Inner eyelid surface temperature as a function of warm compress methodology.

PURPOSE: To (1) determine an optimal method of warm compress (WC) application to maximize heating meibomian glands in minimal time, (2) determine the maximum inner eyelid temperature achievable during 30 min of routine WC application, (3) examine the cooling curve for 10 min after WCs have been discontinued. METHODS: Subjects were randomly assigned to one of three WC methodologies. Group A (GrA), (n = 10): 15 min WC application without reheating. GrB, (n = 10): 30 min WC application with reheating every 2 min. GrC, (n = 12): 30 min WC application optimizing contact with the lower lid and reheating every 2 min. WCs were heated to 45 +/- 0.5 degrees C. Outer and inner lower eyelid surface temperatures were measured at baseline and regular intervals. RESULTS: GrA: the maximum outer and inner lower eyelid surface temperatures = 41.2 +/- 0.3 degrees C at 1 min and 38.8 +/- 0.2 degrees C after 4 min, respectively. GrB: the maximum outer upper eyelid temperature, 43.3 +/- 0.5 degrees C, was reached after 6 min while it required 30 min to reach the maximum inner lower eyelid temperature, 40.4 +/- 0.3 degrees C. GrC: it required 4 min to reach the maximum outer lower eyelid temperature, 42.2 +/- 0.4 degrees C, while it required 20 min to reach the maximum inner lower eyelid temperature, 40.8 +/- 0.3 degrees C. CONCLUSIONS: To optimize WC efficiency, patients should (1) heat the WC to approximately 45 degrees C, (2) optimize contact between the WC and outer eyelid surfaces, (3) reheat the WC frequently and have a replacement heated WC on hand for exchange, and (4) perform the activity for at least 4 min in order to achieve an inner lower eyelid temperature > or = 40 degrees C. Longer therapy may be necessary for more severe obstructions. These data suggest that precise, customized, labor-intensive WC procedure is necessary to optimize treating meibomian gland dysfunction and obstruction using WCs.

Warm compress induced visual degradation and Fischer-Schweitzer polygonal reflex.

PURPOSE: To document adverse visual effects of warm compress therapy and determine potential etiologies in subjects with dry eye symptoms. METHODS: Subjects (n = 24) with dry eye symptoms were recruited. Group 1 (n = 13): baseline measurements for each eye included subjective blur, visual acuity (VA), autorefraction (AR), corneal topography (CT), central corneal curvature (CCC), lipid layer thickness (LLT), and evaluation for corneal striae and edema. A warm, moist compress (44.4-45 degrees C) was applied with gentle pressure for 30 min to the closed eyelids of the randomized experimental eye; nothing was applied to the contralateral control eye. Subjective blur, VA, AR, CT, CCC, and LLT were evaluated for each eye at 5, 15, and 30 min and 5 min after application. Striae and edema were assessed for each eye at 30 and 5 min after application. Group 2 (n = 11): the above warm compress protocol was repeated to investigate the Fischer-Schweitzer polygonal reflex at the times stated. RESULTS: At 5 and 30 min, 71% and 88% of all subjects experienced increased subjective blur and decreased VA. At 30 min: Group 1: Of 13 experimental eyes: 13 experienced subjective blur; nine exhibited a VA decrease > or =2 lines (mean = 3.4 +/- 0.7). For the control eye, two subjects reported blur and none exhibited decreased VA. The findings for AR, CT, CCC, LLT, striae and edema did not correlate with blur or with VA decline. Group 2: Of 11 experimental eyes: 10 exhibited the polygonal reflex compared with 0 controls (p < 0.001); eight exhibited subjective blur; seven exhibited VA decrease > or =2 lines (mean = 2.9 +/- 0.9). The polygonal reflex correlated positively to visual blur (r = 0.88, p = 0.04) and to VA decrease (r = 0.79, p = 0.1). CONCLUSIONS: Warm compress application induces transient visual degradation. Although there was no correlation between visual degradation and AR, CT, CCC, LLT, or the presence of striae or corneal edema, visual degradation correlated positively with the polygonal reflex, which was observed following warm compress application.