Effect of Heating and Massaging of Meibomian Glands on Their Imaging.

Infrared light is used to image the Meibomian glands through their thermal profile. This study aimed to investigate the effects of a combination of heating and an eyelid massage on Meibomian gland visibility and tear film parameters. Twenty-four participants (26 ± 6.9 years) were enrolled in this prospective study, which involved imaging the Meibomian glands of both the lower and upper eyelid and assessing the non-invasive breakup time (NIBUT), tear meniscus height (TMH), and blink rate (using the CA-800, Topcon) at baseline after five minutes of eyelid warming followed by a five-minute eyelid massage. The second session, which was randomised in sequence, repeated the same measurements but without the inclusion of any eyelid warming or massage as the control condition. While there was no change in lower lid Meibomian gland appearance as a result of eyelid heating, eyelid massage, or multiple lid eversion (median 2.0, range 0.0 to 4.0; = 0.782), there was a change in upper lid appearance 5 min after heating and lid massage ( = 0.025), but again, multiple lid eversion had no effect ( > 0.05). The NIBUT decreased on second lid eversion ( = 0.049), although this was not evident on the third lid eversion ( = 0.090). The effect on NIBUT was also apparent with heating ( = 0.034 immediately after) but was sustained with 5 min of eyelid massage ( = 0.031). The TMH increased with heating ( < 0.001), and this effect was sustained with 5 min of eyelid massage ( = 0.011), but there was no lid eversion effect ( > 0.05). The blink rate was unaffected by heating, eyelid massage, or multiple eversions of the eyelids (median 24 blinks/min, range 8 to 59 blinks/min; = 0.61). Conclusions: Eyelid warming can increase the visibility of the Meibomian glands, although this effect was only observed with upper lid imaging and the effect dissipated after 5 min of eyelid massage. Warming and massage also disrupt the tear film, as does multiple lid eversion, emphasising the need to use the least invasive tear film assessment techniques first.