Evaluation of a novel eyelid-warming device in meibomian gland dysfunction unresponsive to traditional warm compress treatment: an in vivo confocal study.

Edoardo Villani,Francesco Pichi,Elena Garoli,Veronica Canton,Roberto Ratiglia,Paolo Nucci

doi:10.1007/s10792-014-9947-3

Abstract

The purpose of the study was to evaluate the efficacy and safety of wet chamber warming goggles (Blephasteam®) in patients with meibomian gland dysfunction (MGD) unresponsive to warm compress treatment. We consecutively enrolled 50 adult patients with low-delivery, non-cicatricial, MGD, and we instructed them to apply warm compresses twice a day for 10 min for 3 weeks and to use Blephasteam® (Laboratoires Thea, Clermont-Ferrand, France) twice a day for 10 min for the following 3 weeks. We considered “not-responders” to warm compress treatment the patients who showed no clinically significant Ocular Surface Disease Index (OSDI) improvement after the first 3 weeks. Clinical and in vivo confocal outcome measures were assessed in the worst eye (lower BUT) at baseline, after 3 weeks, and after 6 weeks. Eighteen/50 patients were not-responders to warm compress treatment. These patients, after 3 weeks of treatment with Blephasteam®, showed significant improvement of OSDI score (36.4 ± 15.8 vs 20.2 ± 12.4; P < 0.05, paired samples t test), increased BUT (3.4 ± 1.6 vs 7.6 ± 2.7; P < 0.05), and decreased acinar diameter and area (98.4 ± 18.6 vs 64.5 ± 14.4 and 8,037 ± 1,411 vs 5,532 ± 1,172, respectively; P < 0.05). Neither warm compresses nor Blephasteam® determined adverse responses. In conclusion, eyelid warming is the mainstay of the clinical treatment of MGD and its poor results may be often due to lack of compliance and standardization. Blephasteam® wet chamber warming goggles are a promising alternative to classical warm compress treatment, potentially able to improve the effectiveness of the “warming approach.”

Highlights

Meibomian gland dysfunction (MGD) is a common chronic condition, affecting the tear film and the ocular surface and causing symptoms of eye irritation [1, 2].Meibomian gland obstruction, due to either terminal duct obstruction or altered secretion, is the most common form of meibomian gland dysfunction (MGD) [2]
In vivo laser scanning confocal microscopy (LSCM) is an emerging technology to study the ocular surface in several conditions, including dry eye and MGD [9,10,11]
LSCM offers new opportunities to perform in vivo, non-invasive examinations of meibomian glands

Summary

Introduction

Meibomian gland dysfunction (MGD) is a common chronic condition, affecting the tear film and the ocular surface and causing symptoms of eye irritation [1, 2].Meibomian gland obstruction, due to either terminal duct obstruction or altered secretion, is the most common form of MGD [2]. Meibomian gland dysfunction (MGD) is a common chronic condition, affecting the tear film and the ocular surface and causing symptoms of eye irritation [1, 2]. Usually achieved with simple warm compresses, is regarded as the mainstay of the clinical treatment of this condition, but its efficacy is affected by lack of standardization, in terms of duration and maintenance of temperature, and by a scarce compliance [3]. In vivo laser scanning confocal microscopy (LSCM) is an emerging technology to study the ocular surface in several conditions, including dry eye and MGD [9,10,11]. LSCM is showing promising clinical applications [9] and recent studies reported its helpfulness in detecting ocular surface response to treatment [12,13,14]

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