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Thread: To warm compress or to not...that is the question.

  1. #1
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    To warm compress or to not...that is the question.

    So, I was just reading some old threads some patients wrote to Dr. Latknay about using warm compresses. I have ocular rosacea and I do warm compresses 2x a day. Dr. Latknay said that warm compresses may be needed to open up the blocked glands, but that they should be used for a few minutes. Otherwise the warm heat can contribute to inflammation which in turn causes the meibomium glands to not function properly. So, are most people finding that warm compresses actually help or should cold compresses maybe be used to help reduce inflammation?

    This may sound odd...where I currently live hasn't seen snow since 1976 and this past January it snowed 1 whole inch! So, my husband and I took advantage and spent hours gathering snow to build snowmen, this was on a Friday night. So, I was out in the cold for several hours. The next day my eyes felt better, then on Sunday it was almost as if I had normal eyes again! I am wondering if the cold temperatures really helped reduce my eye inflammation?

    Any thoughts on cold helping to reduce eye inflammation?

  2. #2
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    I would try continuing with the warm compresses... but after expressing the glands, do a cold compress to counteract any inflamation caused by the heat... That way you get the benefits of both?
    Yet another post-Lasik (2005)...
    Anyone have a time machine so I can go back and undo this mess?

  3. #3
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    going to give it a try...

    Thanks, I will give that a try and see if that helps any.

  4. #4
    Very good question, and one that is often debated in the rosacea community.

    I have found ways to use heat to open the glands without putting the heat directly on the lids, lowering the inflammatory response in the eye area.

    One of the techniques I use is to fill a shot glass with water and microwave it. Then I lean my eyes near the glass so the steam opens the glands. My eyes/lids do not become red when I do this. Also, when I have a steamy hot bath, same effect.

    Many occular rosacea specialists advise against warm compresses, so sometimes we just have to get a little more creative!

  5. #5
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    I find they aggravate rosacea on eyelids, cause inflammtion which makes the problem worse.. personally.

    If you donthave rosacea and have blocked glands causing the prob, they prob help long term. But if you only get temp relief i wouldnt bother with them as they could make it worse imo.
    I want a cure

  6. #6
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    Yep, I do have rosacea and I think the warm compresses have been doing more aggrivation than good. Yesterday I tried a cool compress and it felt better. Today I don't have as much burning as usual...so, maybe the heat was a bad idea.

  7. #7
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    Ema,

    Heat definitely bothered me too. I have occular rosacea as well. My eyes love cold. Air conditioned, refrigerator, you name it. I have even stuck my head in a freezer for relief. The heat truly aggravated my eyes, increased itching and inflammation, etc.

    At the moment, I try not to put anything directly on my eyes, hot or cold. I don't want to confuse the poor glands.

    Melissa
    pianolady

  8. #8
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    So I am not the only nutcase who sticks my head in the freezer?

  9. #9
    ringo Guest
    I agree with all of you regarding hot compresses-- in my view they intensify inflammation even if providing temporary relief by liquefying the oil in the lid glands.

    Inflammation though is the cause of these glands not functioning properly and producing such viscous clogging oil.

    According to my experience and my doctor's views, and other doctors and patients, heat aggravates the inflammation, further compromises the glands and increases the viscosity of the oil. That in turn makes the patient very dependent on daily heat applications.

    The treatment is quite old and was applied before the disease was understood more in depth, as it is now.Especially with rosacea sufferers, according to medical research and patients' feedback, heat is a known aggravating factor.

    The topic of warm compresses is very controversial.There are many people here who also say they benefit from this treatment, at least symptomatically.
    I think everyone should work out with their doctors what works best for them...

    I was criticized severely by some people on the forum for expressing a sceptical attitude towards warm compresses, so I have to say-- please consult your trusted doctor about applying or not applying any treatment--- including the hot compresses. If a treatment for dry eye has a downside (most of them do), it has to be weighed against the relief and benefit the patient is experiencing together with his doctor.

    My view on hot compresses is strictly my own view, and it might be inapplicable to many others' cases.

    thank you for sharing your experiences,
    Regards,
    Dani

  10. #10
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    How frustrating to realize that I could have been doing more harm than good for 10 months now. So, does anyone know what happened first for ocular rosacea patients...the inflammation or the blocked glands? It seems like which ever one started first that it caused the other to happen.

    My eyes are no longer burning insanely every day, just some days now. So, I am thinking the inflammation may be getting better, but they are still pretty dry and definately do not look any better. I guess this all just takes a lot of time to work itself out...such a loooooong process.

    I too have stuck my head in the freezer at work...of course when nobody is looking.

  11. #11
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    Oh one more question...does anyone have a good way to loosen up the oil without applying direct heat...maybe leaning over hot steamy water?

  12. #12
    ringo Guest
    if you have rosacea, I suggest (that is my opinion strictly), not to expose your face or eyes to any sort of heat; you might have become dependent on liquefying the oil in your glands this way;

    but I would suggest that you consult a doctor instead, and ask him for different options that target the inflammation instead: doxycycline (takes time to work), topical antiinflammatory preparations, etc. I would advise ( my own view), not messing with your glands, or traumatizing them in any way (massaging, expressing, heating, or even freezing them;
    may be going for IPL or probing by a doctor might be an option (it helps rosacea overall), but only after strict doctor's recommendation.

    I hope that helps, please do not worry, it just takes TIME.

    Regards,
    Dani

  13. #13
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    Thanks Dani,

    I think I am going to lay off the warm compresses for now...I don't want my eyes to become dependent on heat. I am seeing Dr. Toyos in April and I am hoping he can give me a "routine" that helps more than what I have been told to do in the past.

    I really appreciate your words of encouragement, it is people like you that are helping me get through this incredibly difficult journey both physically and emotionally.

    I was glad to have read that you are seeing and feeling improvement.

  14. #14
    ringo Guest
    Thank you so much for your reply and I guess Dr. Toyos is a good idea.

    I wish you continuous improvemen, a lot of ood luck and good eye days!

    regards,
    Dani

  15. #15
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    Same as you all, occular rosacea in my case, and warm compress does trigger the inflammation of my lids. However, I still does the warm compress routine, but only when I feel that my eyelids are "stuffed" and feel "heavy". So I do the warm compress hygiene three times a week, like every two or three days, just to remove all the "solid oil" which is blocked in my lids. In any case, I do it just before going to bed, because if I do it during the day or in the morning, then, systematically, one of two hours after, my eyes feel terrible and it's going worse til I go to bed.
    So okay for warm compresses, but not too often and only when you feel that you need to do it in order to feel better. That's my opinion.
    Hey, nobody said life would be easy right? Please mum, next time you give birth to me, spend more time on the conception of my eyes, okay?

  16. #16
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    Is ocular rosacea the same as blepharitis? I used to think I had ocular rosacea but eye specialist diagnosed me with blepharitis which seemed similar or the same thing or at least related. Maybe the specialist diagnosed it as such because my acne was gone by the time i hit 22 (25 now)

    Anyway interesting topic as i have always found what dr. latknay suggested. I would only do one minute each eye. I think the heat does help loosen material, but it only takes about 30 seconds imo to do it. I noticed reading some people claiming to do 10 minutes each eye, i tried it the odd time, and my eyes and eyelids felt very sore and dry in the process. Heat tends to dry my skin out, so i stuck with the 30 seconds a minute just to loosen it, and it seems to work without irritating my eyes.

  17. #17
    ringo Guest
    Dear Eyeproblems,

    Sometimes it is very difficult to differentiate between blepharitis and rosacea of the eye, as far as my experience goes. that is especially in cases where there is no facial rosacea.

    In any case, I will quote my doctor's words on this situatoin: imagine the facial skin of a person with rosacea. Now imagine what happens to his facial skin after spending 5-10 minutes in a sauna.(which is absolutely contraindicated in facial rosacea).

    Now imagine an eye afflicted with rosacea (you can have a look at photos of how the surface of an eye with rosacea looks like in many different sources).

    Imagine what happens to it after 5-10 minutes exposure to intense heat (meaning above the normal body temperature or more).

    In my opinion, if someone cannot be absolutely sure that they do not have ocular rosacea, heat should be avoided. In most ocular surface diseases heat is an aggravating factor, as demonstrated by various studies conducted in adverse environments (drafts, winds, heat exposure, low humidity, etc.)

    I guess an occasional hot compress combined with something to counter the inflammation in cases where there are no alternative treatments options, might be acceptable. But I doubt if it is applicable in confirmed rosacea cases.This is my view of this rather complicated issue.

    But after all, it is a matter which only a doctor can decide on; and only after examining each individual eye. So we can go on debating here the pros and cons of this teatment, but ultimately a doctor will decide on each individual case.

    Personally, I cannot tolerate any heat on my eyes. But that is just me.

    Dani

  18. #18
    Dani,
    Could you please quote the source for "most ocular surface diseases heat is an aggravating factor".

    The studies you mention regarding,"drafts, winds, heat exposure, low humidity, etc" are all related to evaporative dry eye and not necesarilly rosacea.

    I would like to read the source material.

  19. #19
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    Hi Ringo,
    I sure am glad that you are on this forum,I think that you are a verry good asset to us! You do seem to be very intelligent! and also a very nice looking lady! I really appreciate all the research that you do and share with us.I am not so sure that the "doctor"knows best though.

    The last two that I have been to keeps telling me to use warm compresses,They all just give me a generalize diagnosis I still don't know exactly what my problem is, water,oil or mucus.

    I cannot seem to get the so called doctors to run any tests to try and find out.It looks like they could take a sample of my tears and oil and analize them to give them an idea whats going on.I couldn't even get them to express my glands to see if they were of the right consistency,they acted like that was beneath them to do that!

    I read your post about heat aggrevating the inflammation which in turn attacts the meibomain and lacrimal glands now that made a lot of sense to me,so I started using the cool moist compresses and so far mt eyes feel a lot better!!My eye problems started when I got the shingles on my forehead and I guess in got into my eye.

    I am so afraid that I will never get rid of the zoster virus thats in my eye.
    Please don't ever give up on this forum I think that would be a tremendous loss for us,you do such a good job trying to help us!!

    Thanks again Dani!
    Gary

  20. #20
    ringo Guest
    Dear indrep,

    Here is example references, just found them now, as what I have mostly been reading is from a medical electronic database papers on heat shock proteins and their role in driving T-cells and inflammation, which I have no way of quoting now.
    -- http://rosacea.emedtv.com/ocular-ros...-rosacea.htmls http://www.dryeyezone.com/talk/archi...hp?t-6698.html, : http://www.randeye.com/CommunityEduc...rtableEys.html

    Evaporative dry eye is a type of ocular surface disease very similar to rosacea, as rosacea sufferers have evaporative dry eye due to clogged inflamed meiboian (lid) oil glands. That makes their tear film very unstable and easy to evaporate, in addition to other problems on their ocular surface. Also, any type of severe dry eye may worsen with application of heat.

    My point here was, that like Gary below explained, some doctors hesitate with the ocular rosacea diagnosis, as it is so similar to other eye disorders. Especially in the absence of facial signs. However, if one does have it, heat aggravates it and this is demonstrated by studies in adverse environments; and by the experience of many sufferers, including in this thread and other threads on the forum regarding the issue.

    All I am trying to say is that one has to exercise caution when applying heat to an inflamed eye, and that it does more harm than good to some people, me included. Propagating it as a universal treatment for dry eye, according to me, is not benefiting some sufferers. By heat, as I said in my previous post, I mean, above body temperature or more. Unfortunately, many people apply hot compresses,baggies,various dry hot material, etc., not lukewarm washcloths (moist, below and up to body temperature).

    And like I said, finally, this issue should be resolved by a person's choice based on personal eperience and doctor's recommendation.

    regards.
    Dani


    Quote Originally Posted by indrep View Post
    Dani,
    Could you please quote the source for "most ocular surface diseases heat is an aggravating factor".

    The studies you mention regarding,"drafts, winds, heat exposure, low humidity, etc" are all related to evaporative dry eye and not necesarilly rosacea.

    I would like to read the source material.
    Last edited by ringo; 19-Mar-2010 at 21:20.

  21. #21
    ringo Guest
    Quote Originally Posted by gary View Post
    Hi Ringo,
    I sure am glad that you are on this forum,I think that you are a verry good asset to us! You do seem to be very intelligent! and also a very nice looking lady! I really appreciate all the research that you do and share with us.I am not so sure that the "doctor"knows best though.

    The last two that I have been to keeps telling me to use warm compresses,They all just give me a generalize diagnosis I still don't know exactly what my problem is, water,oil or mucus.

    I cannot seem to get the so called doctors to run any tests to try and find out.It looks like they could take a sample of my tears and oil and analize them to give them an idea whats going on.I couldn't even get them to express my glands to see if they were of the right consistency,they acted like that was beneath them to do that!

    I read your post about heat aggrevating the inflammation which in turn attacts the meibomain and lacrimal glands now that made a lot of sense to me,so I started using the cool moist compresses and so far mt eyes feel a lot better!!My eye problems started when I got the shingles on my forehead and I guess in got into my eye.

    I am so afraid that I will never get rid of the zoster virus thats in my eye.
    Please don't ever give up on this forum I think that would be a tremendous loss for us,you do such a good job trying to help us!!

    Thanks again Dani!
    Gary
    Hi Gary,

    Thank you so much for this wonderful post... Thank you for your appreciation and all the kind words

    I understand your frustration with the doctors, I have been struggling with this for a long time myself, and given various diagnoses, which all in the end entail the same problems-- dry eye, ocular surface disorder/disease, deficiency and poor qulity of tear film, inflammation, erosions, ulcers,etc.
    So, after a lot of anger, sadness, confusion, I decided-- regardless of what exactly my diagnosis is, I need to focus on treatment options directed at alleviating symptoms and inflammation.

    I agree with you ( based on what I have read, my experience, doctors recommendations, and others' experiences), that applying a moist cool (not cold) or lukewarm compress to the eye, like what you do, is hepful.

    I am really sorry to hear about the possible cause of your dy eye-- shingles...chances are it would not reoccur in your eyes; however, I would suggest that you keep yourself in as good shape as possible-- healthy diet, minimizing stress, taking a lot of vitamins,esp NAC, vit. C, A, E, minerals; a strong eye multivitamin; alongside your dry eye treatments.

    I would suggest you ask a doctor you trust (or a dctor here on the forum), about the risks related to antiinflammatories applied to the eye (like steroids, increased cyclosporin concentratoin preparations,etc.) and potential chances of the virus attacking your eye; as all the antiinlfammatories repress immunity in the eye. Such a risk is quite remote, but it should be discussed in light of adjusting dosages, duration of treatments, regular monitoring, etc.

    If you are on antiinflammatory therapy, the doctor might recommend taking antivirals like oral zovirax on a regular basis at least while on the therapy. That should be enough to keep the virus at bay.

    Hope this helps.

    Dani

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