Once your doctor has identified evaporative dry eye, what can be done? The goal of treatment for evaporative dry is centered around restoring proper function of your meibomian glands. To learn more about these glands, please read the post titled “Evaporative Dry Eye”. In most cases of evaporative dry eye, the oil in the meibomian glands, called the meibum, becomes thick and white, having a toothpaste-like consistency. If this occurs, little to no meibum can be expressed from the glands when you blink, making the tear film unstable and evaporate too fast.

Can I treat evaporative dry eye at home?

My first line of treatment for evaporative dry eye is performing warm compress for 10 min every day at home. This is best done with an eye specific mask that you put in the microwave for 20-30 seconds, then with your eyes softly closed, place the mask over your eyes. The heat from the mask warms the thick meibum above its melting point, allowing it to flow much more easily from your meibomian glands, thus keeping your tears more stable. An analogy would be butter on a pan. If we apply heat to the pan, we can melt the thick butter until it becomes more liquid. A few of my patients have asked what they can do if they do not have a microwave, and the workaround is using a hot washcloth. However, the washcloth loses its heat after only a few minutes, so if you chose to do this route, you need to keep a pot of warm water next to you in order to keep on reheating the cloth throughout the 10 min. A mask like a Bruder mask is much more effective.

How we treat evaporative dry eye in the office

For patients with very thick meibum, so thick that none is getting onto the tear film and the Non-Invasive Tear Break Up Time (NITBUT), as measured with the Oculus K5M seen in Figure 1,

Figure 1: NITBUT photo
Figure 1: NITBUT

is less than 7 seconds, warm compresses at home is likely not enough. At Peak Eyecare, we offer an in-office treatment called Thermal Expression. In this procedure, a pair of specialty designed googles are placed over your closed eyes for 10 min to safely heat your meibomian glands more than you can with just the mask at home. Patients almost always comment on how relaxing it feels during these 10 minutes. After that is finished, I will physically express your glands with a special tool with the help of my microscope. My goal is to squeeze out the toothpaste-like meibum that is blocking the glands until the meibum runs clear like olive oil. We do this procedure twice, separated by 2-3 weeks. It is imperative that you continue to use the warm compress at home during this time to keep the newly cleared glands from clogging up again. Patients report that they notice a big improvement in their symptoms and are less reliant on artificial tears after.

However, no matter how much we do to improve the consistency of the meibum, if we do not also address the inflammation surrounding the openings of these glands, they will continue to clog. At Peak Eyecare, we take high-magnification images of your lid margin to look for telangiectasia, which are tiny blood vessels on the surface of your skin, also known as “spider vessels” (see figure 2). If we see telangiectasia, we have proof that you have excessive inflammation around your meibomian gland openings, and we will be constantly battling the reclogging of your meibomian glands. Our first line of treatment for this is HydroEye Supplements, which is a combination of Omega 3 (Fish Oil) and GLA (an Omega 6 from Black Currant Seed Oil). Working together, these supplements decrease inflammation around the meibomian glands and help your lids produce a healthier meibum. Most patients notice an improvement after 30 days of taking the supplements.

Figure 2: Telangiectasia photo
Figure 2 telangiectasia or “spider vessels”

What special equipment can treat evaporative dry eye?

By far the best treatment for inflammation and meibomian gland dysfunction is Intense Pulsed Light therapy, or IPL. This 4 part treatment provides the biggest improvement in the health of your meibomian glands, and the longest lasting relief of dry eye symptoms compared to any other treatment develops thus far. Please read my next post, IPL for Dry Eye Disease, for an in-depth look at this game-changing technology.