The Dry Eye Zone

Rebecca's Blog

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Study: Heat & squeeze, and Eyepeace or fingers

A study of home-based compresses & lid massage

So 20 people use a same warm compress (same brand) for 10 minutes. Then they massage one eyelid manually and massage the other eyelid with “EyePeace”, a rubbery eyelid squeezy-thingy. Then they repeat daily for two weeks. Clinical signs are measured before and after.

Results: Painfully and unsurprisingly unimpressive across the board.

  • 5 out of 7 clinical tests (visual acuity, tear meniscus height, conjunctival hyperaemia, ocular surface staining, and meibomian gland dropout) showed no improvement, regardless of method.

  • 1 out of 7 (tear film stability) showed only short-lived improvement and didn’t vary based on ‘massage’ method.

  • 1 out of 7 (tear film lipid layer thickness)… well, gosh. So you take something clinically insignificant albetit statistically significant (i.e. improvement with manual massage) and then “marginally” improve on it (Eyepeace), and that’s the most exciting news you have to report. Now is that, or is it not, the polite research way to say “(cough, choke)… No comment!”

My takehome from this study

Just reinforced what I’ve always believed: That applying warm compresses, much less lid massage, to random (heterogeneous) eyes with dry eye symptoms is a waste of time.

To my mind, there are only two rational reasons to do either heat or go the whole hog with heat & squeeze:

  1. Because it really and truly makes you feel better, and/or

  2. Because an eye doctor who actually knows what they’re doing told you to, explaining exactly why and how it will help YOU with your specifically diagnosed eyelid condition, and explaining what method they want you to use and why.

If neither apply, then I would class you with the 20 random people with dry eye symptoms in this study who, it seems, had little to gain. Don’t put yourselves through the nuisance of it without a sound reason.

By the way, there is SO much to like about the study concept

  1. It’s about home remedies, as opposed to expensive in-office procedures.

  2. It engages with nuances of technique for eyelid care, which tends to totally get ignored.

  3. “Investigator-masked, randomised, contralateral-eye trial”… when does anybody apply that kind of design rigor to a study of a cheap, non-pharmaceutical, home remedy? More please, and longer please!

  4. Patient selection was on the basis of “dry eye symptoms”… in other words, as far as I can tell, a bunch of random people whose eye disease state we don’t know, which is a perfectly realistic simulation for a study of this kind. Why? Because so many people with dry eye are told to do warm compresses whether or not they’ve been diagnosed with a form of MGD that is likely to benefit.

On the other hand… No symptom data, i.e. we don’t know how any of these people felt. I understand it may not be useful to try to measure symptoms in each eye individually when they’re receiving slightly different treatments. But… why not measure symptoms as a whole, just to see whether anybody felt better, in general, after two weeks of heat & squeeze?

And then about Eyepeace?

Hm. Beats the heck out of me. Looks a lot less comfortable than my own fingers.

On the other hand… the numbers of people I’ve heard over the years complaint that doctors told the to massage their lids and gave them zero instruction on how to do it… I don’t know. The pragmatist in me says, give people a tool to make it easier.

But, with or without a tool, patients need proper instructions and demonstration in-office. If a doctor doesn’t care how it’s done, what does that tell you about how much they know about the clinical evidence that it works?

Randomised trial of the clinical utility of an eyelid massage device for the management of meibomian gland dysfunction. Wang et al, Cont Lens Anterior Eye. 2019 Jul 26.

Wang MTM1, Feng J2, Wong J2, Turnbull PR2, Craig JP3.

PURPOSE:

To compare the single application and two week treatment effects of device-applied (Eyepeace) and manually-applied eyelid massage techniques, as an adjunct to warm compress therapy, on ocular surface and tear film parameters.

METHODS:

Twenty participants (11 females, 9 males; mean age, 27 ± 11 years) with dry eye symptoms were recruited in a two week, investigator-masked, randomised, contralateral-eye trial. Following 10 min of warm compress therapy application (MGDRx EyeBag®) on both eyes, eyelid massage therapy was applied to one eye (randomised) by device, and to the fellow eye by manual eyelid massage, once daily for 14 days. Ocular surface and tear film measurements were conducted at baseline, and 15 min post-application by a clinician, then again after 14 days of self-administered daily treatment at home.

RESULTS:

Baseline clinical measurements did not differ between the treatment groups (all p > 0.05). Following two weeks of treatment, tear film lipid layer grade improved significantly with device massage (p = 0.008), and was marginally greater than manual massage by less than 1 grade (p = 0.03). Although immediate post-treatment improvements in tear film stability were observed in both groups (both p < 0.05), no significant long-term cumulative effects or inter-treatment differences in stability measures were detected (all p > 0.05). Visual acuity, tear meniscus height, conjunctival hyperaemia, ocular surface staining, and meibomian gland dropout did not change during the treatment period (all p > 0.05).

CONCLUSIONS:

Two weeks of treatment with the eyelid massage device, as an adjunct to warm compress therapy, effected marginally greater improvements in tear film lipid layer thickness than the conventional manual technique, which were statistically but not clinically significant. Future parallel group trials with longer treatment periods and a greater range of disease severity are required.