Effects of controlled heat delivery to the eyelid margin & eyelid hygiene on symptomatology and the tear film in MGD

Abstract

Purpose: The International Workshop on Meibomian Gland Dysfunction has identified heat delivery to the eyelid margin and eyelid massage as the first step in managing MGD of any severity. A difficulty in the past has been to deliver controlled heat to the eyelid margin area. The objective of the investigation was therefore to test the recommendation put forward by assessing the efficacy of the combined use of controlled heat and eyelid massage.

Methods: Two sequential devices were used: EyeGiene® (to produce controlled heat to the eyelid margins) and Supranettes™ eye cleaning wipes (to deliver eyelid massage): twice a day for three weeks and once a day for the reminder of the three month management. The population was eleven dry eye sufferers with MGD defined by a positive OSDI score (Total score≥ 13) and at least Grade 2 eyelid margin anomalies. The primary endpoints were subjective response with the OSDI, tear film stability measured with the Tearscope and tear film lipid composition measured by HPLC.

Results: The results showed that: i. The average OSDI score decreased from “severe” pre-treatment (Total=39.5) to “moderate” at the three week (Total=24.8; p=0.031) and three month (Total=26.6; p=0.038) follow-up. At three months the incidence of severe cases was halved (73% vs. 36%) and the incidence of “asymptomatic” cases nearly one in five (0% vs. 18%). ii. Tear film stability increased significantly between pre-treatment (Med 7.7sec) and the three week (Med 12.7sec; p=0.045) and three month (Med 11.3; p=0.004) follow-up. iii. Total tear film lipid concentration increased significantly from pre-treatment (3.3µg/µl) to the three week (5.8 µg/µl; p=0.079) and three month (7.4 µg/µl; p=0.032) follow-up. iv. Tear film lipid composition was altered during the study period. After three months concentrations of fatty acids (12.6% vs. 7.2%; p=0.033) and cholesterol (1.4% vs. 0.9%; p=0.038) decreased and concentrations of wax ester/cholesterol ester (85.4% vs. 90.6%; p=0.039) and triglycerides (0.5% vs. 1.3%; p=0.013) increased.

Conclusions: The study demonstrated the efficacy of the combined use of controlled heat and mechanical massage in reducing symptoms in MGD. Further, the results suggest that this controlled management affect the meibomian glands as the tear film lipid concentration increased, and its composition was modified leading to improved tear film stability.

Keywords: 486 cornea: tears/tear film/dry eye • 526 eyelid • 583 lipids