Investigating the Short-term Effect of Eyelid Massage on Corneal Topography.
Optom Vis Sci. 2017 May 03;:
Authors: Riede-Pult BH, Evans K, Pult H
PURPOSE: The aim of this study was to evaluate the short-term effect of eyelid massage, after the use of warm compresses, on corneal topography.
METHODS: Corneal topography was evaluated on 20 subjects (mean age, 47.0 [SD ±17.3] years) using the Oculus Keratograph (Oculus, Wetzlar, Germany). Corneal eccentricity (Epsilon) was compared between topography measurements before eyelid warming (using warm compresses) (T1), after eyelid warming (T2), directly after eyelid massage (T3), and 30 minutes after eyelid massage (T4). Differences in corneal eccentricity between the enrolment measurement (T1) and consecutive measurements (T1-4) were analyzed. The contralateral eye-treated by warm compresses, but not by eyelid massage-was the control. Visual acuity (decimal), bulbar conjunctival hyperemia, and corneal staining (Cornea and Contact Lens Research Unit grading scale) were evaluated at T1 and T4 to assess clinical safety.
RESULTS: No significant differences were found between consecutive eccentricity measurements overall and with the central radii (repeated-measures analysis of variance, P > .238 (massaged eyelid: Epsilon T1: 0.48 [95% confidence interval, ±0.07], T2: 0.49 [±0.05], T3: 0.49 [±0.06], T4: 0.48 [±0.06]; horizontal radii T1: 7.76 [±0.13] mm, T2: 7.74 [±0.13] mm, T3: 7.75 [±0.13] mm, T4: 7.76 [±0.13] mm; vertical radii T1: 7.56 [±0.12] mm, T2: 7.55 [±0.10] mm, T3: 7.54 [±0.10] mm, T4: 7.58 [±0.11] mm). Decimal visual acuity significantly improved at the end of the study (massaged eyelid: T1: 1.1 [±0.1]; T4: 1.3 [±0.1]; P < .032). No significant differences were detected between the consecutive evaluation of corneal staining (Wilcoxon test; P > .285). Redness was not significantly different between time points (repeated-measures analysis of variance; P = .187) in the colateral eyes. Hyperemia was significantly reduced in the massaged eyes (T1: 2.0 grade units [±0.3]; T4: 1.9 [±0.3]; P = .021).
CONCLUSIONS: Eyelid warming followed by eyelid massage appears to be a safe procedure, without any clinically relevant short-term effects on the cornea.
PMID: 28471879 [PubMed - as supplied by publisher]
In-vivo heat retention comparison of eyelid warming masks.
Cont Lens Anterior Eye. 2016 Aug;39(4):311-5
Authors: Bitton E, Lacroix Z, Léger S
PURPOSE: Meibomian gland dysfunction (MGD) is one of the most common causes of evaporative dry eye. Warm compresses (WC) are recommended as adjunct therapy to slowly transfer heat to the meibomian glands to melt or soften the stagnant meibum with targeted temperatures of 40-45°C. This clinical study evaluated the heat retention profiles of commercially available eyelid warming masks over a 12-min interval.
METHODS: Five eyelid-warming masks (MGDRx Eyebag(®), EyeDoctor(®), Bruder(®), Tranquileyes XR™, Thera°Pearl(®)) were heated following manufacturer's instructions and heat retention was assessed at 1-min intervals for 12min. A facecloth warmed with hot tap water was used as comparison.
RESULTS: Twelve (n=12) subjects participated in the study (10F:2M, ranging in age from 21 to 30 with an average of 23.2±3.8years). Each mask demonstrated a unique heat retention profile, reaching maximum temperature at different times and having a different final temperature at the end of the 12-min evaluation. After heating, all eyelid warming masks reached a temperature near 37°C within the first minute. The facecloth was significantly cooler than all other masks as of the 2-min mark (p<0.05).
CONCLUSIONS: Reusability, availability and heat retention profiles should be considered when selecting an eyelid warming masks for adjunct WC therapy in the management of MGD. All masks tested, with the exception of the facecloth, demonstrated stable heat retention throughout the 12min, bringing further awareness that patient education is required to discuss the shortcomings of the heat retention of the facecloth, if only heated once.
PMID: 27162126 [PubMed - indexed for MEDLINE]
Microwave decontamination of eyelid warming devices for the treatment of meibomian gland dysfunction.
Cont Lens Anterior Eye. 2016 Aug;39(4):293-7
Authors: Bilkhu P, Wolffsohn JS, Hilton A, Matthews G, Legood S, Riley L
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.
PMID: 26733053 [PubMed - indexed for MEDLINE]
Comparison of Self-applied Heat Therapy for Meibomian Gland Dysfunction.
Optom Vis Sci. 2015 Sep;92(9):e321-6
Authors: Wang MT, Jaitley Z, Lord SM, Craig JP
PURPOSE: To compare the effects on ocular temperature, lipid layer grade, tear film stability, and tear meniscus height after a single application of two commercially available warm compresses in mild-to-moderate dry eye and to report participant treatment preference.
METHODS: Forty-one subjects with mild-to-moderate dry eye symptoms were enrolled in a randomized, paired-eye, investigator-masked trial. Heat was applied simultaneously to one eye (randomized) with a portable eye mask (EyeGiene) and to the contralateral eye with a microwave-heated flaxseed eye bag (MGDRx Eye Bag). Outer and inner eyelid temperatures, tear film lipid layer grade (LLG), and noninvasive tear film breakup time (NIBUT) were measured at baseline and immediately after 10 minutes of device application.
RESULTS: Outer and inner eyelid temperatures, LLG, and NIBUT did not differ before treatment between eyes assigned to eye mask and eye bag therapy. All measurements were significantly increased from baseline, after warming with both devices (all p < 0.05). Outer and inner eyelid temperature changes were significantly greater with the eye bag than with the eye mask (outer eyelid, +3.5 ± 1.0°C vs. +2.4 ± 0.8°C; inner eyelid, +3.5 ± 1.0°C vs. +2.5 ± 0.9°C; all p < 0.001), although there was no significant difference in LLG and NIBUT improvement between treatments (all p > 0.05). A majority of subjects (78%) preferred the application of heat with the eye bag over the eye mask.
CONCLUSIONS: Both the EyeGiene mask and the MGDRx Eye Bag are convenient eyelid warming devices that result in clinically and statistically significant increases in NIBUT and LLG in patients with mild-to-moderate dry eye symptoms. The MGDRx Eye Bag is more effective in raising ocular temperature and is the preferred treatment method among subjects.
PMID: 25955642 [PubMed - indexed for MEDLINE]
Ex vivo heat retention of different eyelid warming masks.
Cont Lens Anterior Eye. 2015 Jun;38(3):152-6
Authors: Lacroix Z, Léger S, Bitton E
PURPOSE: Meibomian gland dysfunction (MGD) appears to be the most common cause of evaporative dry eye, in which the meibum has an altered chemical structure that increases its melting point. Eyelid warming masks slowly transfer heat, preferably between 40 and 45°C to the inner meibomian glands, in an attempt to melt or soften the stagnant meibum. This ex vivo study evaluates the heat retention properties of commercially available masks over a 12-min interval.
METHODS: Five eyelid-warming masks (MGDRx EyeBag®, EyeDoctor®, Bruder®, Tranquileyes™, Thera°Pearl(®) were heated following manufacturer's instructions and heat retention was assessed at 1-min interval for 12 min on a non-conductive surface. A facecloth warmed with hot tap water was used as comparison.
RESULTS: All masks reached above 40°C within the first 2 min after heating and remained so for 5 min, with the exception of the facecloth, which lasted only 3 min and quickly degraded to 30°C within 10 min. The Bruder® and Tranquileyes™ reached >50°C, after heating and the Bruder® maintained >50°C for nearly 6 min. The MGDRx EyeBag®, and Thera°Pearl® had the most stable heat retention between 2 and 9 min, remaining between the targeted temperature.
CONCLUSIONS: Heat retention profiles are different for commercially available eyelid warming masks. This ex vivo study highlights that despite the popularity of the time-honored facecloth, it is poor at retaining the desired heat over a 5-10 min interval. Clinical studies need to corroborate these results, remembering that ocular tissue parameters may be factors to consider.
PMID: 25735560 [PubMed - indexed for MEDLINE]
Evaluation of an eyelid warming device (Blephasteam) for the management of ocular surface diseases in France: the ESPOIR study.
J Fr Ophtalmol. 2014 Dec;37(10):763-72
Authors: Doan S, Chiambaretta F, Baudouin C, ESPOIR study group
INTRODUCTION: Eyelid hygiene, including massage and warm compresses, is an important part of the treatment and prevention of Meibomian gland dysfunction (MGD). Although effective, it requires active participation of the patient and lacks standardisation. Blephasteam is a medical device designed to warm and humidify the eyelid with heating glasses, in order to liquify meibum, thus relieving symptoms and preventing relapse.
MATERIALS AND METHODS: The ESPOIR study (Evaluation of the Satisfaction of Patients with Management of Ocular Surface Diseases) presented herein was designed to evaluate the safety and efficacy of this medical device in patients with MGD. A total of 28 French centers participated in the study. One hundred and two patients presenting with symptomatic dysfunction or Meibomian-related dry eye underwent two sessions per day with the eyelid warming device and recorded diary entries on a number of parameters every 2 days for the first week and then weekly for the remaining 2 weeks. Patients were assessed on days 0 and 21.
RESULTS: Symptomatology, as recorded on a visual analogue scale (VAS) by the investigator (the primary efficacy variable) was significantly (P<0.001) improved at the end of the study (59.97, 95% CI 55.64-64.30 vs. 39.71, 95% CI 34.78-44.65 on Days 0 and 21 respectively), as was the mean symptoms score (mean decrease of 19.93 ± 22.15 VAS units; P<0.001), hyperemia score (-1.57 ± 1.96 and -1.45 ± 1.85; P<0.001, in the worse and contralateral eye respectively), and quality of meibum (mean -4.03 ± 3.08; P<0.001 and -3.32 ± 3.20; P<0.01, in the worse and contralateral eye respectively). More than twice as many reported their symptoms had improved or disappeared compared with those whose symptoms had not changed or had worsened. Global symptomatology, as assessed by the patients, declined throughout the study, and a large majority of patients were satisfied or very satisfied with the treatment. Clear vision and blinking were not impaired during use of the eyelid warming device, which insures proper spreading of the tear film, and patients were able to continue daily activities such as reading and watching television. No adverse events were reported, and there were no changes in intraocular pressure or visual acuity. Safety was rated as satisfactory or very satisfactory by more than 95% of the investigators.
CONCLUSION: The study suggests that the eyelid warming device is safe and effective in reducing ocular discomfort and symptoms in MGD.
PMID: 25282620 [PubMed - indexed for MEDLINE]
Evaluation of a novel eyelid-warming device in meibomian gland dysfunction unresponsive to traditional warm compress treatment: an in vivo confocal study.
Int Ophthalmol. 2015 Jun;35(3):319-23
Authors: Villani E, Garoli E, Canton V, Pichi F, Nucci P, Ratiglia R
The purpose of the study was to evaluate the efficacy and safety of wet chamber warming goggles (Blephasteam(®)) in patients with meibomian gland dysfunction (MGD) unresponsive to warm compress treatment. We consecutively enrolled 50 adult patients with low-delivery, non-cicatricial, MGD, and we instructed them to apply warm compresses twice a day for 10 min for 3 weeks and to use Blephasteam(®) (Laboratoires Thea, Clermont-Ferrand, France) twice a day for 10 min for the following 3 weeks. We considered "not-responders" to warm compress treatment the patients who showed no clinically significant Ocular Surface Disease Index (OSDI) improvement after the first 3 weeks. Clinical and in vivo confocal outcome measures were assessed in the worst eye (lower BUT) at baseline, after 3 weeks, and after 6 weeks. Eighteen/50 patients were not-responders to warm compress treatment. These patients, after 3 weeks of treatment with Blephasteam(®), showed significant improvement of OSDI score (36.4 ± 15.8 vs 20.2 ± 12.4; P < 0.05, paired samples t test), increased BUT (3.4 ± 1.6 vs 7.6 ± 2.7; P < 0.05), and decreased acinar diameter and area (98.4 ± 18.6 vs 64.5 ± 14.4 and 8,037 ± 1,411 vs 5,532 ± 1,172, respectively; P < 0.05). Neither warm compresses nor Blephasteam(®) determined adverse responses. In conclusion, eyelid warming is the mainstay of the clinical treatment of MGD and its poor results may be often due to lack of compliance and standardization. Blephasteam(®) wet chamber warming goggles are a promising alternative to classical warm compress treatment, potentially able to improve the effectiveness of the "warming approach."
PMID: 24752646 [PubMed - indexed for MEDLINE]
Warm compresses and the risks of elevated corneal temperature with massage.
Cornea. 2013 Jul;32(7):e146-9
Authors: Blackie CA, McMonnies CW, Korb DR
PURPOSES: To quantify the changes in corneal temperature resulting from intensive warm compress (WC) application with minimal pressure and to review the significance of these changes within the context of the peer-reviewed literature.
METHODS: WC were applied intensively and unilaterally at 45 ± 0.5°C for 30 minutes with the contralateral eye serving as a control. Outer upper eyelid and central corneal surface temperatures were measured using an Infrared pyrometer at baseline. The WC were removed for repeat measurements of the outer upper eyelid surface and central corneal temperatures every 2 minutes and replaced with a new WC heated to 45 ± 0.5°C. Lid and corneal temperatures were monitored for 10 minutes after the final WC application.
RESULTS: The mean age of the subjects was 37.1 ± 15.0 years (n = 12). The mean maximum outer upper lid temperature of 42.2 ± 1.3°C was reached after 6 minutes. The mean maximum corneal temperature of 39.4 ± 0.7°C was reached after 8 minutes of heating. The control eye showed no significant change in temperature from baseline throughout the experimental period.
CONCLUSIONS: These data show that WC use for lid warming, even when only minimal contact pressure is applied, also transfers significant heat to the cornea. Corneal temperatures reach peak temperature after about 8 minutes of WC application. Recent reports discussing the increased potential for transient and long-term corneal molding subsequent to the heat and pressure of WC application are briefly reviewed.
PMID: 23665651 [PubMed - indexed for MEDLINE]
A comparison of an eyelid-warming device to traditional compress therapy.
Optom Vis Sci. 2012 Jul;89(7):E1035-41
Authors: Pult H, Riede-Pult BH, Purslow C
PURPOSE: To assess the warming and humidifying effect and ocular safety of the Blephasteam® eyelid-warming device vs. warm and moist compresses in healthy volunteers.
METHODS: Twenty subjects (8 females, 12 males; mean age 39.2 years) were included in the study. Temperature and relative humidity were measured over a period of 10 min at the lower eyelid margin of one randomly selected eye during application of the Blephasteam device and, 1 h later, during application of warm compresses (in a randomized order). Ocular signs and visual acuity were assessed before and after each application.
RESULTS: The mean duration of warming (temperature ≥38°C) was significantly longer with Blephasteam than with compresses (7.5 vs. 1.0 min; p < 0.01). There was no significant difference between treatments in the duration of 100% relative humidity. Compared with pretreatment values, visual acuity significantly improved after Blephasteam treatment (p < 0.05) but significantly decreased after treatment with compresses (p < 0.05). Limbal redness, eyelid redness, and corneal staining scores all improved significantly after Blephasteam treatment (p < 0.05 for all). Ocular signs did not change after compress treatment except conjunctival redness, which was significantly increased (p = 0.01 vs. pretreatment).
CONCLUSIONS: The Blephasteam eyelid-warming device appeared to provide more effective warming than warm and moist compresses in a group of healthy volunteers. Visual acuity, limbal redness, and eyelid redness were improved after Blephasteam use but not after treatment with compresses.
PMID: 22729167 [PubMed - indexed for MEDLINE]
Application of a heat- and steam-generating sheet increases peripheral blood flow and induces parasympathetic predominance.
Evid Based Complement Alternat Med. 2011;2011:965095
Authors: Nagashima Y, Igaki M, Suzuki A, Tsuchiya S, Yamazaki Y, Hishinuma M, Oh-Ishi S, Majima M
To promote the practical application of a Japanese traditional medical treatment, such as hot compresses, we developed a plaster-type warming device consisting of a heat- and steam-generating sheet (HSG sheet). First, we tested its effects when applied to the anterior abdominal wall or lumbar region of women complaining of a tendency towards constipation. Application of the sheet to either region produced a feeling of comfort in the abdomen, as assessed by a survey of the subjects. The significant increases in the total hemoglobin observed in these regions suggested an increase in peripheral blood flow, and significant increases in the HF component on ECG and in the amplitude of gastric motility suggested parasympathetic predominance. We concluded that application of the HSG sheet improves the peripheral hemodynamics and autonomic regulation, induces a feeling of comfort in the abdomen, and provides a beneficial environment for the improvement of gastrointestinal movements.
PMID: 21584198 [PubMed]
[NITINOL shape memory staple for osteosynthesis of the scaphoid].
Oper Orthop Traumatol. 2009 Nov;21(4-5):361-72
Authors: Winkel R, Schlageter M
OBJECTIVE: Reconstruction of the scaphoid with use of NITINOL shape "memory" staples.
INDICATIONS: Unstable fractures and nonunion of the middle third of the scaphoid, which need open reduction and internal fixation from palmar. The staples can only be used, if the arms of the staples can be inserted parallel to and at a distance of 3 mm to the fracture line.
CONTRAINDICATIONS: Allergy to nickel. Cases in which the arms of the staple cannot be inserted parallel to and at best 3 mm apart from the fracture line.
SURGICAL TECHNIQUE: In fractures, open reduction of the scaphoid through a palmar approach. If necessary, interposition of a bone graft and Kirschner wire transfixation. Drilling of the drill holes parallel and at a distance of 3 mm to the fracture line. Insertion of the NITINOL staple. In nonunion, excision of the fibrous nonunion, refreshening of the fracture surfaces, interposition of a bone graft and, if needed, fixation with a Kirschner wire. Drilling of the drill holes for the NITINOL staple and insertion of the staple. Within a few minutes the warming-up staple contracts and thereby compresses the scaphoid.
POSTOPERATIVE MANAGEMENT: Immobilization in a short cast with thumb support for 6 weeks. Control for bone healing by radiographs or computed tomography. Staples, which do not cause hardware problems, are not removed. Kirschner wires are removed after bone healing.
RESULTS: From October 1995 to December 2006, the authors used NITINOL staples for 65 osteosyntheses of the scaphoid. Indications were 15 unstable fractures, 47 nonunions, and three partial necroses. 61 out of 65 scaphoids healed without further surgery, three of the 61 patients showed a delayed healing. Two of the four nonunions were related to the use of the NITINOL staples. Seven staples were removed, one for loosening. NITINOL shape memory staples have proven to be very helpful for osteosynthesis in fractures and nonunion of the scaphoid, if the prerequisites are given for their use.
PMID: 20058116 [PubMed - indexed for MEDLINE]
Effects of far-infrared radiation on lactation.
Ann Physiol Anthropol. 1990 Apr;9(2):83-91
Authors: Ogita S, Imanaka M, Matsuo S, Takebayashi T, Nakai Y, Fukumasu H, Matsumoto M, Iwanaga K
Massage and warm compresses to the breast have been commonly used for stimulating and/or increasing blood flow to the breasts, and for enhancing lactation consequently. However, more effective and easier remedies seem to be necessary. The vasodilating and warming effects of ceramics far-infrared radiation were studied. Based on the results obtained, the effect of a ceramic disc on lactation, attached to the breast skin, was evaluated in 27 puerperal women who had had poor lactation previously and in 36 with currently poor lactation monthly until weaning. Approximately 3/4 of these puerperal women enhanced lactation significantly one month after attachment and 1/2 of the women were able to breast-feed until weaning. Thus, we found that ceramics far-infrared radiation may be an effective remedy for enhancing lactation.
PMID: 2400465 [PubMed - indexed for MEDLINE]