The most important part of the treatment is HOT EYELID MASSAGE to melt and open up the waxy blockages of the glands and express healthy clear oil. Making hot eyelid massage part of your daily hygiene routine just after your shower (eg like brushing teeth) is the key to long term control of blepharitis. Success in the treatment of blepharitis requires a program that matches the treatment to your symptoms. Hot eyelid massage will form the mainstay of your treatment. It often takes 6 – 12 weeks before treatment starts to be effective.
The simplest (and often the best) way to correct Meibomian oil gland dysfunction is to hold a small thin folded hot towel or flannel over your eyelids to melt the thickened waxy oil in the Meibomian oil glands, and gently push backwards on your eyelids through the towel, near where the eyelashes come out, to express the natural oil from the gland openings near the eyelashes. Make the towel hot with running tap water which is quite hot (but not so hot that you can’t tolerate it). After counting for 10 seconds whilst pushing backwards towards the upper eyelashes, make the towel hot again, then put the hot towel over the lower eyelids on both sides and count for 10 seconds whilst pushing backwards near where the lower eyelashes come out. You can repeat this for another cycle, making it 10 seconds x 2 on the top eyelid and 10 seconds x 2 on the bottom eyelid.
This should not take up more than 40 seconds of your day. Make it part of your daily hygiene routine, either in the morning after coming out of the shower, or in the evening after brushing your teeth.
The main purpose of using hot running tap water, and re-heating the towel every 10 seconds, is to maintain a relatively constant and hot temperature of the hot towel. Avoid letting tap water get into your eyes. Do not wear contact lenses when carrying out hot eyelid massage. Contact lenses must never be worn in the shower or when swimming. The best towels to use are small, thin baby face towels. It is best to do the hot towel massage out of the shower, so that the water can be hot enough.
It is not recommended to roll a cotton bud downwards or upwards on the eyelid as this stretches the delicate thin eyelid skin and can lead to bags around the eyes.
When carried out correctly, hot eyelid massage helps restore Meibomian oil gland function, to express natural oily tears onto the surface of the eye. Expressing natural oily tears onto the surface of your eyes can mean that you don’t have to put in as many artificial tear drops.
If you see a small lump (chalazion) or whitish head on the eyelid margin, do the hot compress treatment frequently and massage locally at the location of the lump or white head, to try to open up the gland and encourage the lump to go away.
If the skin on your eyelids is dry or affected by eczema, the hot towel can make the skin feel more dry and irritated. If this is the case, eye masks which are heated in the microwave are available, or other masks containing hot beads. It is important to try to maintain a constant hot temperature (but not burn the skin on the eyelids), and to gently massage by pushing backwards on your eyelids, to express the oil from the Meibomian oil glands.
Mascara and eyeliner can block the openings of the Meibomian oil glands. It is best to remove mascara and eyeliner with a good quality, plain make up remover each night, and carry out hot eyelid massage to open up the glands. Try to have at least 1 or 2 make-up free days per week.
In some cases where it has not been possible to open the Meibomian oil glands with hot towel massage or other methods, gland expression treatments are available e.g. Lipiflow, MiBoFlo. Following these treatments, it is often necessary to maintain the improvement by daily hot towel massage.