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J. D. Solomon, C. L. Case, J. V. Greiner, C. A. Blackie, J. P. Herman; Transient Visual Degradation and the Polygonal Reflex of Fischer-Schweitzer Following Warm Compress Application. Invest. Ophthalmol. Vis. Sci. 2007;48(13):420.
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© ARVO (1962-2015); The Authors (2016-present)
To document adverse visual effects of warm compress (WC) therapy and determine potential etiologies in subjects with dry eye symptoms.
Subjects (n=24) with dry eye symptoms were recruited. Group 1 (n=13): baseline measurements (OU) included subjective blur, visual acuity (VA), autorefraction (AR), corneal topography (CT), central corneal curvature (CCC), lipid layer thickness (LLT), and evaluation for corneal striae and edema. A warm, moist compress (44.4-45°C) was applied with gentle pressure for 30 min to the closed eyelids of the randomized experimental eye; nothing was applied to the contralateral control eye. Subjective blur, VA, AR, CT, CCC and LLT were evaluated OU at 5, 15, and 30 min and 5 min post-application. Striae and edema were assessed OU at 30 min and 5 min post-application. Group 2 (n=11): the above WC protocol was repeated to investigate the polygonal reflex of Fischer-Schweitzer at the times stated.
At 5 and 30 min, 71% and 88% of all subjects experienced increased subjective blur and decreased VA. At 30 min: Group 1: Of 13 experimental eyes: 100% experienced subjective blur and 70% exhibited a VA decrease ≥2 lines (mean=3.4±0.7). For the control eye, 15% reported blur and 0% exhibited decreased VA. The findings for AR, CT, CCC, LLT, striae and edema did not correlate with blur or with VA decline. Group 2: Of 11 experimental eyes: 91% exhibited the polygonal reflex compared to 0% of controls (p<0.001), 73% exhibited subjective blur and 64% exhibited VA decrease ≥2 lines (mean=2.9±0.9). The polygonal reflex correlated positively to visual blur (r=0.88, p=0.04) and to VA decrease (r=0.79, p=0.1).
WC application induces transient visual degradation. While there was no correlation between visual degradation and AR, CT, CCC, LLT, or the presence of striae or corneal edema, visual degradation correlated positively with the polygonal reflex, which was observed following WC application.
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