Evaluation of an eyelid warming device (Blephasteam®) for the management of ocular surface diseases in France: The ESPOIR study

doi:10.1016/j.jfo.2014.06.004

Journal Français d'Ophtalmologie

Volume 37, Issue 10, December 2014, Pages 763-772

https://doi.org/10.1016/j.jfo.2014.06.004 Get rights and content

Summary

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.

Résumé

Introduction

L’hygiène des paupières incluant le massage et l’apport de chaleur par compresses chaudes, est un élément important de la prévention et du traitement des dysfonctions des glandes de Meibomius. Bien qu’efficace cette technique implique une participation active du patient et souffre de manque de standardisation. Blephasteam^® est un dispositif médical ; les lunettes chauffantes, délivrent une chaleur humide constante sur les paupières afin de liquéfier le meibum et permettre un soulagement des symptômes et la prévention des rechutes.

Matériel et méthodes

L’étude ESPOIR (Évaluation de la satisfaction des patients vis-à-vis de la prise en charge des pathologies de surface oculaire) présentée, ici, avait pour objectif d’évaluer l’efficacité et la tolérance de ce dispositif médical chez les patients souffrant de dysfonctionnement des glandes de Meibomius (MGD). Un total de 28 centres français ont participé à l’étude. Cent deux patients présentant un dysfonctionnement symptomatique ou une sécheresse oculaire liée aux glandes de Meibomius ont été inclus. Les patients ont bénéficié de deux sessions quotidiennes de dispositif médical et ont recueilli sur un agenda personnel, un ensemble de paramètres, tous les deux jours la première semaine et ensuite de façon hebdomadaire pour les deux semaines restantes.

Résultats

La symptomatologie évaluée à l’aide d’une échelle visuelle analogique (EVA) par l’investigateur (critère principal) s’est montrée significativement (p < 0,001) améliorée en fin d’étude (59,97, 95 % CI 55,64–64,30 vs. 39,71, 95 % CI 34,78–44,65 à j0 et j21 respectivement), en parallèle avec le score moyen de symptômes (diminution moyenne de 19,93 ± 22,15 mm sur l’EVA ; p < 0,001), le score d’hyperémie (–1,57 ± 1,96 et –1,45 ± 1,85 ; p < 0,001 pour respectivement, l’œil le plus atteint et l’œil controlatéral), et la qualité du meibum (diminution moyenne de –4,03 ± 3,08 ; p < 0,001 et –3,32 ± 3,20 ; p < 0,01, pour respectivement, l’œil le plus atteint et l’œil controlatéral). Plus du double de patients ont rapporté que leurs symptômes s’étaient améliorés ou avaient disparu par rapport à ceux dont les symptômes étaient soit inchangés, soit aggravés. La symptomatologie globale évaluée par les patients a diminué tout au long de l’étude et une large majorité de patients ont été satisfaits ou très satisfaits du traitement. Avec les lunettes, la vision n’est pas réduite et le clignement des paupières est maintenu, ce qui favorise l’étalement du film lacrymal. Les patients ont pu continuer leurs activités quotidiennes comme la lecture ou le fait de regarder la télévision. Aucun effet indésirable n’a été rapporté et il n’y a pas eu de modifications de la pression intra-oculaire ou de l’acuité visuelle. La tolérance a été jugée satisfaisante ou très satisfaisante par plus de 95 % des investigateurs.

Conclusion

Cette étude suggère que le dispositif médical est efficace et bien toléré dans l’amélioration du confort oculaire et des symptômes liés aux MGD.

Introduction

The meibomian glands are modified sebaceous glands located in the tarsal plate of the eyelids. Their role is to actively synthesise and secrete lipids and proteins that promote stability of the tear film and, most importantly, to prevent its evaporation [1]. Meibomian gland dysfunction (MGD) is defined as a chronic, diffuse abnormality of the meibomian glands, commonly characterised by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion [2]. It may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease [2]. MGD is a major cause of dry eye disease [1]. Ocular symptoms include mild to persistent irritation, itching, burning, stinging, light sensitivity and blurred vision. The feeling of having the eyelids glued shut on waking is a major discomfort. The symptoms of MGD are a consequence of impaired quality or quantity of meibum provided to the ocular surface. When the meibomian acini become blocked or their function is otherwise impaired, the meibum produced has a deteriorated lipid structure with more branched chain fatty acids and cholesterol. This meibum has poorer physicochemical properties (more waxy and viscous) and is less effective in maintaining the tear film [3].

Treatments options for MGD include lid hygiene, lubricants, topical or systemic antibiotics, and topical steroids [4]. Lid hygiene, which includes eyelid warming using warm compresses, infrared or hot air sources and mechanical lid hygiene, is the mainstay of treatment. In patients with MGD the melting point of the meibum is raised from 32 ˚C to > 35 ˚C [5]. The aim of lid hygiene is to warm the eyelids up to 40 ˚C, to melt the meibum and facilitate its clearance through the application of pressure or massage. However, non-compliance with this approach is common due to the complexity of this process, inadequate eyelid warming and the requirement for long-term treatment.

Eyelid warming devices have been developed to overcome these barriers to treatment. Encouraging results have been observed with a novel eyelid warming device (Blephasteam^®; Laboratoires Théa, Clermont-Ferrand, France), with improvements in tear film lipid layer thickness and ocular comfort in normal subjects and patients with dry eye disease [6], [7] and may offer benefits over traditional compress therapy [8].

The aim of this multicentre study (Evaluation of Satisfaction Regarding Patient's Management of Ocular Surface Diseases, ESPOIR) was to collect information from patients and ophthalmologists in order to investigate the efficacy and safety of the eyelid warming device in the management of patients with MGD in France. The ESPOIR study was performed in Paris and Clermont-Ferrand, and the ESPOIR extension study was performed in 25 centres in France.

Section snippets

Methods

This prospective, open-label, uncontrolled, phase IV, study took place in a total of 28 centres in France. The ESPOIR study was conducted in accordance with Good Clinical Practice guidelines (ICH Guidelines and European directive 2001/20/CE) and the Declaration of Helsinki (2004). All patients provided written informed consent prior to participating in the study which was approved on March 2nd 2010 by the Ethics Committee “Comité de protection des personnes île-de-France V”.

The primary

Inclusion and exclusion criteria

Patients with symptomatic MGD and/or dry eye related to MGD, which had been stable for at least one month, were eligible for inclusion in the study. Exclusion criteria included any of the following in either eye: active pathology requiring a change in ocular treatment within the previous month; history of surgical events, including refractive surgery, within the last 6 months; any ocular anomaly interfering with the ocular surface; best far corrected visual acuity (VA) ≤ 1/10; history of trauma

Study treatment

The eyelid warming device under investigation consists of a pair of glasses, the eyepieces of which create a warm moist chamber (Fig. 1). This latent heat melts the meibum facilitating its release from the glands. The alternating current-supplied device is plugged in for 15 minutes before use; coloured lights indicate when the device is ready for use. Two disposable rings moistened with drinking water are inserted into each eyepiece, and the device worn for 10 minutes; the device times this

Efficacy parameters

At study entry (Visit 1; Day 0) investigators recorded details of patients’ ocular medical history and treatment and ocular symptoms (recorded on a visual analogue scale) and signs (slit lamp examination, lid margin examination, visual acuity, tear osmolarity, and intraocular pressure). Patients were reassessed at the end-of-study visit, which took place at 21 days ± 2 days (Visit 2; Day 21). Details of the study procedures conducted at Visits 1 and 2 are included in Table 1.

Patients were asked

Safety parameters

The safety of the eyelid warming device was assessed using corrected VA and overall assessment by investigators. Best far corrected VA was measured for both eyes separately using a Snellen chart on Days 0 and 21. Investigators were asked the following question on Day 21, “After 21 days of use, how do you consider the safety of the eyelid warming device?” Responses were measured on a scale of 0 to 3 where: 0 = Very satisfactory; 1 = Satisfactory; 2 = Unsatisfactory; 3 = Very unsatisfactory.

Intraocular

Statistical analysis

The efficacy and safety results were evaluated using the intention-to-treat (ITT) dataset, that was all patients enrolled in the study for whom there was evidence that they used the eyelid warming device and for whom any follow-up information was available.

Descriptive statistics were used for the quantitative variables and frequency distribution for the categorical variables. The symptomatology VAS between baseline (Day 0, before device application) and each post-baseline value were compared

Results

A total of 102 patients (36 males, 66 females) with a mean age of 54.5 years ± 20.8 from 28 centres in France were eligible for inclusion in this study. The mean time since MGD diagnosis was 38.0 ± 49.2 months. MGD was the primary diagnosis in 49 patients and a secondary diagnosis in 53 patients (33 acne rosacea, 3 atopy, 1 psoriasis, 3 seborrheic dermatitis, 1 seborrheic dermatitis and acne rosacea, 12 others who had a secondary diagnosis of MGD), but without a determined cause (such as acne

Primary efficacy variable

Symptomatology, as scored on the 0–100 VAS, was significantly (P < 0.001) lower on Day 21 than on Day 0 (59.97, 95% CI 55.64–64.30 vs. 39.71, 95% CI 34.78–44.65 on Days 0 and 21 respectively; 102 and 96 Patients respectively were evaluated in the intent to treat sample) (Fig. 2).

The mean symptomology score as rated by a VAS fell significantly during the course of the study (mean decrease of 19.93 ± 22.15 VAS units; P < 0.001). The proportion of patients without disturbing ocular symptoms also

Safety

There was no significant difference in corrected VA on Days 0 and 21 (mean change 0.2 ± 0.99). Overall, 95.9% (94/98) of investigators rated the safety of the eyelid warming device as satisfactory (50.0%, [49/98]) or very satisfactory (45.9% [45/98]). Of the four patients in whom the investigator rated the safety as less then satisfactory, one patient had an inflamed eyelid, one had lack of efficacy, one had missing data and no reason was recorded for the other. No adverse events were observed

Discussion

Disorders of the eyelid are among the most common pathologies encountered in routine ophthalmological practice. Despite a growing understanding of the interacting pathologies that give rise to this group of disorders [10], [11], eyelid hygiene and eyelid health in general remain the cornerstones of treatment and prevention [12]. The anatomical location of the lacrimal functional unit renders it less available to routine hygiene than the rest of the face. In patients with disorders of the

Conclusion

The eyelid warming device proved effective in decreasing ocular discomfort, ocular symptoms (such as burning and stinging, sensitivity to light), conjunctival hyperemia, eyelid symptoms and quality of the meibum compared with baseline measurements.

Patients were satisfied with their experience of the device and could continue other activities during use. The eyelid warming device is an effective device for providing warmth and humidity to the eye and appears to be a promising alternative or

Disclosure of interest

Laboratoires Thea, the manufacturer of Blephasteam^®, funded the study. The authors and investigators were remunerated for their participation in the study. Dr JF Stolz provided editorial assistance in the preparation of the manuscript and this work was remunerated by Laboratoires Thea.

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Cited by (24)

Meibomian gland dysfunction and blepharitis: A common and still unsolved ophthalmic problem
2023, Clinics in Dermatology
Blepharitis and meibomian gland dysfunction (MGD) are very common, usually underdiagnosed and underappreciated diseases. More than 50% of patients seeking ophthalmologic consultations have symptoms and signs indicating one or both entities. We summarize the key points of diagnosis and management of both diseases, comparing the work of Dry Eye Workshop II (2017) with the dry eye blepharitis syndrome unification theory. The impact of MGD/blepharitis on ocular surgery also is described. Although MGD and blepharitis seem to be uncurable, most of the time they can be successfully controlled. Different management options are available, but the key to success remains simple—routine eyelid hygiene and moisturizing with the use of preservative-free lubricants.
Paediatric ocular rosacea: diagnosis and management with an eyelid-warming device and topical azithromycin 1.5%
2022, Journal Francais d'Ophtalmologie
Citation Excerpt :
There were also improvements in other efficacy variables, including subjective ocular signs (eyelid redness, quality of meibum) and symptoms (burning and stinging sensation, visual fatique) of MGD and dry eye, whilst the global efficacy was assessed as satisfactory or very satisfactory in 83.8% of cases. Similar finding were also observed in a French ESPOIR study (Evaluation of the Satisfaction of patients with Management of Ocular Surface Disease) to evaluate the efficacy and safety of Blephasteam® in patients with MGD [25]. One hundred and two patients were included in the study, with an improvement in the mean VAS score observed from Day 0 (59.97) to Day 21 (39.71).
Ocular rosacea is a chronic inflammatory disorder with periods of exacerbation and remission, often underdiagnosed in children. When diagnosed, its management is challenging because of a lack of effective long-term treatment options.
To report our experience in cases of pediatric ocular rosacea treated with moist heat therapy and topical azithromycin 1.5%.
The medical records of six children diagnosed with ocular rosacea based on a careful medical history and slit-lamp examination of the eyelids and ocular surface were reviewed. Previous treatments were discontinued, and children/parents were instructed to use the eyelid-warming device for 1 or 2 sessions of 10 minutes each day, followed by eyelid massage and cleansing, in combination with azithromycin 1.5% eye drops.
The diagnosis of ocular rosacea in these children was delayed for several months or years from the first identifiable clinical sign or symptom. All the children presented with corneal sequelae and decreased vision. Ocular manifestations included meibomian gland disease, recurrent chalazia, and phlyctenular keratoconjunctivitis. Cutaneous signs were not always associated with the condition. Ocular rosacea was usually resistant to initial treatments with antibiotics and topical corticosteroids. Treatment with the eyelid-warming device in combination with azithromycin 1.5% led to a rapid improvement in the clinical signs and was well tolerated by all patients.
Childhood ocular rosacea is potentially sight threatening. Practitioners should consider this condition in order to minimise diagnostic delay and subsequent complications. Combined therapy of eyelid hygiene (including an eyelid warming device) and azithromycin 1.5% eye drops was effective in treating ocular rosacea in children.
La rosacée oculaire est une maladie inflammatoire chronique avec des périodes d’exacerbation et de rémission, souvent sous-diagnostiquée chez les enfants. Une fois diagnostiquée, celle-ci s’avère difficile à traiter en raison d’un manque d’options thérapeutiques efficaces et à long terme.
Objectif Partage de notre expérience clinique dans les cas de rosacée oculaire pédiatrique traités en associant des lunettes chauffantes et un collyre d’azithromycine à 1,5 %.
Les dossiers médicaux de six enfants présentant une rosacée oculaire diagnostiquée sur la base de leurs antécédents médicaux et de l’examen à la lampe à fente des paupières et de la surface oculaire ont été inclus. Les traitements antérieurs ont été arrêtés et les enfants, avec l’aide de leurs parents, ont été invités à utiliser le dispositif médical de réchauffement des paupières pendant 1 ou 2 séances de 10 minutes chaque jour, suivi d’un massage et nettoyage des paupières, en association avec l’azithromycine topique.
Le retard de diagnostic de la rosacée oculaire était de plusieurs mois ou années après l’apparition du premier signe ou symptôme clinique. Tous les enfants présentaient une atteinte de la cornée et de la fonction visuelle. Les manifestations oculaires incluaient un dysfonctionnement des glandes de Meibomius, des chalazions à répétition, ou la présence d’une kérato-conjonctivite phlycténulaire. Les signes cutanés de la pathologie n’étaient pas toujours présents. La rosacée oculaire était généralement résistante aux traitements initiaux avec des antibiotiques et des corticostéroïdes topiques. Le traitement avec le dispositif de réchauffement des paupières en association avec l’azithromycine 1,5 % a conduit à une amélioration rapide des signes cliniques oculaires et été bien toléré par tous les patients.
La rosacée oculaire chez l’enfant est potentiellement cécitante. Les praticiens doivent considérer cette condition afin de limiter son retard de diagnostic et les complications oculaires associées. Une thérapie combinant l’hygiène des paupières (incluant un dispositif de réchauffement des paupières) et un collyre d’azithromycine à 1,5% a démontré son efficacité dans la prise en charge de la rosacée oculaire chez l’enfant.
Treatment of Dry Eye Disease in Europe
2022, Dry Eye Disease
Dry eye disease (DED) treatment in Europe in general follows TFOS Dry Eye Workshop (DEWS) II recommendations. However, diagnostic and treatment options vary between different European countries due to availabilities and reimbursement issues. Pharmacists, optometrists (mainly UK), general practitioners, general ophthalmologists, and dry eye specialists are involved in the care of DED patients. Specific Dry Eye Clinics are increasingly founded and welcome by DED patients to establish a correct diagnosis and initiate an appropriate treatment in DED. The newly founded European Dry Eye Society supports European researchers and clinicians to expand their knowledge in the area of dry eye and other ocular surface diseases.
Therapeutic profile of a latent heat eyelid warming device with temperature setting variation
2020, Contact Lens and Anterior Eye
Citation Excerpt :
Furthermore, all treatments were capable of delivering therapeutic benefits of improved lipid layer thickness and tear film stability. These trends are in agreement with earlier studies reporting the clinical efficacy of the commercial latent heat device [12–20]. The results are also consistent with previous research, which indicate that eyelid warming therapy can encourage melting of inspissated meibum in MGD, thereby reducing gland blockage and facilitating delivery of the meibomian lipids into the tear film [9–11].
To compare the effects on ocular temperature and tear film parameters following a single application of a latent heat eyelid warming device at a range of temperature settings.
Fifteen subjects were enrolled in a prospective, investigator-masked, randomised, cross-over trial. On separate days, participants were randomised to 10-minute application of a research latent heat device (Laboratoires Théa) at device temperature settings of 45 °C, 50 °C and 55 °C. Outer eyelid and corneal temperatures, tear film lipid layer grade, and non-invasive tear film breakup time (NIBUT) were measured at baseline and immediately after 10 min of device application.
Baseline measurements did not differ between treatment groups (all p > 0.05). Ocular temperatures, lipid layer grade and non-invasive tear film stability rose significantly following device application in all treatment groups (all p < 0.05). The 55 °C setting effected a mean ocular surface temperature rise in the order of +4 °C from baseline, which was 1.46 and 1.26 times greater than at the 45 °C and 50 °C temperature settings, respectively (all p < 0.05). Similarly, improvements in mean non-invasive tear film stability from baseline in the order of +7 s were observed, which were 2.43 and 1.66 times greater than those at the lower temperature settings of 45 °C and 50 °C, respectively (all p < 0.05).
At all temperature settings, the latent heat device resulted in clinically and statistically significant increases in ocular temperature, lipid layer grade, and non-invasive tear film stability. However, the 55 °C setting proved to be most effective at raising ocular temperature (in the order of +4 °C from baseline) and improving tear film stability.
The optimum temperature for the heat therapy for meibomian gland dysfunction
2019, Ocular Surface
Citation Excerpt :
Elevated eyelid temperature delivers more meibomian oil to the eyelid [5]. Numerous devices have been developed to warm the eyelid [6–21] and the warming relieves dry eye symptoms [13,15–18,21], improves meibum score [11,15,16], increases tear breakup time [11,15–17], and tear lipid layer thickness [14] and ameliorates dry eye related morphological changes in the meibomian gland [11,16–18]. One study found that heating did not improve their breakup time or lipid layer thickness [14].
Numerous devices have been developed to warm the eyelid as a therapy for Meibomian gland dysfunction. The optimum temperature for such therapy was determined.
Meibum lipid disorder versus temperature was calculated from previously published phase transition parameters measured using infrared spectroscopy. Phase transitions parameters were calculated from meibum obtained from donors with Meibomian gland dysfunction (M_MGD), donors who were susceptible to dry eye after hematopoietic stem cell transplantations (M_HSCT) and meibum from donors without dry eye (Mn).
Heating Mn to 40 °C increases the lipid disorder by 20.4%–90%. Heating the meibum another 4° increases the disorder to 95%. M_MGD is 73.2% disordered with no heating. Heating M_MGD to 41.5 °C increases the disorder by 26.8%–90% disordered. Heating M_MGD another 5.1 °C increases the disorder to 95%. As M_HSCT is much more ordered, 56.9% disordered compared with M_n and M_MGD, a higher temperature above safety limits, 52 and 59 °C is need to disorder M_HSCT to 90 and 95% disorder.
Heating the eye lid above the phase transition temperature of meibum increases the disorder of meibum lipid which could ameliorate dry eye symptoms. The optimum temperature for disordering Mn and M_MGD to 90% maximum disorder is 40 and 41.5 °C, respectively. Safety issues and discomfort should be considered in obtaining an optimal level of disorder, especially for severe cases of dry eye.
TFOS DEWS II Management and Therapy Report
2017, Ocular Surface
Citation Excerpt :
Visual acuity also significantly improved after use of Blephasteam® [453]. Two prospective, non-randomized studies found improved symptoms in patients with MGD [430,454] and increased TBUT. Decreased acinar diameter and area were also observed in individuals unresponsive to warm compress treatment [430].
The members of the Management and Therapy Subcommittee undertook an evidence-based review of current dry eye therapies and management options. Management options reviewed in detail included treatments for tear insufficiency and lid abnormalities, as well as anti-inflammatory medications, surgical approaches, dietary modifications, environmental considerations and complementary therapies. Following this extensive review it became clear that many of the treatments available for the management of dry eye disease lack the necessary Level 1 evidence to support their recommendation, often due to a lack of appropriate masking, randomization or controls and in some cases due to issues with selection bias or inadequate sample size.
Reflecting on all available evidence, a staged management algorithm was derived that presents a step-wise approach to implementing the various management and therapeutic options according to disease severity. While this exercise indicated that differentiating between aqueous-deficient and evaporative dry eye disease was critical in selecting the most appropriate management strategy, it also highlighted challenges, based on the limited evidence currently available, in predicting relative benefits of specific management options, in managing the two dry eye disease subtypes.
Further evidence is required to support the introduction, and continued use, of many of the treatment options currently available to manage dry eye disease, as well as to inform appropriate treatment starting points and understand treatment specificity in relation to dry eye disease subtype.

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¹: ESPOIR study group: C. Baudouin, V. Borderie, T. Bourcier, J.-L. Bourges, D. Bremond-Gignac, H. Chenal, F. Chiambaretta, B. Cochener, J. Colin, C. Creuzot-Garcher, S. Doan, A. Ducasse, S. Fauquier, D. Flores, P. Gain, J.-L. Georges, D. Giffon, T. Hoang-Xuan, M. Labetoulle, K. Laouar, S. Maes-Castellarin, S. Mainguy, C. Meuriot-Tuil, S. Morax, B. Mortemousque, M. Muraine, P.-J. Pisella, B. Rysanek, P.-Y. Robert, S. Roncin, J.-F. Rouland, F. Roux, C. Speeg, G. Touvron-Reynier and Y. Uteza.

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Original articleEvaluation of an eyelid warming device (Blephasteam®) for the management of ocular surface diseases in France: The ESPOIR studyÉvaluation de Blephasteam®, lunettes chauffantes à chaleur humide, dans la prise en charge des pathologies de la surface oculaire en France

Summary

Introduction

Materials and methods

Results

Conclusion

Résumé

Introduction

Matériel et méthodes

Résultats

Conclusion

Introduction

Section snippets

Methods

Inclusion and exclusion criteria

Study treatment

Efficacy parameters

Safety parameters

Statistical analysis

Results

Primary efficacy variable

Safety

Discussion

Conclusion

Disclosure of interest

J Fr Ophtalmol

The international workshop on meibomian gland dysfunction: executive summary

Invest Ophthalmol Vis Sci

The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee

Invest Ophthalmol Vis Sci

Differences in meibomian fatty acid composition in patients with meibomian gland dysfunction and aqueous-deficient dry eye

Br J Ophthalmol

The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction

Invest Ophthalmol Vis Sci

Examining the effects of Blephasteam®–clinical study results

Acta Opthalmol

Original article
Evaluation of an eyelid warming device (Blephasteam^®) for the management of ocular surface diseases in France: The ESPOIR studyÉvaluation de Blephasteam^®, lunettes chauffantes à chaleur humide, dans la prise en charge des pathologies de la surface oculaire en France

Examining the effects of Blephasteam^®–clinical study results