title: Warm compress induced visual degradation and Fischer-Schweitzer polygonal reflex.
abstract: OBJECTIVE
  To document adverse visual effects of warm compress therapy and determine potential etiologies in subjects with dry eye symptoms.
  
  
  METHODS
  Subjects (n = 24) with dry eye symptoms were recruited. Group 1 (n = 13): baseline measurements for each eye included subjective blur, visual acuity (VA), autorefraction (AR), corneal topography (CT), central corneal curvature (CCC), lipid layer thickness (LLT), and evaluation for corneal striae and edema. A warm, moist compress (44.4-45 degrees C) was applied with gentle pressure for 30 min to the closed eyelids of the randomized experimental eye; nothing was applied to the contralateral control eye. Subjective blur, VA, AR, CT, CCC, and LLT were evaluated for each eye at 5, 15, and 30 min and 5 min after application. Striae and edema were assessed for each eye at 30 and 5 min after application. Group 2 (n = 11): the above warm compress protocol was repeated to investigate the Fischer-Schweitzer polygonal reflex at the times stated.
  
  
  RESULTS
  At 5 and 30 min, 71% and 88% of all subjects experienced increased subjective blur and decreased VA. At 30 min: Group 1: Of 13 experimental eyes: 13 experienced subjective blur; nine exhibited a VA decrease > or =2 lines (mean = 3.4 +/- 0.7). For the control eye, two subjects reported blur and none exhibited decreased VA. The findings for AR, CT, CCC, LLT, striae and edema did not correlate with blur or with VA decline. Group 2: Of 11 experimental eyes: 10 exhibited the polygonal reflex compared with 0 controls (p < 0.001); eight exhibited subjective blur; seven exhibited VA decrease > or =2 lines (mean = 2.9 +/- 0.9). The polygonal reflex correlated positively to visual blur (r = 0.88, p = 0.04) and to VA decrease (r = 0.79, p = 0.1).
  
  
  CONCLUSIONS
  Warm compress application induces transient visual degradation. Although there was no correlation between visual degradation and AR, CT, CCC, LLT, or the presence of striae or corneal edema, visual degradation correlated positively with the polygonal reflex, which was observed following warm compress application.
authors.affiliation: Schepens Eye Research Institute, Boston, Massachusetts, USA. Jess1ateyes@aol.com
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Solomon
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Case
authors.forename: Jack V
authors.initials: JV
authors.lastname: Greiner
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Blackie
authors.forename: John P
authors.initials: JP
authors.lastname: Herman
authors.forename: Donald R
authors.initials: DR
authors.lastname: Korb
mesh_terms: D000328:Adult; D001458:Bandages / Q000009:adverse effects; D001767:Blinking / Q000502:physiology*; D003315:Cornea / Q000473:pathology; D019781:Corneal Topography; D015352:Dry Eye Syndromes / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012029:Refraction, Ocular / Q000502:physiology*; D015354:Vision, Low / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology*