Contact Lens Practice Pearls
Eyelid Warming Methods for MGD Therapy
BY GREGORY J. NIXON, OD, FAAO
Since the release of the Tear Film and Ocular Surface Society’s (TFOS) report of the International Workshop on Meibomian Gland Dysfunction (MGD) in 2011, it is now thought that MGD is not only the leading cause of evaporative dry eye, but likely the leading cause of dry eye disease itself (Nichols et al, 2011). Therefore, comprehensive management of MGD is necessary to maintain good ocular health and comfort, particularly for contact lens wearers. To maximize the effectiveness of your MGD treatment, provide your patients with a plan that will foster compliance.
Lid Warming Methods
The TFOS MGD report concluded that the main cause of MGD is obstruction of the terminal ducts with thickened, opaque meibum (Nichols et al, 2011). Lid warming is considered the mainstay of MGD therapy to elevate temperatures to the melting point of meibum (above 35°C in MGD patients) to aid gland secretion (Geerling et al, 2011).
Traditionally, this has been accomplished by soaking a washcloth in warm water to use as a compress. Despite this still being a commonly recommended therapy, evidence suggests that this type of compress doesn’t hold the appropriate temperature for a sufficient duration. Lacroix et al (2015) compared the heat retention of a warm soaked washcloth to that of five commercially available eyelid heat masks. Each product was warmed according to the manufacturer’s recommendations, and heat retention was measured every minute for 12 minutes. The desired temperature range, to be above the melting point of the meibum but to avoid burning the skin, was between 40º C to 45º C. While each of the products reached 40°C, the washcloth exhibited the worst heat retention, dropping out of the target temperature range after just three minutes. All five commercial eyelid warming products retained temperatures above 40°C for six minutes, with three of those products maintaining that temperature for the full 12-minute test period.
Effectiveness Breeds Compliance
As an MGD sufferer myself, these results support my experience with using a washcloth as a warm compress compared to an eyelid heat mask. The lack of heat retention with the washcloth regimen not only hinders the efficacy of the treatment itself, but it significantly impaired my compliance to perform the procedure at all, further preventing my condition from being managed appropriately. The convenience of a ready-made product that takes 20 seconds to heat and retains its temperature for an extended period of time can bring easy and lasting relief, improving both efficacy and compliance to MGD therapy when followed by digital expression.
Complaints of dryness and ocular discomfort are common among contact lens wearers. Maintaining a clear, hydrated ocular surface is a key element to maintaining comfortable lens wear for patients suffering from MGD. It is well accepted that practitioner recommendations carry significant weight regarding the products that patients choose to purchase. Based on the evidence cited here, I encourage you to start recommending an eyelid warming mask in place of the time-honored warm washcloth to improve the efficacy and compliance of your MGD therapy. Since adopting this strategy in our office, we have noted significantly happier and healthier contact lens patients. CLS
For references, please visit www.clspectrum.com/references and click on document #236.
Dr. Nixon is the assistant dean for Clinical Services and professor of clinical optometry at The Ohio State University College of Optometry. He is also in a group private practice in Westerville, Ohio. You can reach him at firstname.lastname@example.org.