I have one question, why warm compresses works on dry eye symptoms even if you don't have blepharitis?. I'm a post-lasik patient, every doctor I see discard blepharitis as a main cause for my dry eyes. I don't experience much relief from artificial tears, I use warm compresses for 10 minutes and don't experience burning, glare, floaters for a much longer time, compared to artificial tears.

You may have meibomian gland dysfunction (MGD) - which results in a thick oil in your meibomian gands. Warmth makes the oils more liquidy, and this results in a better tear film. Warm compresses are great!!!

I hope this helps

Bill Trattler, MD
Miami, FL

Whats more LASIK has probably caused your meiobian gland dysfuntion. If you think of the oil coming out of your eyelids as like butter which needs a certain amount of aqueous (water) tear to mix with to keep it runny. The aqueous layer also has salt and antibodies which would help keep these gland openings clean. I am not a doctor just someone who was given LASIK when she shouldn't have been cos her eyes were borderline dry eye. I agree artifical tears don't work because they do not contain an oil layer and therefore alone can increase evaporation. Maybe try tears plus warm compresses straight after. I am waiting for a good eye drop to be introduced that contains castor oil (Endura by the way isn't that good in my opinion)

Dr. Trattler: I have been checked by two doctors already. I expressed my concern about having MGD, but both said my Meibomian glands are fine. Neither of them recommend warm compresses for my dry eye,they only prescribe me a couple of artificial tears to experiment with. I have described the effect of warm compresses on my vision, but they didn't pay much attention. So, I'm very confused, the relief I experience with warm compresses clearly indicate I have MGD? (Artificial tears don't do much for me). Restasis could help me?

Ann, before LASIK I didn't have any problem with my eyes either, this really sucks....
Thanks!!

Believe it or not - the diagnosis of MGD can be a challenge - and I would recommend that you see a specialist in corneal disseases.
Restasis is an excellent option - it helps with MGD and dry eye. Studies have shown that it increases goblet cell density by almost 200 percent over a number of months.
And warm compresses are safe and have been shown to be very helpful. I recommend warm compresses to many patients who previously underwent LASIK and have dry eyes.

Please see your doctor and discuss this in greater detail, or get an opinion from a corneal specialist. You can also cite my article on this topic that is in the peer-reviewed literature. Your doctors can review the article.

DI PASCUALE MA , Liu TS, Trattler W, Tseng SC, et al
Lipid tear deficiency in persistent dry eye after laser in situ keratomileusis and treatment results of new eye-warming device.
J Cataract Refract Surg 2005;31:1741-9

Abstract:

PURPOSE: To determine whether lipid tear deficiency is a significant pathogenic factor in persistent dry eyes after laser in situ keratomileusis (LASIK). SETTING: Ocular Surface Center, Miami, Florida, USA. METHODS: Thirty-four eyes of 17 patients (mean 46.35 years +/- 11 [SD]) complaining of persistent dryness more than 12 months after LASIK were prospectively studied by symptom scoring and kinetic analysis of tear interference image, tear breakup time, and fluorescein clearance test. Once patients had been clear of inflammation and treated for aqueous tear deficiency, lipid tear deficiency was further confirmed and treated with Eyefeel (Kao, Inc.), an eye-warming device, 4 times daily for 4 weeks. RESULTS: Sixteen patients were asymptomatic before LASIK but dryness persisted for 41 +/- 19.3 months. Delayed tear clearance was observed in 15 patients (88.2%) and floppy lids in 12 patients (70.5%). Aqueous tear deficiency was reconfirmed in 16 eyes (53.3%). After Eyefeel treatment, there was a subjective improvement of ocular surface diseases index from 60.6 +/- 10.6 to 25.8 +/- 18.5 (P = .0007). Tear breakup time was improved from 2.4 +/- 3.9 seconds to 7.9 +/- 3.6 seconds (P = .004). There was a tear interference pattern change from a vertical lipid tear deficiency to a horizontal normal in 7 eyes. There was a mean lipid spread time improvement from 1.3 +/- 0.4 sec to 0.8 +/- 0.4 sec (P = .001), and there was a mean lipid thickness improvement from 63.5 +/- 23 nm to 79.5 +/- 27 nm (P = .04). CONCLUSION: Persistent nature of dry eye after LASIK is attributed to in part to delayed tear clearance, undercorrected aqueous tear deficiency, and nonrecognized lipid tear deficiency.

Thanks for your response Dr. Trattler, the last Dr. I see is a corneal specialist (anterior eye segment). When examining my eyelids he said that my glands were fine. (I just had one gland blocked by oil). His final diagnosis was "aqueous tear deficiency caused by
the cut of corneal nerves ocurred in LASIK". Then he recommend a different brand of
artificial tears (Refresh liquigel). This tear it's a little bit thicker than the one that I was using before (genteal). This artificial tear it's not helping me either, so my best treatment now is warm compresses.

Is there a study that shows dry eye can cause higher order aberrations, Dr. Trattler?
This last Dr. I saw doesn't believe me that after I put warm compresses my glare dissapear
for a brief moment. He also thinks my pupil size it's larger than the ablation zone, so I want
to discuss this topic in great detail with him.

I'm gonna send this study you post, thanks for that!