Background: Thermal pulsation (LipiFlow) warms the eyelids from the palpebral conjunctival surface. However, temperature and blood flow responses across multiple ocular-surface locations have not been systematically evaluated in a clinical cohort of patients with meibomian gland dysfunction (MGD). We examined changes in ocular surface temperature, blood flow and non-invasive tear break-up time (NIBUT) after LipiFlow in patients with MGD. Methods: Thirteen patients (3 men, 10 women; mean age, 64.9 ± 18.1 years) with MGD were included. The temperature and blood flow of the upper and lower eyelid skin and the palpebral and bulbar conjunctiva, along with the NIBUT, were measured before, 5 min after and 1 month after LipiFlow. The change from baseline was analyzed with Steel’s test. Results: All locations changed significantly 5 min after the treatment: the temperature rose by 1.13–1.21 °C, the blood flow increased to 1.24–1.45 times the baseline value, and NIBUT increased by 3.1 ± 2.7 s. At 1 month, temperature had returned to baseline at all locations, and blood flow had largely returned toward baseline, although bulbar conjunctival blood flow remained significantly elevated; NIBUT remained significantly longer than before treatment. Conclusions: Thermal pulsation warmed the ocular surface, including the palpebral conjunctiva where the meibomian glands are located. The improvement in tear film stability persisted for 1 month despite the largely transient temperature and blood flow responses.

Background: Tixel^® C (Novoxel Ltd., Netanya, Israel) is a thermomechanical system that conducts heat to soft tissue via a titanium tip heated to 400 °C and has been used for skin rejuvenation, including the eyelids. Its efficacy for dry eye disease (DED) and meibomian gland dysfunction (MGD) has been reported, but it has not been evaluated in Japanese patients. Methods: This multicenter, open-label, single-arm, exploratory clinical study examined the efficacy and safety of Tixel C for evaporative dry eye associated with MGD. Patients underwent three treatment sessions at 2-week intervals, with 10 pulses applied to the upper and lower eyelids of both eyes in two overlapping rows (skin contact, 6 ms; tip protrusion, 400 μm). The primary endpoint was the change in tear film break-up time (TBUT) and the secondary endpoint was the change in the Ocular Surface Disease Index (OSDI). Results: Twenty patients (4 men, 16 women; mean age, 53.6 ± 16.7 years) were enrolled, and 3 patients discontinued the study. The mean TBUT change was 2.470 s and OSDI improved by a mean of −29.459 (p < 0.0001). No major adverse events occurred. Conclusions: Tixel C was associated with improved tear film stability and subjective symptoms, and no major adverse events were observed during the short follow-up period.