熱感眼霜對於MGD患者淚液表現與瞼板腺型態的影響

目的在瞼板腺功能障礙(MGD)的治療中，熱敷是最常見且首選的初始治療方式。然而，傳統熱敷方法（如熱毛巾和加熱眼罩）存在清潔、依從性和成本問題。隨著人們對臉部保養意識的提高，本研究將探討在眼霜中加入發熱成分，於日常保養中對眼瞼進行加熱與按摩，是否能幫助MGD患者促進瞼板腺正常分泌，以舒緩眼睛乾澀不適。研究旨在探討熱感眼霜對於視覺表現、瞼板腺型態、淚液表現、眼表健康及主觀乾眼症狀的影響。方法本研究為隨機、平行、對照試驗，受試者左右眼隨機分配至A組和B組，A組塗抹發熱成分添加較多之眼霜；B組塗抹發熱成分添加較少之眼霜。A組和B組接受相同的收案流程與檢查項目，除建立基線(Baseline)數據外，受試者需於眼霜介入後第一週、第二週、第四週及第八週進行回訪追蹤檢查。研究內容主要分為主觀檢測：OSDI問卷、遠距離矯正視力、高對比度視力與低對比度視力；及客觀檢測：瞼板腺缺損面積、非侵入性淚液破裂時間、淚液脂質層厚度、淚河高以及眼表健康評估。結果研究結果顯示，在視覺表現方面隨著眼霜介入，A組遠距離矯正視力與高對比度矯正視力具有顯著差異，但臨床上不具實質差異，低對比度視力則無顯著差異，B組中三項視力值均無顯著差異。淚液表現方面，A組與B組中非侵入性淚液破裂時間、淚液脂質層厚度均有顯著改善，而B組中淚河高具顯著差異，但臨床上不具實質差異，A組中淚河高則不具顯著差異。瞼板腺缺損面積方面，A組與B組均有顯著下降。不同回訪時間點A組與B組眼表健康評估(例如結膜泛紅充血、輪部泛紅充血、內眼瞼泛紅程度、內眼瞼平滑程度以及角膜表皮細胞受損分級)方面均無顯著差異。主觀乾眼症狀方面，A組與B組均有顯著改善。結論無論是使用發熱成分添加較多亦或者較少之熱感眼霜，兩者短期內均能改善輕度瞼板腺功能障礙患者之瞼板腺缺損面積、淚液脂質層厚度與非侵入性淚液破裂時間，主觀乾眼症狀評分隨著淚液破裂時間增加而下降。眼表健康評估並無顯著差異，可能因研究納入的為輕度瞼板腺功能障礙患者，未來可納入較為嚴重的瞼板腺功能障礙患者(例如瞼板腺功能障礙分級為三或四級之患者)以評估治療效果。總體而言，根據研究結果顯示熱感眼霜對於舒緩瞼板腺功能障礙患者的相關症狀可能具有潛在益處，未來應進行更長期，樣本數更多的研究以確認其治療效果。

PurposeIn the treatment of Meibomian Gland Dysfunction (MGD), heat application is the most common and preferred initial therapy. However, traditional heat application methods (such as warm towels and heated eye masks) present issues with cleanliness, compliance, and cost. With the growing awareness of facial skincare, this study aims to explore whether incorporating heating elements into eye creams, and applying them during daily skincare routines, can help MGD patients promote normal meibomian gland secretion and alleviate dry eye discomfort. The study aims to investigate the effects of the thermal eye cream on visual performance, meibomian gland morphology, tear film characteristics, ocular surface health, and subjective dry eye symptoms.MethodThis study is a randomized, parallel, controlled trial. Subjects' left and right eyes were randomly assigned to Group A and Group B. Group A applied an eye cream with a higher concentration of heating ingredients, while Group B applied an eye cream with a lower concentration of heating ingredients. Both groups underwent the same enrollment process and examination items. Besides establishing baseline data, subjects were required to return for follow-up examinations in the first week, second week, fourth week, and eighth week after the eye cream intervention. The study content mainly included subjective assessments: OSDI questionnaire, distance corrected visual acuity, high contrast visual acuity, and low contrast visual acuity; and objective assessments: meibomian gland defect area, non-invasive tear break-up time, tear lipid layer thickness, tear meniscus height, and ocular surface health evaluation.ResultThe study results showed that in terms of visual performance, with the intervention of the eye cream, Group A exhibited significant differences in distance corrected visual acuity and high contrast corrected visual acuity, but these differences were not clinically meaningful. Low contrast visual acuity showed no significant differences. In Group B, none of the three visual acuity measures showed significant differences. Regarding tear performance, both Group A and Group B showed significant improvement in non-invasive tear break-up time and tear lipid layer thickness. Group B showed a significant difference in tear meniscus height, but this was not clinically meaningful, while Group A showed no significant difference in tear meniscus height. In terms of meibomian gland defect area, both Group A and Group B showed significant reductions. Across different follow-up time points, there were no significant differences in ocular surface health evaluations(e.g. conjunctival hyperemia, limbal hyperemia, degree of palpebral conjunctival redness, smoothness of palpebral conjunctiva, and grading of corneal epithelial cell damage.) between Group A and Group B. Regarding subjective dry eye symptoms, both Group A and Group B showed significant improvements.ConclusionBoth the thermal sensation eye creams with higher or lower concentrations of heating ingredients improved meibomian gland defect area, tear lipid layer thickness, and non-invasive tear break-up time in patients with mild meibomian gland dysfunction in the short term. Subjective dry eye symptom scores decreased with increased tear break-up time. There were no significant differences in ocular surface health assessments, possibly due to the inclusion of patients with mild meibomian gland dysfunction. Future studies could include patients with more severe meibomian gland dysfunction (e.g., Grade 3 or 4) to evaluate treatment efficacy. Overall, the study results suggest potential benefits of thermal sensation eye creams in alleviating symptoms associated with meibomian gland dysfunction, warranting longer-term studies with larger sample sizes to confirm therapeutic efficacy.