Treating my dry eye: what worked and what didn't
Every treatment I've tried, ranked by how helpful it was
My demographics and medical history:
Caucasian male in my 20s, otherwise healthy, history of severe acne (never took accutane or antibiotics for it). Cured my acne by switching to an anti-inflammatory diet, been on that for for 8+ years prior to getting dry eye.
Dry eye subtype:
Evaporative dry eye with poor quality and/or insufficient meibum / tear film, clogged glands, with intermittent, added irritation and inflammation from blepharitis and ocular rosacea
Basically I have MGD, ocular rosacea, and blepharitis. My glands were very clogged when I was first diagnosed.
Treatments
More helpful treatments are closer to the top of each list.
Most helpful:
IPL (on the eyelids, with metal eyeshields)
Lipiflow (so far it’s been great for 6 months, then the MDG comes back)
blinking exercises
"eye yoga" and facial massage to relax eye, eyelid, and facial muscles
meditation
exercise, sleep, stress/anxiety reduction
plant-based anti-inflammatory diet
Helpful:
Zocular Zocufoam (foaming cleanser)
Cliradex Light (foaming tea tree cleanser)
EyeEco Onyix silicone sleep mask
GENTLE manual expression at home after Blephasteam or a warm compress not more often than 1x per week. I bought a metal paddle online specifically for this, did I mention you have to be really patient and gentle?
manual debridement / exfoliation / cleaning of eyelid margin every morning with organic cotton q-tip (I kid you not, you have to get the organic cotton ones, name-brand q-tips made my eyes sting!!)
fish oil
avoiding alcohol, spicy foods, and sunlight (rosacea triggers)
Not sure if it helped:
Blephasteam. I think it’s probably better than warm compresses for most patients with mild MGD but I didn’t use it long enough to notice a persistent difference. I also didn’t start Blephasteam until after doing Lipiflow twice. Won’t work for severe MGD.
Miboflo (relieves MGD symptoms a bit, but not sure if it lasts)
Cliradex towelettes
Zocular ZocuShield gel
Avenova (used at least 1x per day for 2 weeks, hard to tell if it made a difference)
Green tea with lemon (but h/t to Hokucat for the good idea!)
Don't think it helped:
Warm compresses 1x or 2x per day (tried both Bruder mask style, and the USB powered ones). This did improve my tear film when my MGD was bad, but I don’t think it was worth it because they seem to have caused or exacerbated my ocular rosacea. I should have just gotten Lipiflow instead.
Eyedrops, including Retaine MGD. Temporary symptomatic relief that went away quickly. I dont use any eyedrops. That deserves its own post.
Overly forceful manual expression, including when done by the doctor after IPL. The expression should be gentle. If a lot of force is required then the gland is clogged and must be heated before it can be expressed.
The "bundle method" for warm compresses, maybe I have the wrong kind of towels but it really didn't work for me. It was definitely less effective than both the Bruder and USB warm compresses.
Running hot water on my eyelids in the shower
Header image from here.