Effects of warm compress on tear film, blink pattern and Meibomian gland function in dry eyes after corneal refractive surgery

Abstract

Background To assess the effects of warm compress (WC) on tear film lipid layer, blink pattern and Meibomian gland function in patients with dry eye following femtosecond laser small incision lenticule extraction (SMILE) and laser-assisted subepithelial keratomileusis (LASEK). Methods We enrolled 37 eyes of 37 participants, each with dry eye for more than 2 years following SMILE (25 eyes) or LASEK (12 eyes). WC was performed using a spontaneously heating eye mask. Tear film break-up time (TBUT), tear film lipid layer thickness (TFLLT), blink pattern, Meibomian secretory function scores (MGS), visual acuity, spherical equivalent (SE), keratometry, central corneal thickness (CCT) and aberration were assessed before and after WC. Results After WC, the following mean values all increased relative to baselines: CCT, SE, minimum (Min-), maximum (Max-) and average (Ave-) TFLLT, TBUT, total MGS (TMGS), number of glands secreting any liquid (MGL), and complete blink rate (CBR) (p values ranging from < 0.001 to 0.042). Partial blink frequency (PBF) and partial blink rate (PBR) decreased (p = 0.002 in both cases). The decrease of PBF was higher in SMILE subgroup than in LASEK (p = 0.030). TBUT variation was positively correlated with that of Ave-TFLLT and TMGS (p = 0.046, 0.028, respectively). Max-TFLLT variation was correlated with that of TMGS (p = 0.020). Conclusions WC may temporarily increase tear film thickness and stability, decrease partial blink, and partly augment Meibomian gland function in dry eye patients after corneal refractive surgeries. Future studies are required to investigate long term clinical efficacy and safety.

Evaluation of lipid layer tear film changes after femtosecond small incision lenticule extraction

“…Reduction in the blink rate and an incomplete blink may result in subsequent reduction in the meibomian gland lipid secretion and changes in LLT. 23 After SMILE procedure, there was a decrease in partial blink rate and partial blink frequency, but an increase in complete blink rate was reported in a study by Zhou et al 26 The authors further reported temporary increase in tear film thickness and stability if warm compress was used to treat the meibomian gland disorder after SMILE procedure. Spherical equivalent (SE) also influences the dry eyes syndrome.…”

2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management

“…Other simple treatments for dry eye disease include warming the meibomian glands. Microwave-heated compresses work well 340,341 and are better than the traditionally advocated water-warmed flannels, 342,343 as they maintain the required temperature 344 of approximately 40°C 345 ; however, there is still scope to refine the treatment protocol and to assess whether mechanical in-office [346][347][348] or portable devices we have evaluated 349 outperform simple approaches. We have shown that the meibomian glands do need to be more than 10% of their original length to have potential of expressing meibum.…”

The preoperative management of meibomian gland dysfunction prior to corneal refractive surgery

“…There is also evidence that meibomian gland function can improve if treated even further down the line. Zhou et al [62 ▪ ] studied 37 patients who developed symptomatic MGD for 2–3 years following SMILE or LASEK procedures. When treated with warm compresses for 20 min, there were significant improvements in tear film lipid layer thickness and increases in total meibomian gland secretions.…”