Eyelid Warming Devices: Safety, Efficacy, and Place in Therapy

Figures & data

Table 1 Number of Studies per Treatment Modality

Treatment	Number of Studies	Clinical Improvement^a
Heated eye coverings	9	S: 7/9 (78%)
		T: 5/9 (56%)
		M: 4/9 (44%)
Moisture chamber	13	S: 8/13 (62%)
		T: 6/13 (46%)
		M: 1/13 (8%)
Devices that deliver a combination of heat and pressure	20	S: 19/20 (95%)
		T: 17/20 (85%)
		M: 19/20 (95%)
Intense pulsed light	23	S: 22/23 (96%)
		T: 20/23 (87%)
		M: 20/23 (87%)
Low level light therapy	1	S: 0/1 (0%)
		T: 0/1 (0%)
		M: 1/1 (100%)
Quantum molecular resonance	1	S: 1/1 (100%)
		T: 1/1 (100%)
		M: 1/1 (100%)
Total	62	S: 52/62 (84%)
		T: 44/62 (71%)
		M: 41/62 (66%)

Notes: Symptoms = as assessed with symptom questionnaires or visual analogue scales, tear stability = invasive or non-invasive tear breakup time, Meibomian gland function = meibum quality, expressibility, lid margins, or meibography.

Abbreviations: ^aS, improved symptoms; T, improved tear stability; M, improved meibomian gland function.

Table 2 Summary Heated Eye Coverings for the Treatment of MGD

Device	Paper	N	Clinical Outcomes That Were Improved^a	Adverse Events Related to Treatment
Towel Hot Eye Mask Memoto Este Azuki no Chikara Eye Hot R	Arita et al 2015. Effects of Eyelid Warming Devices on Tear Film Parameters in Normal Subjects and Patients with Meibomian Gland Dysfunction.^Citation20	10	Improved symptoms Improved tear stability Improved meibomian gland function	Not reported
MGDRx EyeBag	Jeon et al 2021. Comparison of the efficacy of eyelid warming masks and artificial tears for dry eye symptoms in contact lens wearers.^Citation22	78	Improved symptoms	Not reported
EyeGiene	Sim et al 2014. A Randomized, Controlled Treatment Trial of Eyelid-Warming Therapies in Meibomian Gland Dysfunction.^Citation18	65	Improved meibomian gland function	Minor discomfort using EyeGiene
MGDRx EyeBag	Bilkhu et al 2014. Randomized masked clinical trial of the MGDRx EyeBag for the treatment of meibomian gland dysfunction-relate evaporative dry eye.^Citation21	25	Improved symptoms Improved tear stability Improved meibomian gland function	Transient stinging when heated EyeBag was placed on the upper eyelid
MGDRx EyeBag	Ngo et al 2019. An Eyelid Warming Device for the Management of Meibomian Gland Dysfunction.^Citation24	25	Improved symptoms	Not reported
Disposable eyelid warming steamer with menthol and without menthol	Arita et al 2017. Effects of Warm compress containing menthol on tear film in healthy subjects and dry eye patients.^Citation19	55	Improved symptoms Improved tear stability	No adverse events
TheraPearl	Olafsson et al 2021. TheraPearl Eye Mask and Blephasteam for the treatment of meibomian gland dysfunction: a randomized, comparative clinical trial.^Citation25	70	Improved symptoms Improved tear stability	Not reported
MGDRx OPTASE	Murphy et al 2020. The Efficacy of Warm Compresses in the Treatment of Meibomian Gland Dysfunction and Demodex Folliculorum Blepharitis.^Citation23	42	Improved symptoms Improved meibomian gland function	Not reported
MGDRx EyeBag	Turnbull et al 2018. Comparison of treatment effect across varying severities of meibomian gland dropout.^Citation26	81	Improved tear stability	Not reported

Notes: ^aMeibomian gland function = meibum quality, expressibility, lid margins, or meibography, tear stability = invasive or non-invasive tear breakup time, symptoms = as assessed with symptom questionnaires or visual analogue scale.

Table 3 Summary of Moisture Chamber Goggles for the Treatment of MGD

Device	Paper	N	Clinical Outcomes that Were Improved^a	Adverse Events Related to Treatment
Blephasteam	Benitez del Castillo et al 2014. Evaluation of the efficacy, safety and acceptability of an eyelid warming device for the treatment of MGD.^Citation28	73	Improved symptoms	No adverse events
Custom device	Matsumoto et al 2006. Efficacy of a New Warm Moist Air Device on Tear Functions of Patients with Simple Meibomian Gland Dysfunction.^Citation30	35	Improved symptoms Improved tear stability	Not reported
Custom device	Spiteri et al 2007. Tear lipid layer thickness and ocular comfort with novel device in dry eye patients with and without Sjögren’s syndrome.^Citation32	26	Improved symptoms	No adverse events
Custom device	Mitra et al 2005. Tear film lipid layer thickness and ocular comfort after meibomian therapy via latent heat with novel device in normal subjects.^Citation92	24	No improved symptoms, tear stability, or meibomian gland metrics	No adverse events
Blephasteam	Pult et al 2012. A Comparison of an Eyelid-Warming Device to Traditional Compress Therapy.^Citation35	20	No improved symptoms, tear stability, or meibomian gland metrics	Not reported
Blephasteam	Purslow et al 2013. Evaluation of the ocular tolerance of a novel eyelid-warming device used for meibomian gland dysfunction.^Citation93	25	No improved symptoms, tear stability, or meibomian gland metrics	No adverse events
Custom device + ATs	Ren et al 2018. Short-term effect of a developed warming moist chamber goggle for video display terminal-associated dry eye.^Citation31	22	Improved symptoms Improved tear stability	No adverse events
Blephasteam	Turnbull et al 2018. Comparison of treatment effect across varying severities of meibomian gland dropout.^Citation26	81	Improved tear stability	Not reported
Prototype	Wang et al 2020. Therapeutic profile of a latent heat eyelid warming device with temperature setting variation.^Citation34	15	Improved tear stability	No adverse events
Blephasteam + Optrex spray	Bilkhu et al 2021. Provocation of the ocular surface to investigate the evaporative pathophysiology of dry eye disease.^Citation29	40	Improved symptoms	Not reported
Blephasteam	Villani et al 2015. Evaluation of a novel eyelid-warming device in meibomian gland dysfunction unresponsive to traditional warm compress treatment: an in vivo confocal study.^Citation33	50	Improved symptoms Improved tear stability	No adverse events
Blephasteam	Sim et al 2014. A Randomized, Controlled Treatment Trial of Eyelid-Warming Therapies in Meibomian Gland Dysfunction.^Citation18	65	Improved symptoms Improved meibomian gland function	Minor discomfort using EyeGiene
Blephasteam	Olafsson et al 2021. TheraPearl Eye Mask and Blephasteam for the treatment of meibomian gland dysfunction: a randomized, comparative clinical trial.^Citation25	70	Improved symptoms Improved tear stability	Not reported

Notes: ^aMeibomian gland function = meibum quality, expressibility, lid margins, or meibography, tear stability = invasive or non-invasive tear breakup time, symptoms = as assessed with symptom questionnaires or visual analogue scale.

Table 4 Summary of Devices That Deliver Heat and/or Pressure for the Treatment of MGD

Device	Paper	N	Clinical Outcomes That Were Improved^a	Adverse Events Related to Treatment
LipiFlow	Greiner. 2012. A single LipiFlow thermal Pulsation System treatment improves meibomian gland function and reduces dry eye symptoms for 9 months.^Citation45	21	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
iLux LipiFlow	Tauber et al 2020. Comparison of the iLUX and the LipiFlow for the Treatment of Meibomian Gland Dysfunction and Symptoms: A Randomized Clinical Trial.^Citation38	142	Improved symptoms Improved tear stability Improved meibomian gland function	iLux: some participants felt it was too hot. Petechial hemorrhage in lower palpebral conjunctiva. Corneal staining/reduced VA. LipiFlow: none
iLux	Schanzlin et al 2022. Efficacy of the Systane iLux Thermal Pulsation System for the Treatment of Meibomian Gland Dysfunction After 1 Week and 1 Month: A Prospective Study.^Citation52	30	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
MiBoFlo LipiFlow	Li et al 2021. Effect of a Novel Thermostatic Device on Meibomian Gland Dysfunction: A Randomized Controlled Trial in Chinese Patients.^Citation50	54	Improved symptoms Improved meibomian gland function	No adverse events
LipiFlow	Zhao et al 2016. Clinical Trial of Thermal pulsation (LipiFlow) in Meibomian Gland Dysfunction with Pre-treatment Meibography.^Citation53	46	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
LipiFlow	Blackie et al 2016. The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye.^Citation43	200	Improved symptoms Improved meibomian gland function	Eyelid/discomfort/pain/dermatitis
TearCare	Badawi et al 2019. TearCare system extension study: evaluation of the safety, effectiveness, and durability through 12 months of a second TearCare treatment on subjects with dry eye disease.^Citation40	12	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
TearCare	Badawi et al 2018. A novel system, TearCare, for the treatment of the signs and symptoms of dry eye disease.^Citation39	24	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
TearCare LipiFlow	Gupta et al 2022. TearCare for the Treatment of Meibomian Gland Dysfunction in Adult Patients with Dry Eye Disease: A Masked Randomized Controlled Trial.^Citation41	135	Improved symptoms Improved tear stability Improved meibomian gland function	Lipiflow: pain, injection TearCare: SPK, chalazion, blepharitis
TearCare	Karpecki et al 2020. A prospective, post-market, multicenter trial (CHEETAH) suggested TearCare system as a safe and effective blink-assisted eyelid device for the treatment of dry eye disease.^Citation42	29	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
LipiFlow	Godin et al 2018. Outcomes of Thermal Pulsation Treatment for Dry Eye Syndrome in Patients with Sjogren Disease.^Citation55	13	Improved tear stability Improved meibomian gland function	Not reported
LipiFlow	Hagen et al 2018. Comparison of a single-dose vectored thermal pulsation procedure with a 3-month course of daily oral doxycycline for moderate to severe meibomian gland dysfunction.^Citation47	28	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
LipiFlow	Kim et al 2017. Effect of thermal pulsation treatment on tear film parameters in dry eye disease patients.^Citation48	98	Improved symptoms Improved tear stability	Not reported
LipiFlow	Schallhorn et al 2016. Effectiveness of an Eyelid Thermal Pulsation Procedure to Treat Recalcitrant Dry Eye Symptoms After Laser Vision Correction.^Citation51	57	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
LipiFlow	Satjwatcharaphong et al 2015. Clinical Outcomes Associated with Thermal Pulsation system Treatment.^Citation37	32	Improved symptoms Improved tear stability Improved meibomian gland function	Not reported
LipiFlow	Zhao et al 2016. Evaluation of Monocular Treatment for Meibomian Gland Dysfunction with an Automated Thermodynamic System in Elderly Chinese Patients: A Contralateral eye Study.^Citation54	29	Improved symptoms Improved tear stability Improved meibomian gland function	Not reported
LipiFlow	Finis et al 2014. Evaluation of an Automated Thermodynamic Treatment (LipiFlow) System for Meibomian Gland Dysfunction: A Prospective, Randomized, Observer-Masked Trial.^Citation44	31	Improved symptoms Improved tear stability Improved meibomian gland function	Not reported
LipiFlow	Greiner J. 2013. Long-term (12-month) improvement in meibomian gland function and reduced dry eye symptoms with a single thermal pulsation treatment.^Citation45	18	Improved symptoms Improved meibomian gland function	Not reported
LipiFlow	Friedland et al 2011. A Novel Thermodynamic Treatment for Meibomian Gland Dysfunction.^Citation36	14	Improved symptoms Improved tear stability Improved meibomian gland function	Physical discomfort with treatment
LipiFlow	Lane et al 2012. A New System, the LipiFlow, for the Treatment of Meibomian Gland Dysfunction.^Citation49	139	Improved symptoms Improved tear stability Improved meibomian gland function	Eyelid discomfort Conjunctival injection

Notes: ^aMeibomian gland function = meibum quality, expressibility, lid margins, or meibography, tear stability = invasive or non-invasive tear breakup time, symptoms = as assessed with symptom questionnaires or visual analogue scale.

Table 5 Summary of Intense Pulsed Light for the Treatment of MGD

Device	Paper	N	Clinical Outcomes That Were Improved^a	Adverse Events Related to Treatment
E>Eye	Craig et al 2015. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction.^Citation62	28	Improved symptoms Improved tear stability	Not reported
E>Eye	Piyacomn et al 2020. Efficacy and Safety of Intense Pulsed Light in Patients With Meibomian Gland Dysfunction-A Randomized, Double-Masked, Sham-Controlled Clinical Trial.^Citation68	114	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Quadra4 + loteprednol	Gupta et al 2016. Outcomes of Intense Pulsed Light Therapy for Treatment of Evaporative Dry Eye Disease.^Citation64	100	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
IPL Diamond Series Q4 + expression + 1 drop of steroid/NSAID	Toyos et al 2015. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year Retrospective Study.^Citation72	91	Improved symptoms Improved tear stability	Blistering, cheek swelling, conjunctival cyst, floaters, hair loss (brow and forehead), light sensitivity, redness
Quadra Q4 + expression + NSAID for 2 days	Vegunta et al 2016. Combination Therapy of Intense Pulsed Light Therapy and Meibomian Gland Expression (IPL/MGX) Can Improve Dry Eye Symptoms and Meibomian Gland Function in Patients With Refractory Dry Eye.^Citation73	35	Improved symptoms Improved meibomian gland function	No adverse events
E>Eye + expression	Albietz et al 2018. Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction.^Citation58	26	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Lumenis M22 + expression	Arita et al 2018. Multicenter study of intense pulsed light therapy for patients with refractory meibomian gland dysfunction.^Citation60	31	Improved symptoms Improved tear stability Improved meibomian gland function	Not reported
Lumenis M22 + expression	Arita et al 2019. Therapeutic efficacy of intense pulsed light in patients with refractory meibomian gland dysfunction.^Citation59	45	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Lumenis M22 + expression	Choi et al 2019. Meibum Expressibility improvement as a therapeutic target of intense pulsed light treatment in meibomian gland dysfunction and its association with tear inflammatory cytokines.^Citation61	30	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Lumenis M22 + expression	Dell et al 2017. Prospective evaluation of intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction.^Citation63	40	Improved symptoms Improved tear stability Improved meibomian gland function	Not reported
E>Eye	Guilloto et al 2017. Effect of pulsed laser light in patients with dry eye syndrome.^Citation80	36	No statistical testing	Redness and light sensitivity
E>Eye	Jiang et al 2016. Evaluation of the safety and effectiveness of intense pulsed light in the treatment of meibomian gland dysfunction.^Citation65	40	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
E>Eye	Karaca et al 2018. Intense regulated pulse light for the meibomian gland dysfunction.^Citation66	26	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Lumenis M22 Optima + expression	Seo et al 2018. Long-term effects of intense pulsed light treatment on the ocular surface in patients with rosacea-associated meibomian gland dysfunction.^Citation69	17	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Lumenis M22 + ATs	Yin et al 2017. Changes in the meibomian gland after exposure to intense pulsed light in meibomian gland dysfunction.^Citation74	35	Improved symptoms Improved tear stability Improved meibomian gland function	Not reported
Eye-light (IPL+LLLT)	Solomos et al 2021. Meibomian Gland Dysfunction: Intense Pulsed Light Therapy in Combination with Low-Level Light Therapy as Rescue Treatment.^Citation70	11	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Epi-C Plus (IPL+LLLT)	Stonecipher et al 2019. Combined low level light therapy and intense pulsed light therapy for the treatment of meibomian gland dysfunction.^Citation71	230	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Eye-light + MY MASK-E	Marta et al Intense Pulsed Plus Low-Level Light Therapy in Meibomian Gland Dysfunction.^Citation67	31	Improved symptoms Improved meibomian gland function	No adverse events
Icon Aesthetic System	Cheng et al Intense Pulsed Light Therapy for Patients with Meibomian Gland Dysfunction and Ocular Demodex Infestation.^Citation75	25	Improved symptoms Improved tear stability Improved meibomian gland function	Not reported
Thermaeye Plus	Verges et al Prospective evaluation of a new intense pulsed light, thermaeye plus, in the treatment of dry eye disease due to meibomian gland dysfunction.^Citation78	44	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Lumenis M22 alone Lumenis M22 + expression	Shin et al Intense pulsed light plus meibomian gland expression versus intense pulsed light alone for meibomian gland dysfunction: A randomized crossover study.^Citation76	72	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events
Lumenis M22	Tang et al A Retrospective Study of Treatment Outcomes and Prognostic Factors of Intense Pulsed Light Therapy Combined With Meibomian Gland Expression in Patients With Meibomian Gland Dysfunction.^Citation77	44	Improved symptoms Improved tear stability Improved meibomian gland function	Not reported
Lumenis M22	Yan et al The Efficacy of Intense Pulsed Light Combined With Meibomian Gland Expression for the Treatment of Dry Eye Disease Due to Meibomian Gland Dysfunction: A Multicenter, Randomized Controlled Trial.^Citation79	120	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events

Notes: ^aMeibomian gland function = meibum quality, expressibility, lid margins, or meibography, tear stability = invasive or non-invasive tear breakup time, symptoms = as assessed with symptom questionnaires or visual analogue scale.

Table 6 Other Devices for the Treatment of MGD

Treatment Type	Device	Paper	N	Clinical Outcomes That Were Improveda	Adverse Events Related to Treatment
Low Level Light Therapy	Healite II	Park et al 2022. Effect of low-level light therapy in patients with dry eye: a prospective, randomized, observer-masked trial.^Citation86	40	Improved meibomian gland function	No adverse events
Quantum Molecular Resonance	Rexon-Eye	Ferrari et al 2019. High Frequency Electrotherapy for the Treatment of Meibomian Gland Dysfunction.^Citation89	25	Improved symptoms Improved tear stability Improved meibomian gland function	No adverse events

Notes: ^aMeibomian gland function = meibum quality, expressibility, lid margins, or meibography, tear stability = invasive or non-invasive tear breakup time, symptoms = as assessed with symptom questionnaires or visual analogue scale.

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