Microwave decontamination of eyelid warming devices for the treatment of meibomian gland dysfunction

PURPOSE: The role of bacteria in meibomian gland dysfunction is unclear, yet contamination of compresses used as treatment may exacerbate this condition. This study therefore determined the effect of heating on bacteria on two forms of compress. METHODS: Cotton flannels and MGDRx EyeBags (eyebags) were inoculated by adding experimental inoculum (Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa; one species for each set of 3 eyebags and flannels). One of each were then randomised in to 3 groups: no heating (control); therapeutic (47.4±0.7°C); or sanitisation (68±1.1°C). After treatment, bacteria cell numbers were calculated. The experiment was repeated in triplicate. RESULTS: There was a statistically significant difference between each treatment with the eyebag for S. aureus (control=7.15±0.11logC/ml, therapeutic heating=5.24±0.59logC/ml, sanitisation heating=3.48±1.43logC/ml; P<0.001) and S. pyogenes (7.36±0.13, 5.73±0.26, 4.75±0.54; P<0.001). P. aeruginosa also showed a significant reduction (P<0.001) from control (6.39±0.34) to therapeutic (0.33±0.26) and sanitisation (0.33±0.21), but the latter were similar (P=1.000). For the flannels, there was significant difference between each treatment for S. aureus (6.89±0.46, 3.96±1.76, 0.42±0.90; P<0.001). For S. pyogenes, there was a significant reduction (P<0.001) from control (7.51±0.10) to therapeutic (5.91±0.62) and sanitisation (5.18±0.8), but the latter were similar (P=0.07). For P. aeruginosa, there was a significant difference (P<0.001) from control (7.15±0.36) to sanitisation (5.83±0.44); but not to therapeutic (6.84±0.31) temperatures (P=0.07). CONCLUSIONS: Therapeutic heating produces a significant reduction in bacteria on the eyebags, but only sanitisation heating appears effective for flannels. However, patients should be advised to heat the eyebag to sanitisation temperatures on initial use.

Effect of a commercially available warm compress on eyelid temperature and tear film in healthy eyes

Purpose: To evaluate eyelid temperature change and short-term effects on tear film stability and lipid layer thickness in healthy patients using a commercially available warm compress (MGDRx EyeBag) for ophthalmic use. Methods: Eyelid temperature, noninvasive tear film breakup time (NITBUT), and tear film lipid layer thickness (TFLLT) of 22 healthy subjects were measured at baseline, immediately after, and 10 minutes after application of a heated eyebag for 5 minutes to one eye selected at random. A nonheated eyebag was applied to the contralateral eye as a control. Results: Eyelid temperatures, NITBUT, and TFLLT increased significantly from baseline in test eyes immediately after removal of the heated eyebag compared with those in control eyes (maximum temperature change, 2.3 +/- 1.2[degrees]C vs. 0.3 +/- 0.5[degrees]C, F = 20.533, p < 0.001; NITBUT change, 4.0 +/- 2.3 seconds vs. 0.4 +/- 1.7 seconds, p < 0.001; TFLLT change, 2.0 +/- 0.9 grades vs. 0.1 +/- 0.4 grades, Z = -4.035, p < 0.001). After 10 minutes, measurements remained significantly higher than those in controls (maximum temperature change, 1.0 +/- 0.7[degrees]C vs. 0.1 +/- 0.3[degrees]C, F = 14.247, p < 0.001; NITBUT change, 3.6 +/- 2.1 seconds vs. 0.1 +/- 1.9 seconds, p < 0.001; TFLLT change, 1.5 +/- 0.9 vs. 0.2 +/- 0.5 grades, Z = -3.835, p < 0.001). No adverse events occurred during the study. Conclusions: The MGDRx EyeBag is a simple device for heating the eyelids, resulting in increased NITBUT and TFLLT in subjects without meibomian gland dysfunction that seem to be clinically significant. Future studies are required to determine clinical efficacy and evaluate safety after long-term therapy in meibomian gland dysfunction patients. © 2013 American Academy of Optometry

Randomised masked clinical trial of the MGDRx eyebag for the treatment of meibomian gland dysfunction-related evaporative dry eye

Background/aims To investigate the efficacy and safety of the MGDRx EyeBag (The Eyebag Company, Halifax, UK) eyelid warming device. Methods Twenty-five patients with confirmed meibomian gland dysfunction (MGD)-related evaporative dry eye were enrolled into a randomised, single masked, contralateral clinical trial. Test eyes received a heated device; control eyes a non-heated device for 5 min twice a day for 2 weeks. Efficacy (ocular symptomology, noninvasive break-up time, lipid layer thickness, osmolarity, meibomian gland dropout and function) and safety (visual acuity, corneal topography, conjunctival hyperaemia and staining) measurements were taken at baseline and follow-up. Subsequent patient device usage and ocular comfort was ascertained at 6 months. Results Differences between test and control eyes at baseline were not statistically signi ficant for all measurements ( p>0.05). After 2 weeks, statistically significant improvements occurred in all efficacy measurements in test eyes ( p<0.05). Visual acuity and corneal topography were unaffected (p>0.05). All patients maintained higher ocular comfort after 6 months ( p<0.05), although the bene fit was greater in those who continued usage 1-8 times a month (p<0.001). Conclusions The MGDRx EyeBag is a safe and effective device for the treatment of MGD-related evaporative dry eye. Subjective benefit lasts at least 6 months, aided by occasional retreatment. Trial registration number NCT01870180.

Effect of a commercially available warm compress on eyelid temperature and tear film in healthy eyes

PURPOSE: To evaluate eyelid temperature change and short-term effects on tear film stability and lipid layer thickness in healthy patients using a commercially available warm compress (MGDRx EyeBag) for ophthalmic use. METHODS: Eyelid temperature, noninvasive tear film breakup time (NITBUT), and tear film lipid layer thickness (TFLLT) of 22 healthy subjects were measured at baseline, immediately after, and 10 minutes after application of a heated eyebag for 5 minutes to one eye selected at random. A nonheated eyebag was applied to the contralateral eye as a control. RESULTS: Eyelid temperatures, NITBUT, and TFLLT increased significantly from baseline in test eyes immediately after removal of the heated eyebag compared with those in control eyes (maximum temperature change, 2.3 ± 1.2 °C vs. 0.3 ± 0.5 °C, F = 20.533, p <0.001; NITBUT change, 4.0 ± 2.3 seconds vs. 0.4 ± 1.7 seconds, p <0.001; TFLLT change, 2.0 ± 0.9 grades vs. 0.1 ± 0.4 grades, Z = -4.035, p <0.001). After 10 minutes, measurements remained significantly higher than those in controls (maximum temperature change, 1.0 ± 0.7 °C vs. 0.1 ± 0.3 °C, F = 14.247, p <0.001; NITBUT change, 3.6 ± 2.1 seconds vs. 0.1 ± 1.9 seconds, p <0.001; TFLLT change, 1.5 ± 0.9 vs. 0.2 ± 0.5 grades, Z = -3.835, p <0.001). No adverse events occurred during the study. CONCLUSIONS: The MGDRx EyeBag is a simple device for heating the eyelids, resulting in increased NITBUT and TFLLT in subjects without meibomian gland dysfunction that seem to be clinically significant. Future studies are required to determine clinical efficacy and evaluate safety after long-term therapy in meibomian gland dysfunction patients. Copyright © 2014 American Academy of Optometry.