Aim The main treatment for meibomian gland dysfunction (MGD), a major cause of dry eye, is eyelid warming. Lack of compliance is the main reason for treatment failure. This has led to the development of eyelid-warming devices that are safe, effective and convenient. To obtain robust evidence demonstrating their efficacy, the authors conducted a 3-arm randomized clinical study.MethodsThe authors conducted a 3-month assessor-blinded, randomized, controlled trial of patients from the Singapore National Eye Centre experiencing at least one of eight dry eye symptoms ‘often’ or ‘all the time’. Patients who wore contact lenses, had an active infection or known diagnosis of thyroid dysfunction and rheumatoid arthritis were excluded from the study. MGD participants were randomly assigned to warm towel (n = 25), EyeGiene® (Eyedetec Medical Inc., Danville, CA, USA) (n = 25) and Blephasteam® (Spectrum Thea Pharmaceuticals LTD, Macclesfield, UK) (n = 25) treatments. The primary efficacy and safety outcomes included the proportions of participants with improved symptoms and changes in best corrected visual acuity (BCVA), respectively. Other outcomes included tear break up time (TBUT), Schirmer test, corneal fluorescein dye staining and number of visibly occluded meibomian gland (MG) orifices.ResultsThe study population was 53.5 ± 11.1 years old and predominantly Chinese. For severity of symptom after 3 months of treatment, 78.3% Blephasteam® participants reported improvement compared to 45.5% warm towel participants (p = 0.023). The corresponding proportions for improvement in the frequency of symptoms were 82.6% and 50.0%, respectively (p = 0.020). The proportions of improvement of symptoms in EyeGiene® patients were not significantly different from warm towel intervention. At 1 month of treatment, the crude odds ratio of improvement of severity of irritation for Blephasteam® compared to control was 3.0 (95% CI 0.88–10.18). However, the odds ratio adjusted by age was 5.67 (1.30–24.66). The lid-warming treatments did not significantly change the TBUT, Schirmer test results or number of visibly occluded MGs in the study period. All treatment modalities did not worsen BCVA after 3 months.ConclusionBlephasteam® is more effective than warm towel for MGD treatment, with warm towel and EyeGiene® being comparable effective. Older age might predict for treatment efficacy. All studied therapies were safe for visual acuity (VA) for 3 months of treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s40123-014-0025-8) contains supplementary material, which is available to authorized users.

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Citation: Yeo S, Tan JH, Acharya UR, Sudarshan VK, Tong L. Longitudinal changes in tear evaporation rates after eyelid warming therapies in meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2016;57:197457: -198157: . DOI:10.1167 PURPOSE. Lid warming is the major treatment for meibomian gland dysfunction (MGD). The purpose of the study was to determine the longitudinal changes of tear evaporation after lid warming in patients with MGD.METHODS. Ninety patients with MGD were enrolled from a dry eye clinic at Singapore National Eye Center in an interventional trial. Participants were treated with hot towel (n ¼ 22), EyeGiene (n ¼ 22), or Blephasteam (n ¼ 22) twice daily or a single 12-minute session of Lipiflow (n ¼ 24). Ocular surface infrared thermography was performed at baseline and 4 and 12 weeks after the treatment, and image features were extracted from the captured images.RESULTS. The baseline of conjunctival tear evaporation (TE) rate (n ¼ 90) was 66.1 6 21.1 W/ min. The rates were not significantly different between sexes, ages, symptom severities, tear breakup times, Schirmer test, corneal fluorescein staining, or treatment groups. Using a general linear model (repeat measures), the conjunctival TE rate was reduced with time after treatment. A higher baseline evaporation rate ( ‡66 W/min) was associated with greater reduction of evaporation rate after treatment. Seven of 10 thermography features at baseline were predictive of reduction in irritative symptoms after treatment.CONCLUSIONS. Conjunctival TE rates can be effectively reduced by lid warming treatment in some MGD patients. Individual baseline thermography image features can be predictive of the response to lid warming therapy. For patients that do not have excessive TE, additional therapy, for example, anti-inflammatory therapy, may be required. (ClinicalTrials.gov number, NCT01683318 and NCT01448369.)

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