Effect of Using a Combination of Lid Wipes, Eye Drops, and Omega-3 Supplements on Meibomian Gland Functionality in Patients With Lipid Deficient/Evaporative Dry Eye

Purpose: The aim of this study was to assess the efficacy of using a combination treatment approach consisting of lipid emulsion eye drops, eyelid cleansing wipes, and omega-3 vitamin supplements compared with warm compresses in improving meibomian gland functionality in patients with lipid-deficient/evaporative dry eye disease (LDDE). Methods: This single-center, open-label, investigator-masked, randomized study enrolled patients aged >= 18 years, clinically diagnosed with LDDE defined as having <= 6 functional meibomian glands [meibomian gland yielding liquid secretion (MGYLS)] and positive for dry eye symptoms at screening. Patients were randomized to receive either the combination treatment (lipid emulsion eye drops, omega-3 supplements, and lid hygiene with eyelid wipes) or to apply warm, wet compresses once daily, 8 minutes per day, for 3 months. Meibomian gland functionality (number of MGYLS; primary outcome) and patient-reported subjective assessments (SPEED and OSDI questionnaires; secondary outcomes) were evaluated. Adverse events (AEs) and visual acuity were assessed as safety endpoints. Results: Mean patient age was 41.7 years (n = 26; n = 13 per group). Mean +/- SD number of MGYLS was not statistically significantly different between groups at baseline (combination treatment, 3.5 +/- 1.5; warm compresses, 4.2 +/- 1.4, P > 0.5), and was significantly greater with combination treatment versus warm compresses after 3 months of treatment (9.3 +/- 2.7 vs. 4.7 +/- 2.3; P = 0.006). Dry eye symptoms were significantly improved in both groups at all follow-up visits. Two AEs unrelated to treatment were reported; the BCVA was unchanged from baseline in both groups. Conclusions: The combination treatment regimen resulted in significant improvement in meibomian gland functionality and dry eye symptoms. No safety issues were observed.