Consistent Lid Hygiene Recommendations May Improve Patient Compliance

Senior patient with ophthalmologist in the office
Senior woman patient talking with female ophthalmologist during a medical consultation at the ophthalmologic office. Doctor offering eye medcine for a patient
In-person demonstrations as well as written and verbal instructions are key to patients’ management of meibomian gland dysfunction, a study explains.

Appropriate lid hygiene recommendations and consistent patient education is key to compliance in meibomian gland dysfunction (MGD), according to a study published in Clinical Ophthalmology. The compliance rate was 54.6% when patients were given detailed written instruction, verbal instruction, and a demonstration of proper hygiene technique by a single instructor. Patients with symptomatic MGD were more compliant, the survey results show. 

Study data was collected from 77 patients (63 women, mean age 66.71±8.17) with varying levels of education, employment status, and differing numbers of oral and topical medications including glaucoma medication. Patients underwent a subjective evaluation of MGD related symptoms including dryness, discomfort, ocular fatigue, itching, foreign body sensation, burning, photophobia, soreness, and blurry vision.

Finally, an ocular surface examination was performed.  Specific tests included tear film break-up time (TBUT), fluorescein staining, and meibomian gland expression.

After evaluation, patients were given a detailed instruction brochure and instructed on specific MGD protocol and were asked to perform lid hygiene twice per day. Eight weeks after instruction, patients were asked to self-report compliance by completing a newly developed 7-item questionnaire. 

Investigators report that patient demographics including age, sex, education, employment status, number of medications, or history of glaucoma did not influence compliance. Certain clinical signs including higher scores of meibomian gland expressibility and moderate to severe ocular surface staining were associated with increased lid hygiene compliance (χ2 = 10.13, P =.001 and χ2 = 10.48, P =.001, respectively).

In patients with low compliance (n=35), patient-centered factors were cited including lack of time (51.4%), lack of knowledge regarding the disease and necessity for treatment (5.7%), concerns regarding other systemic conditions (5.7%), and forgetting (5.7%). Complexity of the regimen (11.4%), the inconvenience of preparation (8.6%), and difficulty in remembering the steps (5.7%) were procedure-related factors for noncompliance.

Lid-hygiene is an important first line therapy for MGD with variability among clinicians in treatment method and instruction. Doctors should consider the reasons for noncompliance when prescribing and educating on treatment. Education on MGD, its impact on eye health, the importance of lid hygiene and the long-term benefit, in addition to modifications in the regimen may improve compliance. 

The limitations of the study included small sample size, short duration of study, and the disadvantages of self-reported treatment adherence which tend to overestimate long-term compliance. The study also failed to evaluate the severity of dry eye symptoms related to MGD and there was variation in the equipment used for lid warming and cleansing potentially affecting patient compliance.


Chuckpaiwong V, Nonpassopon M , Lekhanont K, Udomwong W, Phimpho P, Cheewaruangroj N. Compliance with lid hygiene in patients with meibomian gland dysfunction. Clin Ophthalmol. 2022:16(4):1173-1182. doi:10.2147/OPTH.S360377