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http://www.revoptom.com/content/c/20600/
VOLUME 3, NUMBER 9
AUGUST 6, 2012

WHAT SHOULD I KNOW ABOUT WARM COMPRESS THERAPY WHEN TREATING PATIENTS WITH MEIBOMIAN GLAND DYSFUNCTION (MGD)?
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Keep in mind that it is important to apply sustained moist heat when treating MGD. To optimize the efficiency of warm compress therapy, patients should heat the compresses to 45°C, optimize contact with the outer eyelid surface, and maintain consistent pressure for at least four minutes to achieve an inner lower eyelid temperature greater than or equal to 40°C. Additionally, patient compliance rates will be much higher if instructed to perform warm compress therapy for just four or five minutes, compared to 20 minutes or more.

Recommending commercial warm compresses, including TranquilEyes (Ocusoft) and Bruder Moist Heat Compresses (Bruder Healthcare), may yield better compliance than suggesting the use of a wet washcloth or warmed foods, such as baked potatoes and hard-boiled eggs (which could cause corneal deformation).

Further, new developments that combine the massage and sustained moist heat, such as the LipiFlow Thermal Pulsation System (TearScience), may provide optimal treatment for MGD.

Finally, when considering meibomian gland expression for diagnostic purposes, research shows that it may not be necessary to express the entire upper and lower eyelid margins to determine the degree of MGD. In fact, one report indicated that perhaps the most important area of functioning meibomian glands is located in the lower eyelid, which includes the central and nasal meibomian glands.

1. Blackie CA, Solomon JD, Greiner JV, et al. Inner eyelid surface temperature as a function of warm compress methodology. Optom Vis Sci. 2008 Aug;85(8):675-83.
2. Olson MC, Korb DR, Greiner JV. Increase in tear film lipid layer thickness following treatment with warm compresses in patients with meibomian gland dysfunction. Eye Contact Lens. 2003 Apr;29(2):96-9.
3. Lam AK, Lam CH. Cornea. Effect of warm compress therapy from hard-boiled eggs on corneal shape. 2007 Feb;26(2):163-7.
4. Korb DR, Blackie CA. Case Report: A successful LipiFlow treatment of a single case of meibomian gland dysfunction and dropout. Eye Contact Lens. 2012 Mar 12. [Epub ahead of print]
5. Friedland BR, Fleming CP, Blackie CA, et al. A novel thermodynamic treatment for meibomian gland dysfunction. Curr Eye Res. 2011 Feb;36(2):79-87.
6. Blackie CA, Korb Dr. The diurnal secretory characteristics of individual meibomian glands. Cornea. 2010 Jan;29(1):34-8.
http://www.revoptom.com/content/c/20600/

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