Dip eyes in water technique (Akshi Nimanjjana): Efficacy of a simple technique in the management of meibomian gland dysfunction

Abstract

Abstract Background: Dip eyes in water (DEW) is an ancient technique to improve eye hygiene. Conventionally, the eyes are cleaned by splashing water on them. However, splashing is not very effective as the eyes get closed reflexly when the water is splashed onto the eyes. On the other hand, in the DEW technique, it is conveniently possible to keep eyes fully open when dipped inside the water in the eye cup. Meibomian gland dysfunction (MGD) is a chronic, frustrating disease for which there is no gold standard, and eye hygiene is presumed to play an important role. Aim: The present study was tested in a cohort of MGD patients using the DEW technique. Materials and methods: DEW was prescribed to seven patients who were symptomatic for a period ranging from 6 months to 2 years. The main four symptoms were irritation in the eyes, persistent watering of the eyes, burning sensation, and foreign-body sensation. The scale of assessment of these four symptoms was severe (+++), moderate (++), mild (+), and no symptoms (−). The outcome assessment criteria were complete relief in these four symptoms and were assessed after 1 year of starting treatment. The DEW technique was performed 3–4 times per day. It was added to the ongoing conservative treatment. Once complete relief was obtained, other conservative management measures were stopped, and only the DEW treatment continued. It was advised that the DEW treatment be continued as a part of the regular eye hygiene daily routine. Results: Five out of seven patients reported complete relief in outcome criteria (four symptoms), one had partial relief, and there was no relief in one of the patients. After a follow-up of 1 year, one patient (the one with partial relief) was lost to follow-up. Five out of seven patients had significant relief, and 5/6 patients had sustained relief on long-term follow-up. No adverse effects were reported by any of the patients. Conclusion: The DEW technique is promising in providing significant relief in patients with MGD. The encouraging results of DEW in this series can help prescribe and extend the indications of DEW in managing MGD and other eye disorders, in which eye hygiene plays a therapeutic role and as a daily routine eye-care practice to prevent various eye disorders.