REDUCING DISCOMFORT ASSOCIATED WITH MEIBOMIAN GLANDS EXPRESSION WITH PRE-OPERATIVE LOCAL ANESTHESIA: A PROSPECTIVE DOUBLE-BLIND STUDY

Dry eye disease is highly prevalent, with Meibomian gland dysfunction (MGD) being one of its leading causes. Meibomian gland expression (MGX) is an established therapeutic approach, yet its effectiveness and patient adherence are often limited by the pain associated with the procedure. Therefore, we conducted a study to evaluate whether applying lidocaine gel to the eyelid margins prior to MGX can reduce pain during the procedure, potentially improving patient comfort and maximizing the utility of this treatment.

The study was conducted at the Dry Eye Clinic of the Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel. Participants were patients diagnosed with dry eye disease secondary to evaporative dysfunction associated with Meibomian gland dysfunction (MGD). The study adhered to the tenets of the Declaration of Helsinki and received institutional review board approval 

This prospective, randomized, double-blind study included patients diagnosed with dry eye disease due to Meibomian gland dysfunction scheduled for Meibomian gland expression (MGX). Participants were randomly assigned to either a treatment group receiving lidocaine gel applied to the eyelid margins prior to MGX or a control group receiving artificial tear ointment. All patients received lidocaine drops before the procedure. Pain was assessed using a visual analog scale (VAS), and physiological discomfort was evaluated through heart rate monitoring from baseline to peak intraoperative values. Procedure duration was recorded for each session.

A total of 40 patients were enrolled (20 in the lidocaine gel group and 20 in the control group). Pain scores were significantly lower in the lidocaine group compared to control (4.5 ± 2.06 vs 6.9 ± 1.59, p < 0.001). The increase in heart rate during the procedure was also smaller in the lidocaine group (4.05 ± 2.98 vs 6.00 ± 3.04, p = 0.048). No significant difference was observed in procedure duration between the groups (p = 0.737).

Preoperative application of lidocaine gel to the eyelid margins significantly reduces pain and discomfort during MGX, as reflected by both subjective and physiological measures. This simple, safe, and inexpensive approach may improve patient tolerance, cooperation, and adherence to repeated MGX treatments, thereby enhancing long-term outcomes in MGD-related dry eye disease.