PURPOSE: The investigators propose a new treatment for refractory Meibomian Gland Dysfunction (MGD) patients with plasma jet to remove the hyperkeratinization layer from the lid margin to unblock terminal gland ducts and use thermal stimulation to enhance meibum delivery. METHODS: A prospective, interventional clinical safety and efficacy trial with 25 patients from the Department of Ophthalmology at Escola Paulista de Medicina (UNIFESP) to determine the efficacy and safety of the treatment of refractory MGD patients with plasma jet on both upper and lower lids. Patients will be submitted to an ophthalmology workup with best-corrected visual acuity (BCVA) (ETDRS chart) and dry eye questionnaires (DEQ-5 and OSDI). Bulbar redness, tear film meniscus height, noninvasive breakup time (NIKBUT), meibography under infrared light will be measured with Keratograph (Oculus®). Following, tear film osmolarity (i-PenTM), meibomian gland expression, and Marx line assessment. All exams were performed at the baseline, 30 days, and 90 days after the plasma jet application.
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Dry Eye Questionnaire (DEQ-5)
Timeframe: 30 days
Ocular Surface Disease Index (OSDI)
Timeframe: 30 days
Bulbar redness
Timeframe: 30 days
Tear film meniscus height
Timeframe: 30 days
Non-invasive tear breakup time (NITBUT)
Timeframe: 30 days
Tear film osmolarity
Timeframe: 30 days
Meibomian gland expression
Timeframe: 30 days