I have performed this thermal pulsation procedure since October 2012 and have found it to be a useful adjunct in the management of dry eye. It is important for patients to understand that the treatment is not a cure and that the amount of symptomatic improvement they will have is dependent on how advanced the disease prior to treatment.
Patients also must understand that they may continue to require other therapies (topical drops, cyclosporine [Restasis, Allergan], punctum plugs, or doxycycline) after the treatment, depending on the level of disease before treatment.
It took 4 weeks for me to develop an understanding of what kind of result could be expected based on patients’ pre-treatment level of disease. Patients with mild to mild/moderate MGD have significant relief of symptoms with the treatment alone. Those with moderate/severe disease often have relief of symptoms with the treatment plus other therapies, such as punctum plugs, cyclosporine, or doxycycline.
Some patients with severe disease may not have any symptomatic relief at all. The benefit they receive from the treatment is maintaining the small number of glands they have left. This must be explicitly stated to these patients prior to their treatment. I have noted that several patients with severe disease had significant improvement in their symptoms after three treatments in 9 months. This may be a result of the patietns having very thick secretions that did not melt after the first treatment.