Increase in Tear Film Lipid Layer Thickness Following Treatment with Warm Compresses in Patients with Meibomian Gland Dysfunction

PURPOSE.Warm-compress therapy applied to the skin of the closed eyelids has been recommended as a treatment for meibomian gland dysfunction (MGD). Previous studies have evaluated the effects of warm-compress therapy on tear-film fluorescein break-up time and tear evaporation rate. The purpose of this study was to determine if tear-film lipid layer thickness (TFLLT) was altered following 5, 15, and 30 minutes of warm, moist compress therapy. METHODS.Twenty patients with a diagnosis of dry eye associated with MGD and a baseline TFLLT of ≤ 90 nm (baseline difference between experimental and control eyes ≤ 25 nm) were studied. The skin of the closed eyelids of one eye of each subject was treated for a total of 30 minutes with a compress saturated with warm (40.0 ± 2.0°C) water used as a compress; and the skin of the closed eyelids of the contralateral control eye was treated for a total of 30 minutes with a compress saturated with room-temperature (24.0°C ± 1.0°C) water used as a compress. The subjects’ eyes were randomized into experimental and control eyes. TFLLT was measured at the following time points5, 15, and 30 minutes during the 30-minute treatment period, and after 5 minutes following the 30-minute treatment period. RESULTS.The mean baseline TFLLT of the experimental eye prior to treatment with a warm, moist compress was 57.8 ± 12.9 (standard error) nm; after 5 minutes of treatment, TFLLT was 105.8 ± 23.7 nm; after 15 minutes of treatment, 117.8 ± 26.4 nm; after 30 minutes of treatment, 121.5 ± 27.1 nm; and after 5 minutes following the 30-minute treatment, 96.0 ± 21.5 nm. The mean baseline TFLLT of the control eye prior to treatment with a room temperature, moist compress was 63.0 ± 14.1 nm; after 5 minutes of treatment, TFLLT was 63.8 ± 14.3 nm; after 15 minutes of treatment, 62.3 ± 13.9 nm; after 30 minutes of treatment, 64.5 ± 14.4 nm; and after 5 minutes following the 30-minute treatment period, 58.5 ± 13.1 nm. Using a paired-data t- test, the results demonstrated a significant increase in mean TFLLT in the experimental eye after 5 minutes (P < 0.001), 15 minutes (P < 0.001), and 30 minutes (P < 0.001) of treatment, and after 5 minutes following the 30-minute treatment period (P < 0.001) when compared to baseline TFLLT. In comparison, there was no significant increase in TFLLT of the control eye after 5 minutes (P = 0.79), 15 minutes (P = 0.77), and 30 minutes (P = 0.81) of treatment, and after 5 minutes following the 30-minute treatment period