title: Effectiveness of an Eyelid Thermal Pulsation Procedure to Treat Recalcitrant Dry Eye Symptoms After Laser Vision Correction.
abstract: OBJECTIVE
  To provide an initial retrospective evaluation of the effectiveness of a thermal pulsation system to treat intractable patient-reported dye eye symptoms following laser vision correction.
  
  
  METHODS
  A total of 109 eyes of 57 patients underwent thermal pulsation therapy (LipiFlow; TearScience, Morrisville, NC) for the treatment of dry eye symptoms following laser vision correction. A standardized dry eye questionnaire, the Standard Patient Evaluation of Eye Dryness (SPEED II), was administered to all patients before and after thermal pulsation therapy. The primary outcome was patient-reported dry eye symptoms as measured by this questionnaire.
  
  
  RESULTS
  The mean patient age was 49 years (interquartile range [IQR]: 38 to 60), 70% were female, and the primary refractive procedure was LASIK (n = 91, 83%) or photorefractive keratectomy (PRK) (n = 18, 17%). Patients underwent thermal pulsation therapy at a mean of 40.5 months (IQR: 27.6 to 55.0) after the primary procedure. The mean pre-therapy SPEED II questionnaire score was 17.5 (IQR: 14 to 21), with a reduced mean post-therapy score of 10.2 (IQR: 6 to 14; 95% confidence interval [CI]: 8.8 to 11.5, P < .001). Patients with PRK tended to report more improvement. At the follow-up clinical evaluation, objective improvements were noted in tear break-up time (+1.9 sec; 95% CI: 1.3 to 2.5), reduction in grade of meibomian gland dysfunction (-0.69; 95% CI: -0.54 to -0.84), and corneal staining (-0.74; 95% CI: -0.57 to -0.91).
  
  
  CONCLUSIONS
  In this initial retrospective evaluation, a significant improvement in patient-reported dry eye symptoms was observed following thermal pulsation therapy. This treatment modality may have utility in the management of dry eye symptoms following laser vision correction, but further study is needed to define its role. [J Refract Surg. 2017;33(1):30-36.].
authors.forename: Craig S
authors.initials: CS
authors.lastname: Schallhorn
authors.forename: Julie M
authors.initials: JM
authors.lastname: Schallhorn
authors.forename: Stephen
authors.initials: S
authors.lastname: Hannan
authors.forename: Steven C
authors.initials: SC
authors.lastname: Schallhorn
mesh_terms: D000328:Adult; D063171:Corneal Pachymetry; D015352:Dry Eye Syndromes / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D018903:Photorefractive Keratectomy; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013666:Tears / Q000737:chemistry; D014792:Visual Acuity / Q000502:physiology