Severely obstructed meibomian glands can have higher melting points. Multiple treatments over a short period may be of benefit, but the cost is prohibitive and a clinical trial would be necessary to support this observation.
I have also had a patient referred with a persistent epithelial defect (PED) with MGD one peruses multiple Internet sites there is considerable patient dissatisfaction. This is likely the result of patients having expectations that are too high for their level of MGD.
It is mandatory that physicians clearly articulate the results that patients are likely to obtain with the treatment. Patients with mild-to-moderate disease have the most relief, in my experience, but may be most reluctant to undergo the treatment because of cost considerations. These are patients who are likely to require other therapies.
Patients with moderate-to-severe disease will often require other therapies. I currently provide re-treatment to patients with mild-to-moderate disease every 12 months. Patients with moderate-to-severe disease may require treatments more frequently.
The thermal pulsation therapy has proven to be an important additiaon to my armamentarium in the management of MGD and dry eye. It requires a careful and meticulous pre-treatment evaluation so that the level of disease can be documented and the likely result articulated to patients.