## 4 Discussion  
In this study, the action of eye stimulation with TECAR was investigated. This therapeutic methodology represents the most advanced step of thermotherapy in physical medicine and rehabilitation, using heat as a therapeutic means in terms of interaction between heat and tissues. The current passage through tissues induces an increase in tissue temperature, causing vasodilatation; reducing muscle spasms; and increasing pain threshold, cell activity and the elasticity of the connective tissue [27,28]. The biological effects are attributable not only to the phenomenon of active hyperemia, but also to bio-stimulation and cellular communication processes inherent in the cellular component of the treated tissue [29]. The positive effects of the therapy could be attributed to the  
Figure 5: OCTA images stored before (**a**) and after the TECAR treatments (**b**). In both images, in the upper line, the images are related to the angiographic image of the 4.5 mm \(\times\) 4.5 mm rectangle scan of the ONH; in the medium line, the images refer to the segmentation of volumetric data that leads to identification of retinal capillary plexuses; in the bottom line, the vessel density is shown by the color maps. The different numbers of the outer ring represent the capillary density of the peripapillary area. ability of the TECAR therapy technique to stimulate deep tissue through endogenous heat, evoking anti-inflammatory and regenerative effects [30]. The electromagnetic field probably affects the kinetics of ionic binding in cellular macromolecules, by modulating the release of cytokines, driving the immune response toward an anti-inflammatory/reparative profile [31; 32]. Currently, TECAR therapy seems to be one of the most beneficial therapies used in recovery [33]; it also has several contraindications that the operator must consider before starting the treatment. Absolute contraindications of TECAR therapy are patients with pacemakers, hemorrhagic gastrointestinal ulcers, infusion pumps and electric cable implants, deep-vein thrombosis, uncontrolled ischemic heart disease and localized cancerous areas/tumors [34]. Meibomitis is a condition that involves multiple structures of the eye causing a series of symptoms all related to the same cause. This ophthalmologic disease may cause severe pain and obvious vision loss, which seriously affect the normal life of patients [35]. After the TECAR treatments, an improvement was demonstrated both in terms of subjective symptoms and in terms of anatomical tissue evidence. The statistical analysis highlighted no statistical differences between each of the datasets for meibography, as shown in Tables 2 and 3, but it is possible to observe a decrease in the scale values. On the other hand, for TBUT, both T1 and T2 sessions for Group 1 and Group 2 presented significant different distribution with respect to the T0 dataset; in particular, after the T1 session, a marked improvement could already be seen. For interferometry and tear meniscus height, the Kruskal-Wallis test showed a significant difference only for Group 1 datasets (see Table 2). For all these three variables, however, the test highlighted statistical differences in all comparisons between Group 1 datasets and Group 2 datasets (see Table 3). The second target of the present study was to evaluate the blood flow in the ophthalmic nerve. For the objective assessment of disease progression, qualitative and quantitative analyses were performed using the OCTA technique. After the TECAR treatments, the OCTA images (Figure 5b) showed an improvement in blood flow and density, probably due to an improvement of the oxygenation of vessels. The optic nerve showed revascularization with a greater blood supply guaranteed by the process of active hyperemia, with consequent better troponin of the optic nerve. The anti-inflammatory effect was also important at the level of the most superficial part of the eye without highlighting side effects in terms of burns and damage to the eye itself.