Patient Guide
The same plan Dr. Eslani gives his dry eye patients in San Diego: preservative-free artificial tears, eyelid cleaning, and a heated mask with eyelid massage. Here is exactly how to do each step, the products he recommends, and when home care is not enough.
The Basics
Every blink spreads a thin layer of tears across the eye. When that layer breaks down, the eye surface dries out and becomes irritated.
Your tear film is made of three layers. A mucus layer helps tears stick to the eye. A water layer provides moisture and comfort. On top, a thin oil layer stops the tears from evaporating.
That oil comes from tiny glands along the edge of your eyelids, called meibomian glands. In most people with dry eye, these glands become clogged. The oil layer thins, tears evaporate too fast, and the eye becomes irritated.
The plan below does two things: it adds moisture, and it unclogs the glands so your own tears last longer. Each step matters, and they work best together.
Burning or stinging
A gritty or sandy feeling, as if something is in the eye
Redness
Blurry vision that clears when you blink
Watery eyes, because an irritated eye makes reflex tears that do not protect it
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Step 1 · At least 6 times a day
Artificial tears are the most common treatment for mild dry eye. The key is using the right kind, often enough, even on days your eyes feel fine.
Use them in both eyes at least 6 times a day, even when your eyes feel fine. Extra drops are safe.
Look for “Preservative-Free” (PF) on the box. Preservatives can irritate the eye surface when drops are used many times a day.
Avoid “get the red out” drops. They whiten the eye by shrinking blood vessels but do not treat dryness, and frequent use can make redness worse.
Using other eye drops too? Wait 5 minutes between different drops.
Tilt your head back.
Gently pull your lower eyelid down to make a small pocket.
Put one drop into the pocket.
Close your eyes gently for 30 to 60 seconds.
Do not let the tip of the bottle touch your eye.
Any one of these is a good choice. Pick the format that fits your day.
Preservative-free bottle
A multi-dose bottle that stays preservative-free, convenient if you use drops many times a day.
Single-use vials
Open a vial, use it, and throw it away. Easy to carry in a pocket or bag.
Vials or preservative-free bottle
Available both as single-use vials and as a preservative-free multi-dose bottle.
Single-use vials
Preservative-free single-use vials for frequent daily use.
Step 2 · Twice a day, morning and bedtime
Oil and debris that build up along the lash line clog the gland openings. A gentle daily lid scrub keeps them clear.
Choose one cleanser:
Store-bought eyelid scrub wipes or foam, or
Baby shampoo: 2 to 3 drops mixed into half a cup of warm water. Never use baby shampoo undiluted.
Scrub at the base of the lashes, side to side. That is where the openings of the oil glands sit.
Wash your hands.
Close your eyes.
With a wipe or cotton pad, scrub gently side to side along the lash line for 20 to 30 seconds per eyelid.
Rinse with warm water and pat dry.
A mild sting is normal. If it burns, stop and contact our office.
Step 3 · 3 to 4 times a day
Heat softens the thickened oil inside the glands. Massage right afterward pushes it out onto the eye, where it protects your tears.
Heat on high for 10 minutes with your eyes closed. It should feel very warm and soothing, never burning.
Massage right away, while the oil is still soft.
Upper eyelid: starting at the brow, roll down toward the lashes.
Lower eyelid: starting at the cheek, roll up toward the lashes.
Do 5 to 10 strokes across the whole eyelid. Always push toward the lash line.
Press on the eyelid, not the eyeball. Finish with an artificial tear.
A warm washcloth cools within a minute or two, which is not long enough to soften the oil in the glands. An electric heated mask holds a steady temperature for the full 10 minutes.
If it feels too hot, turn it down.
Do not sleep with the mask on.
Had eye or eyelid surgery recently? Ask us before using heat.
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Two heat settings (104°F and 113°F), gentle compression, a remote control, and Bluetooth music. Folds for travel and is FSA/HSA eligible. Its maker says it is not for people who have had eye surgery or who have glaucoma, cataracts, or a retinal condition, so ask us first if that applies to you.
Budget pick · about $29 on Amazon
Well rated, with a timer. Its top setting runs hotter, so start in the middle.
Prices are approximate and change often.
Putting It Together
Fitting all three steps into your day is easier than it sounds. Here is a schedule many patients follow.
Wake up
Mid-morning
Lunch
Afternoon
Bedtime
Follow the 20-20-20 rule: every 20 minutes on a screen, look at something 20 feet away for 20 seconds, and blink fully.
Keep screens slightly below eye level.
Avoid fans, car vents, and air conditioning blowing at your face.
Use a humidifier in the bedroom, and drink enough water.
Most people feel better after 4 to 6 weeks of doing all three steps every day. The glands take time to recover, so stopping after a few good days usually lets symptoms come back.
Screens make dry eye worse because we blink far less while focusing on them, so the tear film has more time to evaporate between blinks.
Know the Warning Signs
These are not typical dry eye symptoms, and they should not wait for your next appointment.
A sudden change in vision or loss of vision
Eye pain, not just irritation
Strong sensitivity to light
Thick discharge, or one very red eye, especially if you wear contact lenses
If you have any of these, contact an eye doctor's office the same day, or go to your nearest emergency department if you cannot reach one. Contact lens wearers with a painful red eye should remove their lenses and be seen promptly.
Beyond Home Care
If you have followed all three steps every day for 4 to 6 weeks and still have symptoms, the next step is finding out exactly which type of dry eye you have.
First
Tear break-up time, surface staining, and a close look at the eyelids and oil glands show whether your dry eye is evaporative, aqueous-deficient, or mixed.
Prescription
Prescription drops can calm the inflammation that keeps dry eye going when artificial tears alone are not enough.
In the office
In-office treatments that clear blocked oil glands more thoroughly than home heat and massage can.
Advanced
For severe or stubborn cases: autologous serum tears, amniotic membrane, punctal plugs, and scleral lenses.
What the Research Says
The steps in this guide follow the advice of national eye health authorities.
National Eye Institute (NIH)
The NEI names artificial tears as the most common treatment for mild dry eye.
Read the NEI guide ↗American Academy of Ophthalmology
The AAO advises gently scrubbing the base of the eyelashes with baby shampoo diluted in warm water, or with lid wipes.
Read the AAO guide ↗American Academy of Ophthalmology
People normally blink about 15 times a minute, but only about 5 to 7 times a minute while using screens.
Read the AAO guide ↗American Board of Ophthalmology
The Board's free public search confirms whether an ophthalmologist, including Dr. Eslani, is board certified.
Search the ABO directory ↗FAQ
Persistent dry eye has a cause that can be found and treated. Request a dry eye evaluation with Dr. Eslani.