There are many reasons for feeling dry eye. New research shows that while some patients have decent Schirmer's scores (the little papers they stick in your eye to measure tear production), they seem to have a neuropathic sensation of dry eye, even when there is no "classic" dry eye diagnosis. For others, there are definite issues with tear film production and/or composition. If you have not had a tear film test (Schirmer's) and a comprehensive "dry eye" evaluation, you probably should have one done. Most optometrists do this. You may have meibomitis, which means the meibomium glands (the glands where your eyelashes are attached) may be plugged, preventing the mucin (oil component) from blending with your tear film properly. Treatment for this is lid therapy (see below).

Dry eye also calls for better drops, and if you have not already tried them, I recommend "Dr. Holly's drops," Dwelle, Dakrina and NutraTear, available from They have sample packs you can order to see which one is best. Dwelle is very viscous, good for nighttime use. Dakrina is thinner, but not thin, good first thing in the morning. NutraTear is good for all day maintenance. But be sure not to use them too frequently, or you may experience a rebound effect and your eyes will feel even worse. You might also try Soothe drops.

Fish oil or flaxseed oil supplements are also an important addition to dry eye treatment. Flaxseed is somewhat more palatable than fish oil, which can cause belching and fish breath throughout the day.

Some people also benefit from a course of doxycycline, which somehow seems to thin the secretions and improve tear film composition. Ask your OD about this.

Protecting your eyes is also important. If you are able to tolerate the overnight gels or goo, I suggest using them, but covering your eyes with saran wrap and then a sleep mask while you sleep. This keeps the moisture in. If you cannot tolerate that stuff, using Dwelle and then covering your eyes may help. Some people wear moisture chamber goggles, which are effective, but can be tough to get used to.

I also recommend that first thing in the morning and before going to bed at night, you flush your eyes with Unisol 4 unpreserved saline. This is what I use all day and during the night to keep my eyelids from sticking and my eyes from burning. If you wear makeup, be sure to cleanse thoroughly to make sure you get it all off and be careful not to get it in your eyes. If you should, flush them with the Unisol 4 immediately. I keep mine in the refrigerator, and it feels sooooooo good. I also have bottles of it all over the place in my home and at work. Overhead fans and forced air cooling and heating can also make a bad situation worse, so try to keep out of the air flow if possible.

Last, but not least, I recommend a book for the lay person, Reversing Dry Eye Syndrome, by Steven Maskin, MD. It has a wealth of information that can be of great help. It's available through

Here's the lid therapy info:


Lid therapy is designed to eliminate surface debris and infection from the lids and improve the quality and flow of the oily secretion from the meibomian glands.

It is important that the entire procedure is performed twice daily for a period of three weeks.


Hold a hot washcloth (as hot as you can tolerate) over the eyes for 1 minute. Alternatively turn the water in your shower up as high as you can tolerate and have the hot water run over your eyes for 1 minute.


Gently rub the lid margin with the washcloth 2-3 times.


Put 1 drop of Baby Shampoo into 5ml of water. Dip a Q-tip into the solution and scrub the lid margin gently for 20 seconds. Rinse the eye with an eyebath.


The index finger is rolled up the lower lid to the lid margin. Pressure is applied inwards as the finger is rolled up to express the secretion from the gland. Lid massage should be done 20 to 30 times on each eye.

There are 23 glands in each eye, running upwards to the lid margin, behind the eyelashes. Ensure that you do 3 rolls to cover the entire lower lid and all of the glands. Research has shown that as few as 2 glands blocked can have a detrimental effect on tear film performance.

Think of your finger being like a steam roller. Pressure must be kept in against the eyeball to keep the gland blocked as your finger rolls up the lid and the fluid inside is pushed out.

There is also a wealth of information on dry eye available throughout the site, which can be accessed through the "find" tab at the top of the forums using keywords "dry eye." Information on Dr. Holly's drops is also available in many posts in the Dwelle diaries, keyword "dwelle."
Original Post
Does the hot compress have to come before the lid/eyelash scrubbing?

I thought before would help with getting the eyes cleaner, but when I talked to my doctor about the routine he said that the compress goes after the washing (or rather, his employee in charge of explaining said that). I guess I can see the advantage to this order because you may decrease the risk of infecting glands by starting with clean eyes, but since his employee did the explaining I did not have the chance to ask him.
Candace, I'm sorry for the late reply. I missed your post, somehow.

I generally start with the hot compresses, which loosen the secretions and make it easier to clean the "goo" from the meibomium glands. I've yet to get an infection from this method in 11+ years.

Has the regimen helped your dry eye?
I just visited a new doctor in Toronto and she wants to fit me with scleral lenses since I have highly irregular and scarred corneas, plus very dry eyes. She could not take a topography of my cornea because of the irregularity so she has ordered trial lenses. She asked me to not wear lenses for 7 days and I am horrified to not be able to read, use the computer, watch tv...she said my current lenses shape the eyes so she prefers to fit them with this one week hiatus.

Anyone been fitted with sclerals and have to wait a week? It's depressing not to be able to see things that are important.
"It's depressing not to be able to see things that are important."

VSRN could use this comment as a slogan: VSRN... because it's depressing not to see things.

Corneal shaping and molding can occur with rigid lenses, especially after refractive surgery. A week would be a minimal amount of time to see how much molding has developed before attempting to refit.
I had PRK in 1996 and 1998, so quite a long time ago. Dr. Maller fitted me with larger RPG lenses and now I have problems, so looking at sclerals. I guess I still need to keep the lenses out for a week. Any negatives to using sclerals? Seems they are good for dry eyes but the size and process to get them in and out are a bit scary.
Dear Stupid (Sorry. I couldn't resist!)

Before considering sclerals, you must first attempt to understand why the large corneal lenses that have worked relatively well for so many years are now causing issues. The answer may be just a small adjustment of the fit. Scleral lenses are not uniquely better at correcting post-ablation vision issues than large corneal lenses. What fits... fits. There are a lot of variables involved in designing post-RS lenses and, for that reason, one cannot assume that a scleral lens will work better than your previous ones. This is why your doctor needs to have a clear understanding of the problems that have developed.
Thanks Dr. Hartzok. I am in touch with Dr. Maller and I will attempt to visit him again. In the meantime, I have a new scleral lens for my right eye only (the dominant one). Taking the lens out is still scary. I tried today for 3 hours and have a mild burning and the vision is a bit blurry for the distance. I am going back for another visit. At this point, I am feeling that it might not be a perfect solution for me. I did manage ok with the corneal lens but I over-used it apparently (2 years) so might have caused me the keratitis and neo vasculitis.

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