Dry eyes and the Bruder mask
Blog vol 7.3. Dry eyes and the Bruder mask
The Covid pandemic caused an explosion of screen use for everything from shopping to family get-togethers to classes to online work to entertainment. We rely on our eyes more than ever. Hours spent looking at a screen exacerbates any pre-existing focussing or eye alignment problem. When we stare at a screen, we reduce our blink rates by as much as half the normal rate.
When Dr. Jerilee Nyman joined our practice in 2013 she brought with her a mask, a Bruder mask. This German product is heated in the microwave and is contoured to fit over your closed eyes. This mask is still part of our treatment plan for dry eyes. Since the 2017 DEWS II report on Dry Eye Disease emphasized the role of the meibomian glands in tear evaporation, treatment of these glands has been key to most dry eye therapy.
Dry Eye Disease (DED) is a chronic condition. Every time you blink, you stimulate the meibomian glands in your lids to release the meibum and this oily substance coats the outer surface of the tear layer to help spread the tears and to prevent evaporation. Less meibum leads to more evaporation leads to dry eyes which leads to inflammation; the cycle continues, with resulting irritation, redness, itchiness, and blurred vision.
The heat from the Bruder mask “melts” the oil and fats in the meibum so that they flow more easily. After an 8–10-minute exposure, you massage the gland, about a minute with lid to improve flow. The lack of blinking causes the glands to stop flowing, the opening for each gland seals up with dry meibum, the glands then swell with unexpressed meibum, and left unchecked, the glands then start to atrophy and die off.
I have been prescribing these masks for years but never tried one out myself. I have relatively dry eyes; does the mask actually help? I found out that this treatment requires commitment: you heat the mask, not hot but nice and warm, then find 10 minutes in your schedule for keeping your eyes closed (harder than you think), then once the heat is removed, massage the top and bottom lids up and down for roughly two minutes. Your lids are very supple at this point, now take the cleaning cloth (we usually use Blephaclean) and wipe back and forth on the tiny openings on the lid margins. Done. Repeat every day for ten days and supplement with a nonpreserved lubricant drop.
I have just finished day three and found that my eyes need a lot of work. Getting some crustiness out on each treatment. After the ten-day treatment you must keep going, at least weekly, to keep up the meibum flow. This is a chronic condition. I also take a daily re-esteriified Omega 3 oil that is absorbed by the body and literally fills up the meibomian glands with oil, also recommended.
It actually works. I have sent countless patients home with a mask and the task of heating/massaging/scrubbing. The key is the maintenance. Most people do the initial 10-day session but then do not continue. Think of it like flossing and brushing your teeth and just make it a regular routine.
A lot of our life is like that, regular maintenance, make it a good habit.
‘til next week,
The good doctor
