Impact of thermo-mechanical skin treatment on refraction and keratometry in patients with dry eye disease and the implications for cataract surgery


Purpose: To determine the changes in keratometry measurements and refraction in patients having the thermo-mechanical periorbital skin treatment, Tixel®, to treat dry eye disease (DED). Methods: A multi-centre, prospective, non-masked study was conducted. DED patients were recruited in 3 international centres and were evaluated in 5 visits separated by an interval of 2 weeks except for the last visit which took place after 18 weeks from visit 1. The same clinical examination was performed at all visits: OSDI questionnaire, tear stability, keratometry, best corrected visual acuity and refraction. Tixel® treatment was applied at the first 3 visits. Results: 89 participants (24 males/65 females; mean age: 55.0 ± 14.2 years) were included: 20 presented moderate DED symptoms and 69 severe DED symptoms. Significant differences were found for the spherocylindrical refraction (vector analysis) between visit 1 and visits 2 and 3. Following cumulative analysis, 11.86 % and 16.94 % of participants had more than 0.5 dioptre (D) change in mean keratometry and keratometric astigmatism, respectively, at 3 months post-treatment. A total of 5.40 % had a sphere and cylinder change greater than 0.50D and 16.21 % had the axis changed more than 10 degrees (vector analysis). These changes were particularly significant in patients with severe DED symptoms. Conclusions: Keratometry readings and refraction can change following thermo-mechanical skin treatment for DED, especially in those patients with severe DED symptoms. This should be considered as potential errors in intraocular lens calculations may be induced.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Optometry > Optometry
Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Study supported by Novoxel® (Israel). MBV was supported by: 1) the Ministry of Science, Innovation and Universities, Gov
Additional Information: Copyright © 2024 The Authors. Published by Elsevier Ltd on behalf of British Contact Lens Association. This is an open access article under the CC BY license (
Uncontrolled Keywords: Keratometry,Refraction,Dry eye disease,Thermo-mechanical treatment,Tixel
Publication ISSN: 1476-5411
Last Modified: 15 Jul 2024 08:31
Date Deposited: 15 Apr 2024 13:04
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Related URLs: https://linking ... 367048424000560 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2024-06
Published Online Date: 2024-04-08
Accepted Date: 2024-03-30
Authors: Blanco-Vázquez, Marta
Gil-Cazorla, Raquel (ORCID Profile 0000-0003-0855-8554)
Barua, Ankur
Taneja, Mukesh
Hanneken, Ludger
Shah, Sunil (ORCID Profile 0000-0002-5373-5305)



Version: Published Version

License: Creative Commons Attribution

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