Eyelid Warming Protocol Improves Meibomian Gland Functioning

Physician Examining Patient's Eyes
SPEED questionnaire scores were significantly reduced after patients were treated using the system.

A study of 92 participants at Cleveland Eye Clinic demonstrates that a single treatment with an eyelid warming device and gland expression tool reduced both signs and symptoms of dry eye for 12 weeks or longer, according to data published in Optometry and Vision Science.

The research reviewed the controlled heating of meibomian glands with the SmartLid® and Clearance AssistantTM devices (TearCare). This report shows Standardized Patient Evaluation of Eye Dryness (SPEED) scores for all 92 patients were significantly better following the treatment (median score of 9.0), than before, (median score 16.0, P <.001). Total meibomian gland expression scores were improved in 176 eyes from a baseline median of 5.0 in the right eye and 4.0 in the left eye to 9.0 for both by 8 to 12 weeks after treatment. The therapeutic procedure involves a 15-minute warming of the outer eyelid to 113° F with the single-use, eyelid-contoured device fitted to the tarsal plates of the eyelid, and meibum outflow with blinking and mechanical expression performed by a clinician using the Clearance Assistant tool.

In individual temporal, medial, and nasal quadrants of the right and left eyes, median meibomian gland expression scores were significantly different from baseline (1.0 or 2.0) to post-treatment (3.0) for all (P <.001), after statistical adjustment for multiple comparisons and type I error rate. Only small interquartile differences occurred.

Change in SPEED questionnaire scores did not correlate to sex or age (both P >.50). “Before treatment, the patients typically rated their soreness, burning, and fatigue as being uncomfortable and their dryness symptoms as bothersome,” the analysis explains. In contrast, median post-treatment appraisal of these same symptoms were reported as “tolerable.”

There has not yet been much research on the method, but 3 previous studies have demonstrated better meibomian gland secretion scores, and 2 papers showed benefits including improved tear-film breakup time and Ocular Surface Disease Index (OSDI) results, according to the research.

Even though this population sample comprised a wide age range, from 27.4 to 94.3 years of age, it had proportionately more women, and participants older, which is in line with typical risk factors to develop dry eye. However, further exploration with more participants and an even spread of sex and age levels may reveal more specific differences. The retrospective nature of this single-center investigation potentially limits statistical power to lower than the standard 80%, so this study offers initial data.

The current data may indicate clinical relevance for the device, and confirm safety of this technology, the study adds. “After treatment, the median meibomian gland expression score of all eyes progressed to a score of 3, suggesting an increase in the number of functional meibomian glands,” according to the investigation.

Disclosures: The study author has declared affiliations with the pharmaceutical and biotechnology industries, including Sight Sciences, Inc. Please see the original reference for a full list of disclosures.


Chester T. A Single-center retrospective trial of a blink-assisted eyelid device in treating the signs and symptoms of dry eye. Optom Vis Sci. 2021;98:(6):605–612. doi:10.1097/OPX.0000000000001711