The role of heat in rubbing and massage-related corneal deformation.
OBJECTIVE
To examine the role of elevated corneal temperature in the development of rubbing/massage-related corneal deformation and the possibility that warm compresses in the management of meibomian gland dysfunction or chalazion could contribute to such adverse responses.


METHODS
With reference to reports of corneal deformation associated with meibomian gland dysfunction, chalazion, dacryocystoceles and post-trabeculectomy, the mechanisms for increased corneal temperature due to ocular massage, especially when combined with warm compresses are examined.


RESULTS
Several mechanisms for rubbing/massage to elevate corneal temperature have been described, apart from the application of warm compresses or other forms of heat.


CONCLUSIONS
Raised corneal temperature helps to explain corneal deformation which develops in association with rubbing or massage in conditions such as keratoconus, chalazion, post-trabeculectomy, post-laser assisted in situ keratomileusis, post-graft and dacryocystoceles. When combined with warm compresses or other methods of heat delivery to the eye, the elevation of corneal temperature appears to explain how meibomian gland dysfunction treatment involving warm compresses and massage could induce rubbing-related deformation. Patients whose management involves iatrogenic ocular massage appear to require screening for risk of corneal deformation. Risk may be increased for patients with a concurrent habit of rubbing their eyes abnormally in response to allergic itch for example. It appears to be possible to modify ocular massage techniques to reduce the risk of corneal deformation. Careful tutoring and follow-up using corneal topography appears to be required when massage is prescribed, especially when used in conjunction with heat application.
School of Optometry and Vision Science, University of New South Wales, Kensington 2052, Australia. c.mcmonnies@unsw.edu.au
Charles W
CW
McMonnies
Donald R
DR
Korb
Caroline A
CA
Blackie
D001831:Body Temperature / Q000502:physiology; D003315:Cornea / Q000473:pathology*; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology*; D019781:Corneal Topography; D004108:Dilatation, Pathologic; D015352:Dry Eye Syndromes / Q000503:physiopathology; D005141:Eyelid Diseases / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D008297:Male; D008405:Massage / Q000009:adverse effects*; D008537:Meibomian Glands / Q000473:pathology*; D055815:Young Adult