Blepharitis is unpleasant. This inflammation (swelling, redness and discomfort) of the eyelids can often be accompanied by a build-up of scale along the lash line of the eyelids. It looks unsightly and it feels itchy and irritating.
Many people reach straight for the warm compress if they have an episode of this eye condition, but that may be a mistake.
This post explains why heat may not be the best option when it comes to managing this condition.
Inflammation loves heat
One of the biggest mistakes people make in treating their blepharitis is to add heat. But the problem is that inflammation is usually made worse by heat. Heat causes the blood vessels in the skin around your eyes to dilate. This means more blood gets to the area. The body’s inflammation response means that the blood carries more inflammatory cells to the area, resulting in even more of the redness, swelling and pain we associate with blepharitis.
Try cool compresses instead
A quick, easy and effective way to do this is to cool the area with a cold compress.
This can be done with a gel eye-mask which has been stored in the freezer. Lie back with the mask moulded close to your closed eyes for 10-15 minutes a day. Twice a day is even better!
Keep the eyelids clean
The crusting or scale that collects around the base of the eyelashes is actually a biofilm colonised by large numbers of bacteria. This is usually the underlying cause of the inflammation in this eye disease. Keeping the area scrupulously clean will help the inflammation to settle down.
Use an effective lid cleanser to clean the area daily. One of the best systems on the market is called Blephadex. This is available as wipes or a gentle foam cleanser and contains teatree oil.
A professional treatment called BlephEx is an excellent way to remove the biofilm completely from the eyelid margins. It is a bit like the professional clean you get at the dentist. A rotating sponge soaked in a gentle exfoliant is used to scrub the biofilm away. This can be done annually to keep blepharitis at bay, and is relatively inexpensive.
What else can I do?
Steroids and non-steroidal anti-inflammatory drugs (NSAIDS) can be a terrific way to get inflammation under control quickly. Ask your therapeutically-endorsed optometrist about the appropriate eye drops for your blepharitis. They will need to monitor your intra-ocular pressure, as these drugs can have the side effect of raising the pressure inside your eye temporarily.
You can also take over the counter anti-inflammatories such as Nurofen or Voltaren. Talk to your pharmacist if you are taking any other medications.
Are warm compresses useful?
Warm compresses can be an effective way of improving the flow of oil in the Meibomian glands of the eyelids. This is useful for dry eye sufferers. But the key is to first reduce the swelling and redness before any heat is applied.
Once the redness and swelling of the lids is under control, warm compresses can be used under your optometrist’s guidance.
Have enough of your red eyes? See the experts. Call The Eye Practice today or make an appointment online.
PLEASE READ: The information given under Eye Conditions is of a general nature and is not intended to be advice on any particular matter. Please take the appropriate Optometrical advice before acting on any information given under Eye Conditions of The Eye Practice web-site.
I use warm masks as i have peripheral blepheritis and they help.
I have since suffered from ocular shingles in my right eye. It has effected the sight in my eye badly and i still have pain, soreness, and sensitivity to light.
Can i still use my warm mask on my affected eye?
Also, can i rub medical Manuka honey on my affected eye lid. Is it safe?
Thank you for your help. My GP can’t offer any advice.
Hi Janette
I am sorry to hear about your ocular shingles. This can be a very arduous process. I would not use warm compresses on your affected eye as it is likely to increase the inflammation. You need to decrease the inflammation – you should be seeing a corneal specialist for this.
As far as Manuka honey is concerned I do not know whether it can be helpful or harmful as there are no medical studies to support its use in humans for the purpose of treating shingles. There are lab studies but until human studies are performed it cannot be recommended.
Thanks Jim. I have been using warm compresses all this while but changed to using cold compress after washing my eye lids with warm water. Somehow this seems to have alleviated the discomfort I have been having the last 10 years. This has become my routine the last 5 weeks and I’m feeling so much more better than before.
Great to hear Chandra. Depending on the type of blepharitis warm compresses can inflame the eyes further, making them feel worse.
Hi there, I have blepharitis and ocular rosacea. Part of my treatment is twice daily warm eye compresses. I’m wondering what the difference is between using a dry heat compress vs a moist heat compress? Is one better than the other? Is either counter-productive? Many thanks
Hi Rebecca
A moist heat is more effective as there is more efficient transfer of heat through water.
A more import question in the context of rosacea is whether the heat is making things worse! This is because it promotes inflammation. Unfortunately this is a case by case issue and requires a practitioner that understands rosacea and and meibomian gland dysfunction.
I used warm eye mask on my eyes for 10 mins 3 x a day to get rid of a stye. The stye came back a few weeks later. I did the warm compress mask again, now I just do it at night, but I’ve noticed that the skin around my eyes look damaged. as if I have pigmentation. ( I have asian skin ) Do you think the compress was too hot? Im sacred to stop using it incase I get another stye. But I look like I have panda eyes! What to do? Should I use a cold mask ?
Manta
I suspect in your context stopping the warm compresses will allow your eyes to return to normal looking. Do not do cold compresses as it is likely to return the styes. You probably need more sophisticated treatment options like IPL and Rexon Eye.
See our blog:
https://www.theeyepractice.com.au/optometrist-sydney/what-are-the-most-promising-dry-eye-treatments-for-2020/
Hi,
I’ve been diagnosed with bilateral meibomian gland dysfunction and blepharitis. I’ve had it for about 5 years.
Every time I see the ophthalmologist they advise the same thing, hot compress to melt the blocked lids.
Problem is this makes my eyes very red, sore and inflamed.
I use lid wipes (Blephaclean) as recommended by an optician. These work some of the time, and also over the counter preservative free drops.
Can you give me any advice as the best way forward.
I don’t think a lot of ophthalmologists realise how much of a negative impact this problem causes, so just give general advice, warm compress etc etc..
Terry you are absolutely correct. You see no one dies or goes blind from this condition. I am not sure where you are from but this vague description implies you have ocular rosacea. The best management for this assuming this is what you have, as meibomian gland dysfunction and blepharitis are side effects of this condition are:
1. Oral Azithromycin or Oral Doxycycline
2. Preservative free prednisolone minims
3. A procedure called IPL around the lids
4. And another procedure called BlephEx
I assume from your email address you are from the UK?
Cold compress??? Seriously what are you talking about. That will definitely do more harm than good for most people.
Also heat is the only thing that’s going to open clogged meibomian glands.
Katie
Unfortunately you misunderstand the many variations of blepharitis. Many forms of blepharitis have excessive meibum oil, which is inflammatory. Warm compresses in these cases make the inflammation worse.
I have blepharitis and dry eyes and possibly ocular rosacea. And recently I had conjunctivitis. I was prescribed a cortisone gel by the eye specialist and to do warm compresses. However I have woken up this morning and my upper eyelids are really swollen, droopy and itchy. Can I put a cold compress on them ?
Yes you can. Warm compresses potentially is not helping you here.
Tired of seeing conflicting info like this, dealt this this for a year and now im being told what im doing is wrong. How am i supposed to deal with the bkocked glands without heat and how can I deal with the swelling with just cold compresses and no massage. So stressful.
You are right Darrian. Conflicting information is the norm for irritated eyes. The point of this blog is to flag the fact that it is a complex area. Heat by definition causes inflammation. In the context of ocular rosacea, which is very under diagnosed when a patient presents with irritated eyes, heat is often prescribed making the condition worse. Eye allergies are also common. Prescribing heat again will not help.
The moral to the story is that in your particular case, I cannot comment because I have not seen you. I realise that you are frustrated with your eye condition, but there is light at the end of the tunnel. Where are you located and maybe I know someone that I can refer you to.
Hi i m isha i have a chalazion and i take hot compression it increase my swelling and lil pain so what can I do?
Sometimes the best treatment for chalazions is surgical removal.
I put a cold pack on my eyes and my eyes started burning after only having it on 10 seconds why is that
Its possible that the pack was too cold. Wrapping it once in a clean thin tea towel can help. The other issue is that cold might not be in your best interest if the diagnosis is not accurate.
So this should not be cold, but cool…?
Hi, i liked what you had to say!
Can you please send me information on finding an ophthalmologist in the western suburbs of Minneapolis,mn.
I was told I had a wrinkled retina in one eye.
Along with both eyes possibly having rosacea. I do have blepharitis, sensitivity to staph on my eyelids, dry eyes plus meibomian gland dysfunction.
It gets very complicated. Thank you!
Janet you need to see two different types of ophthalmologist. One is called a retinal specialist (wrinkled retina) and the other is called an anterior segment ophthalmologist (for front of the eye like rosacea and meibomian gland dysfunction).
I would visit an optometrist in Minneapolis and ask them to refer you to both of these types of eye specialists. We are based in Australia so I am not familiar with Eye Drs in Minneapolis.
Hello!
I have chronic Dacryostitis – right eye. I need surgery but right now I can’t have it because I had sinuses surgery one month ago.
Every time I had inflammation and swelling I used to take antibiotics and do warm compresses and they helped!
but this time the warm compresses are making it worse, there are more swelling and more pain! What should I do?
Mira
Dacryocystitis is an infection so just take the antibiotics, as warm compresses increase the inflammation and make the condition feel worse.
Hi,
It is one year that I am suffering from belpharitis, I Have Used warm compress daily and then Washed my eyelids with baby shampoo, and I have never used make up for my eyes from last year, but it is more than 10 days that my left eyelids flutters , I am wondering if it is related to using warm compress daily? Or is it related to my blepharitis or the treatment process ?
Sahar
I do not think your eyelids are fluttering because of the blepharitis or the treatment process. One thing I would say though is that using baby shampoo to clean your eyelids potentially is detrimental as it is a mild detergent and in the long term it is likely to irritate your eyes and eyelids. Better to use a commercially available lid cleaner such as Sterilid. The lid twitching can be overuse of digital devices.
i have had swelling in my left eye for awhile, been to the eye doctor and have been prescribed medicine which includes eye drops etc. , I have read a couple of comments and see that warm compresses may not be good which I have been using a lot. I am going to try cold a cold compress to see how that works, is there anything else I can try as well as this I have been battling this for a good while
Maquenta
Without seeing you it is difficult to know what to do as eyelid swelling can be many things. Eye drops are unlikely to help. If it is an infection sometimes an oral antibiotic such as Keflex can be useful, assuming you are not sensitive to it.
I’m dealing with blepharitis and mgd. I’ve been told to use warm compresses but I notice the swelling worse. Should I switch to cold twice a day and then warm once? Will cold compresses actually make mgd worse? It’s very confusing ugh.
Yes it is extremely confusing. Cold compresses will not necessarily make MGD worse. You need to be assess by someone that understands these entities. It a fine line because rosacea is often associated with blepharitis and MGD. Rosacea is best treated using IPL. https://www.theeyepractice.com.au/education-advice/ocular-rosacea/
Hi, my partner has blepharitis although undiagnosed until recent post lense replacement surgery difficulties. Weeks after a smooth recovery he suddenly experienced severe light sensitivity, watery, sore, gritty eyes. We have been researching extensively over the past 2 weeks since his flare up and a visit back to his eye surgeon. Firstly, is it normal for him to have had 14 days in a row now of 95% of the waken day with these extreme symptoms? (Eyes constantly shut from the pain). Secondly, we are unsure how many times a day we should be going through the “cleansing” process followed by antibiotic drops. As we want to try and let it settle but after following a full cleansing process the eyes still feel full of gunk and extremely irritated. He seems to be stuck in a vicious cycle of heat compress, massage out excess oil, cleanse, wipe, moisturise (eye drops) then cold compress. Only to be full of gunk and need to heat compress, clean process again. We need some direction please.
Kim
Often the drops have preservatives, which can cause the irritation to perpetuate. Blepharitis by itself just means inflamed eyelid margins. There are at least 6 subcategories that have different treatments. Without trying to over complicate this, your partner needs to see someone else, who cares to understand these frustrating eye conditions more in depth.
I was advised to use a warm compress and massage followed by drops to unblock meibomian glands. After two days floaters appeared in my right eye which are extrémenla irritating. Could the two events be linked?
Joanie
Most people will experience floaters in their lifetime. It is possible that the eye massage stimulated them but then they also could have happened anyway. You should have your pupils now dilated and your peripheral retina examined with an instrument called a binocular indirect ophthalmoscope. A small percentage of patients that experience floaters can develop a retinal detachment which is serious.
What drops? I am thinking the drops may have caused the floaters
Sheetal
Drops do not cause floaters. They are unrelated and can occur coincidentally.
Don’t agree to this at all, I nearly ALWAYS get a floater 5-10 minutes after using eye drops then they clear..
I am not quite sure what an eye flaoter has to do with this article and what you do not agree with?
Hi, Should I do the eye massage with the cold compress, like you would with the warm compress?
If you trying cold compresses, yes continue lid massage.
I am using warm compress for my eye strain. Is that good to do? I tried OTC eye drops for dry eyes as my eye staring I think comes from computer use – but the OTC drops don’t seem to cut it. Are there other drops that will help the muscle pain from eye strain?
Carmen if you are experiencing muscle pain from eye strain, you might need glasses. See the following article for more information:
https://www.theeyepractice.com.au/eye-strain/
Hi,
I found that warm compress definitely make the swelling of my upper eyelid worse. I have mgd and mild rosacea in one eyelid. My optometrist said to do warm compress, but since stopping them, my eyes got better. My issue now is, i took 2 cotton buds to express my upper eyelid glands. A lot of white gunk came out, now my eyelid is worse than ever and painful. Do you think i damaged my glands, or is it just trauma to the eyelids and they will get better over a few days. My eyes are so dry and irritated now. I expressed the glands but now i feel like nothing is coming out at all now and the upper lid margins are so swollen sore and red. I believe i still have a small chalazion that i may have irritated with the cotton buds.
Adrian, when you try to unblock a stye like that it is possible to force infected pus backwards into the gland and cause it worsen. You need to see your GP for a course of antibiotics such as Augmentin to settle this.
Hey, so ever since I did warm compresses for a chalazion ony right eye, it’s gotten red and inflamed in the center where my eyelid is. Is it because my compresses were too hot and I burned my eyelid? I saw online warm compresses works wonders for eye ailments and draining the eye gland so I don’t understand why it looks that way, how can I fix it?
Geena if you have a chalazion as opposed to a hordeolum (stye), then warm compresses do not help. IPL has been sometimes shown to work and ultimately it can easily be surgically removed.
I too suffer from blepharitis/MGD/ocular rosacea; for quite a long time keeping my eyelids clean and wiping twice a day with avenova was enough to keep things at bay; I did not need pres. free tears either. Lately, it is not doing the trick; so i have been using warm moist heat several times a week and I think I am actually seeing more redness in my eyes; the whites of my eyes close to my nose. Should I drop the warm moist heat and start using cold compresses in hopes that the blood vessels will shrink and my eyes will be whiter? Just afraid that oil will get clogged or backed up. This is a confusing disease. Recently I had to see my eye specialist because of the inflammation and i used azasite lx day for two weeks and an anti-inflammatory drop/2x day for 2 weeks/steroid. Eyes cleared and felt better. But redness is creeping in again and I am thinking of stopping warm moist heat and trying the cold compresses. pres. free natural tears with hyaluronic and Avenova morning and nite.
any advice you can give me will be appreciated.
Possibly this might help Susan, but I would also consider IPL https://www.theeyepractice.com.au/dry-eyes/ipl-for-dry-eyes/
I used a warm gel mask on my eyes last night and after a few minutes I took it off. My vision was so blurry that I could not see anything for about 30 seconds. My vision cleared some but it is still a little blurry. I’m worried I damaged my eyesight by using the mask. Can you damage your eye sight if it was too hot?
Tracy, it is unlikely you will cause more issues in your case. The vision going blurry like that is quite common as a lot of meibum oil is liberated with some people doing this treatment. In this case it is usually a good sign. On the other hand if you have a skin condition called rosacea it can make the rosacea and then the eyes worse.
Hi. I have got a small stye on my upper eyelid right along the lash line. Its been there for more than 20 days nows. I am daily cleaning my eyelashes. Please tell me what else can I do? As I dont want to get it operated.
Jessica
You need to applying warm compresses with gentle finger compression of the stye.
Typically styes are caused by meibomian gland dysfunction. More can be seen here:
https://www.theeyepractice.com.au/dry-eyes/meibomian-gland-dysfunction/
Hi, I have a SB and blepharitis, but it disappears in summer. Eyelid are swollen and red. As for the eyes, I wouldnt say they are very dry, maybe itchy some times, when I spend too much time on blue light. Tried warm compress and eyelid massage. Felt terrible afterwards, eyelids were even more red and the eyes felt like burning. Then tried cold compress and seemed to give a relief. Question, do I need an eyelid massage, as I get dark circles around my eyes because of blepfaritis. Or should I leave it for later, when I deal with redness and swelling using cold compress and moving to hot compress. Do I even need to do a hot compress afterwards if the problem goes away?
If the problem goes away do not use the warm compresses
Thank you for this information! I had a quick question – I’ve been doing blinking exercises after a warm compress, which really seems to help express the meibomian oil, and was wondering if there are any negative side effects associated with squeezing your eyes shut tight. The blinking exercises have helped my MDG a lot, but I worry that squeezing my eyelids shut applies pressure to the eyes similar to rubbing? Thank you again!
This is fine Darrell. You do not need to squeeze them too tight. The main thing is frequency, which should occur 20 times at least each hour. The warm compress once a day is usually enough.
Please advice me, i had what looked and felt like a stye , chemist suggested an ointment called golden eye, after 14 days of using was improved though not completely gone but a week later all came back, ended up seeing a optician in the eye care check up. was told just blocked eye glands and advice to apply heat pack to eyes a few times a day then massage the area which im my case is bottom lid but mainly inside near inner side. Done this since Wednesday, now Sunday and if anything worse, more redder and feels bruised. Can see what looks like 2 heads but nothing brings them up and drains. Its painful and very sore. What should i do now? Also my eye is running a lot all day. I think its spreading too along my bottom lid. Massaging is hurting.
Susan it is likely this will need an oral antibiotic like Azxithromycin or Augmentin. See your GP if your Optician is not allowed to prescribed oral antibiotics and it will clear fairly quickly.
I have ocular rosacea and blepharitis. I haven’t had an issue in about two years,
I am of course getting married in two weeks and have a flare up. I am taking oral doxy and using azithromycin drops and lotemax ointment for the past four days with minimal Improvement. The redness it getting better but my lids are so so inflamed. Any advice? I was
Told warm Compresses but now wonder if I should do cool. I don’t have any crusting, I wake up and my lids are clean just swollen and itchy.
Shannon
I am sorry for the late response. This a classic case of stubborn rosacea, blepharitis treatment.
Congratulation on your marriage!
It is imporatnt to understand that:
1. Roacea and blepharitis you cannot cure, only manage.
2. Any drops must be preservative free.
3. Heat in the context of rosacea causes swelling and inflammation, so as you said often cool is better.
4. Redness and swelling can be controlled using brimonidine 0.025%, drops but with no preservatives.
5. Often drop without preservatives have to compounded and these can get expensive.
6. Oral doxy can replaced with oral Azithromycin for 2 week bursts, but only about 4 times per year maximum. Whereas oral doxy needs to be used ongoing.
7. These are oral antibiotics and sometimes it is also good to take probiotics.
8. Rosacea can have an association with a stomach bug called helicobacter pylori. Get your GP to check for this and if positive, get it treated.
By coincidence I have started a PhD on ocular rosacea and I have discoverd some interesting issues, which revealing here is not appropriate until my research is peer reviewed and accepted in the medical literature. I hope to have this ready in about 18-24 months.
i’ve been applying warm compresses to my eye (rice in sock method) for years now and it has helped my blepharitis and MGD but now im left w very dark under eyes, is there something that could help get rid of it?
Jay the darkness under the eyes, is not necessarily the warm compresses. Many people have this without ever using warm compresses. This is basically a cosmetic problem. I would see a dermatologist about it.