Some of my colleagues have virtually abandoned shampoo lid scrubs and prescribe only hot compresses for treating blepharitis and meibomian gland dysfunction. What is the rationale for either strategy, and are there less tedious ways for patients to provide consistent and adequate heat to their lids?

The purpose of shampoo lid scrubs is to rid patients who have blepharitis/meibomianitis of dandruff-like scaling that can encrust the eyelashes. This scaling sometimes enters the tear film, causing tear film dysfunction.

Some practitioners, however, choose not to prescribe shampoo lid scrubs to these patients. The reason: The shampoo can mix with the meibomian gland oils, saponify the meibum and create a low-level toxic reaction in patients who do not rinse their lids well, says Milton M. Hom, O.D., of Azusa, Calif.

Optometrist J. James Thimons of Fairfield, Conn., has seen week-long shampoo lid scrub regimens result in dry, irritated lid surfaces. This is one of the reasons why Ive moved away from prescribing shampoo lid scrubs, he says.

Dr. Thimons says that lid scrubs with a warm washcloth are as effective as shampoo lid scrubs in eradicating the flaky deposits that result from blepharitis. In fact, because I have rosacea, I lid scrub with a washcloth every morning, he says.  Exfoliating my lashes works very well. Also, this therapy is simple and inexpensive.

Warm compresses and microwaved-food items are replacing soap lid scrubs for treating meibomianitis.

Dr. Hom stopped prescribing shampoo lid scrubs because patients often were noncompliant. In optometry school, we were taught to tell patients to buy cotton swabs and baby shampoo, to place the baby shampoo on the swab and to scrub the lid with the cotton swab, once in the morning and once at night, he says. Well, patients fear poking their eyes out, they find the entire process too complicated to comply with, and they do not want the hassle of replenishing supplies.

For this reason, Dr. Hom prescribes lid scrubs using a washcloth with warm water once in the morning and once at night. This method of treatment is not only as effective as shampoo lid scrubs in ridding the eye of scaling, but patients comply with it because the items are readily available, and they like the feeling of a warm washcloth, he says.

Instruct patients to massage their lids in a circular fashion and express their meibomian glands with their knuckles for 20 seconds. Then, have them repeat the massage. Be sure to caution the patient about the hot washcloth, as the eyelid skin is very thin and therefore sensitive, Dr. Hom says. In other words, you dont want patients burning their eyelids, so encourage them to find the right temperature before they apply the washcloth to their lid.

But are there less tedious ways for patients to provide consistent heat to their lid anatomy for an adequate amount of time? Yes, says Dr. Thimons. Some patients are going to find walking to the sink and reheating their washcloths annoying, which will cause them to stop complying, he says.

Dr. Thimons advice to his patients: Hard boil an egg, place it in a thin wet cloth, and place that on the eye. This provides the patient with an easy mechanism of heat, and the egg fits almost perfectly within the eye socket, he says.

Because eggs can be costly, tell the patient to put that same egg back in the refrigerator to reuse it. By slightly cracking the shell to allow the air to escape from the inside, the patient can place the egg in the microwave for two to three minutes before the next treatment. I have had patients who have used the same egg all week by doing this, Dr. Thimons says.

No matter what treatment you recommend for your meibomianitis patients, always aim to achieve better compliance.

Vol. No: 142:10Issue: 10/15/2005