Investigating the Short-Term Effect of Lid Massage on Corneal Topograph

Abstract

Purpose : In the management of meibomian gland dysfunction, one of the key treatments appears to be the warming of the eye lids followed by lid massage to express the glands. This study aims to evaluate the short term effect of lid massage after the use of warm compresses on the corneal topography.

Methods : In 20 subjects (mean age 47 ±17.3 S.D.) corneal topography was evaluated using the Oculus Keratograph (Oculus, Wetzlar, Germany). The eccentricity (Epsilon) of the cornea was compared between topography measurements of the cornea before warm compresses (T_1.1 and T_1.2), after warm compresses (T₂) and directly after lid massage (T₃) and 30 minutes after gentle lid massage (T₄). Epsilon of the cornea was noted and differences between enrolment measurement ((T_1.1)) and consecutive measurements (T_1-4) were analysed. The contralateral eye - being treated by warm compresses but not by lid massage- was the control, having been observed at same time points. As safety parameters visual acuity, bulbar conjunctival redness and corneal staining was evaluated at T_1.1 and T₄. Visual acuity was additionally evaluated at T₃.

Results : Repeatability of the Keratograph: Repeatability of the Keratograph was analysed for all four quadrants` Epsilon (nasal, temporal, inferior and superior), Epsilon overall and the horizontal and vertical, central radius of both eyes. Measurements were not significantly different (paired t-test: p>0.143). Smallest 95% limit of agreement was found for Epsilon overall (-0.135 to 0.121) and the horizontal (-0.060 to 0.053) and vertical radius (-0.085 to 0.081).

Impact of Lid warming and Massage on the Corneal Topography: No significant differences between consecutive measurements of Epsilon overall or corneal radii were analysed (ANOVA repeated measurements, p>0.238) in both groups.
Safety Parameters: Visual acuity significantly improved at the end of the study (ANOVA repeated measurement; p<0.032). No significant differences were analysed between the consecutive evaluation of corneal staining (Wilcoxon test; p>0.285). Redness was not significant different between time points (ANOVA repeated measurement; p=0.187) in the control group but redness was significantly reduced at the massaged eye lid group (p=0.021).

Conclusions : Eye lid warming followed by lid massage appears to be a safe procedure without any clinically relevant short-term effects on the cornea.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.