Longitudinal Changes in Tear Evaporation Rates After Eyelid Warming Therapies in Meibomian Gland Dysfunction

Abstract

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.)

TFOS DEWS II Tear Film Report

“…Some studies have shown that older age groups (>45 years) have 1.5 times higher evaporation rates than younger adults and women have evaporation rates approximately 1.4 times higher than men [244–246], but other studies have failed to show any impact of age or sex [240,247]. Subjects who blink more than normal (likely being a consequence of evaporation) or have a larger exposed ocular surface have increased tear evaporation rates [246,248].…”

Evaluation of Monocular Treatment for Meibomian Gland Dysfunction with an Automated Thermodynamic System in Elderly Chinese Patients: A Contralateral Eye Study

“…The most effective and well-known treatment is warm compress combined with lid massage, which heats the glands and alleviates gland obstruction [2, 3]. However, for this treatment to be effective, an intensive treatment regimen is required to be performed by the patient, making patient compliance low [4, 5].…”

Assessment of Transepidermal Water Loss From the Ocular Area in Dry Eye Disease

“…2 Therefore, the practitioner has to use several tools to evaluate tear production, tear film stability, ocular surface damage, and other subjective symptoms. Tear evaporation measurements using devices with a closed chamber system, [3][4][5] ventilating chamber system, 6 or infrared thermography 7 have been reported previously. However, direct measurement of TE is not currently feasible in clinical practice.…”