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What a difference heat can make. Do you remember when hot compresses were the only treatment available for meibomian gland dysfunction (MGD)? Or when we didn’t even know what MGD was? At the time, we didn’t have slit lamps and or a dry eye disease (DED) epidemic. Thinking about how far we’ve come reminds me of how different life is today. It is not just technology that has changed. DED has become a much bigger problem due to air conditioning, fans, medications (many of the most-prescribed medications in the United States cause DED¹) and digital device use.

Hot compresses are still important. They are categorized under Stage 1 of TFOS DEWS II’s Staged DED treatment recommendations and, as a result, I make certain that every patient knows the value of having one on hand at home. I don’t travel without one myself. However, as we know, they have limited effectiveness, partially because of patient compliance. Studies have shown that, without intervention (i.e., doctor education), only 55% of patients are compliant with lid hygiene and hot compresses at home after six weeks.²

Patients with chronic MGD also need more heat and expression. Another study found that the optimum temperature for MGD heat therapy is 40°C to 41.5°C.³ The only way to achieve that is with devices that are created specifically for treatment purposes.

In my experience, patients appreciate when we prescribe home therapy, but it is important to educate them on staged treatment from the beginning when identifying MGD. Stage 1 with artificial tears, hot compresses, lid wipes and Omega 3 supplements will begin the day of that first exam and they will need to return so we can determine effectiveness and start our next stage of treatments as medically necessary.

Educate patients about the stages of treatment and the chronicity of DED and MGD. Most patients appreciate an in-office approach to treatment, especially those who are symptomatic and suffering. Get your heat therapy ready and remember you will probably need more than one option due to severity, portability and patient anatomy.

Reference(s):

1. Ding J. Dry eye caused by medications. TFOS. August 29, 2017. Accessed July 29, 2024. https://www.tearfilm.org/dettnews-dry_eye_caused_by_medications/5521_5519/eng/
2. Bzovey B, Ngo W. Eyelid warming devices: safety, efficacy, and place in therapy. Clin Optom (Auckl). 2022 Aug;14:133-147. doi:10.2147/OPTO.S350186
3. Borchman D. The optimum temperature for the heat therapy for meibomian gland dysfunction. Ocul Surf. 2019 Apr;17(2):360-364. doi:10.1016/j.jtos.2019.02.005

APRIL JASPER, OD, FAAO graduated from Nova Southeastern University College of Optometry with highest honors in 1995. She is the owner of Advanced Eyecare Specialists in West Palm Beach, FL. Dr. Jasper completed her residency in primary care, ocular disease and contact lenses in Boston, MA where she also held a position as adjunct professor at NEWENCO. Dr. Jasper has served her patients and colleagues as president of the Florida Optometric Association 2016 to 2017. She continues to share her knowledge and expertise around the world authoring numerous publications, lecturing and as chief editor of Optometric Management magazine.