Avoiding Keratectasia Associated With Warm Compresses And Massage.

Charles McMonnies¹, Donald Korb²

¹School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
²Korb Associates, Boston, United States of America

PURPOSE: To examine the possibility that warm compresses and/or lid massage, when employed in the management of Meibomian gland dysfunction, for example, could have a role in the development of corneal ectasia or other complications.

METHODS: Case histories of corneal ectasia associated with the use of warm compresses and lid massage are cited. The mechanisms for increased corneal temperature due to warm compresses and massage are examined, as is the possibility of corneal trauma.

RESULTS: Mechanisms are proposed whereby massage-related trauma might combine with warm compresses to increase corneal temperature and contribute to the development of adverse changes. The possibility of complications in association with other forms of iatrogenic massage, are examined with reference to chalazion treatment and post-trabeculectomy management.

CONCLUSIONS: Patients whose management involves warm compresses, and/or any form of ocular digital pressure or massage, appear to require screening and assessment of their risk for the possibility of associated adverse responses. For example, there may be increased risk of complications in patients with established chronic habits of abnormal eye rubbing in response to allergic itch or other recurring rubbing provocations. In addition, for patients who appear to be susceptible to the development of keratectasia and the progression of glaucoma or axial myopia, the prescription of massage management techniques may be contraindicated due to the risks associated with massage-related elevated intraocular pressure. Careful tutoring and follow-up is required when massage techniques are prescribed. It is possible to modify massage techniques to reduce the risks of adverse responses.