’s proven efficacy 20– 24, compliance remains a challenge 25 and it is still unclear whether the type of eyelid heating technique can impact efficacy of the treatment. Accordingly, we sought to investigate whether heat delivered indirectly as steam or directly as dry heat was more effective as a treatment for MGD.

Sim, H. S. et al. A randomized, controlled treatment trial of eyelid-warming therapies in meibomian gland dysfunction. Ophthalmol. Ther. 3(1–2), 37–48 (2014). Patients should always keep airflow away from their eyes to avoid exacerbating dry eye. Counsel them to avoid long-term exposure to ceiling and box fans (especially at night) and to keep the heat and air conditioning in the car at their feet, not in their face. Schaumberg, D. A. et al. The international workshop on meibomian gland dysfunction: Report of the subcommittee on the epidemiology of, and associated risk factors for MGD. Invest. Ophthalmol. Vis. Sci. 52(4), 1994–2005 (2011). Lifestyle. Those who smoke should be counseled on the myriad benefits of quitting, including the benefits for their ocular health. Research shows tobacco smoke can exacerbate dry eye, as it causes tear film instability and increases ocular surface staining. 19-21 In fact, one study found patients who smokers are nearly twice as likely to have dry eyes. 20 Encouraging smoking cessation and avoidance of smoke will save them a fortune and prolong their life.Arita, R. et al. Effects of a warm compress containing menthol on the tear film in healthy subjects and dry eye patients. Sci. Rep. 7, 45848 (2017). Xu L, Zhang W, Zhu X, et al. Smoking and the risk of dry eye: a meta-analysis. Int J Ophthalmol. 2016;9:1480-6. Environment. Many environmental changes are inexpensive and particularly effective. Patients should use wraparound glasses and sunglasses when outside to prevent wind current from drying the eyes. In our office, we keep examples of Pantoptix glasses and other forms of protection such as Cocoon (Live Eyewear) that can be worn over regular glasses. For your next at-home spa day, pamper your eyes with this Joanna Vargas Bright Eye Hydrating Mask, which comes from one of the beauty industry’s most in demand facialists. It’s definitely a splurge, but it works double-duty to hydrate and firm the delicate skin all around your eyes (most masks just target the under-eye vicinity). To fight dry skin, the bamboo sheet mask contains hyaluronic acid to impart moisture, and licorice extract to soothe. It's also formulated with arbutin to even out pigmentation, five different peptides to boost elasticity, and Matrixyl 3000 to stimulate collagen production. Though the mask was designed to be used for just 15 to 20 minutes, once it's removed, you can pat the remaining serum into your skin.