Referenced Treatment Algorithm
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.
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.
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Nevertheless, a warm compress to the eyelids is recommended as the 1st step for all 4 Stages of Meibomian Gland Dysfunction (MGD), Dry Eye, Blepharitis, Stye, or Chalazia as a summary of the research below. Our treatment pathway is based on the 3rd party material below and feedback from you...the medical community. Feel free to send us your peer reviewed papers involving the Scorpion 1-Touch system or the Heated Eye Pad.
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Eyelid-warming therapies have been recommended as a treatment for MGD to clear the obstructed glands. The heat transferred melts the pathologically altered lipids that have become inspissated and stagnant and relieve the dry eye symptoms associated with MGD. Warming can be achieved by a variety of means, such as warm moist compresses, warm moist air, warm compression devices.
Third Party Papers
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Warm compresses (WCs) are routinely recommended and, provided compliance is good, they are generally considered to be good supplemental therapy for MGD.5Y10 The heat from the compress is understood to soften the secretions in obstructed glands, temporarily increasing the lipid layer thickness and stabilizing the tear film, thus preventing excessive evaporation of the aqueous layer and evaporative dry eye.
Alternatives to WC for heating the glands in the treatment of MGD and which do not prescribe additional manual pressure over the eyelids during treatment are currently available. In general, the prescription of WC should include assessment of the risk for adverse consequences. Corneal deformation and associated visual degradation may result if patients are not screened for such consequences.
Increased LLG across all three (external eye-lid) treatment groups suggests that all methods increase meibum outflow to the tear film, resulting in a thicker lipid layer after treatment. These results suggest that all three treatments are effective in improving tear film quality, independent of MGD severity based either on symptoms or based on gland dropout
No symptoms of ocular discomfort, itching, or photophobia
Clinical signs of MGD based on gland expression
No ocular surface staining
Inform patient about MGD, the potential impact of diet, and
Consider eyelid hygiene including warming/expression as
Minimal to mild symptoms of ocular discomfort, itching, or photophobia
Minimal to mild MGD clinical signs
None to limited ocular surface staining: DEWS grade 0–7;
Advise patient on improving ambient humidity; optimizing
Institute eyelid hygiene with eyelid warming (a minimum of
All the above, plus (±)
Moderate symptoms of ocular discomfort, itching, or photophobia with limitations of activities
Moderate MGD clinical signs
|All the above, plus|
Oral tetracycline derivatives (+)
Lubricant ointment at bedtime (±)
Anti-inflammatory therapy for dry eye as indicated (±)
Marked symptoms of ocular discomfort, itching or photophobia
|All the above, plus|
Anti-inflammatory therapy for dry eye (+)
|“Plus” disease Specific conditions occurring at any stage and requiring treatment. May be causal of, or secondary to, MGD or may occur incidentally|
|1. Exacerbated inflammatory ocular surface disease|
2. Mucosal keratinization
3. Phlyctenular keratitis
4. Trichiasis (e.g. in cicatricial conjunctivitis, ocular
6. Anterior blepharitis
7. Demodex-related anterior blepharitis, with cylindrical dandruff
|1. Pulsed soft steroid as indicated|
2. Bandage contact lens/scleral contact lens
3. Steroid therapy
4. Epilation, cryotherapy
5. Intralesional steroid or excision
6. Topical antibiotic or antibiotic/steroid
7. Tea tree oil scrubs
|At each treatment level, lack of response to therapy moves treatment to the next level. A ± sign means that the evidence to support the use of the treatment at that level is limited or emerging; thus its use should be based on clinical judgment. A + sign indicates that the treatment is supported by the evidence at that stage of disease.|
|Meibum quality is assessed in each of eight glands of the central third of the lower lid on a scale of 0 to 3 for each gland: 0, clear; 1, cloudy; 2, cloudy with debris (granular); and 3, thick, like toothpaste (total score range, 0–24). Expressibility is assessed on a scale of 0 to 3 in five glands in the lower or upper lid, according to the number of glands expressible: 0, all glands; 1, three to four glands; 2, one to two glands; and 3, no glands. Staining scores are obtained by summing the scores of the exposed cornea and conjunctiva. Oxford staining score range, 1–15; DEWS staining score range, 0–33.|