E icacy o eyelid wa ming de ices as i s -s ep ea men in meibomian
gland dys unc ion: A sys ema ic e iew wi h me a-analysis
An onio Balles e os-S´
anchez
a,b,*
, Ca los Rocha-de-Lossada
c,d,e,
,
Jos´
e-Ma ía S´
anchez-Gonz´
alez
b
a
School o Op ics and Op ome y, Uni e si a Poli `
ecnica de Ca alunya, Te assa, Spain
b
Depa men o Physics o Condensed Ma e , Op ics A ea, Uni e si y o Se ille, 41012, Se ille, Spain
c
Oph halmology Depa men , VITHAS Malaga, 29016, Malaga, Spain
d
Regional Uni e si y Hospi al o Malaga, Hospi al Ci il Squa e, 29009, Malaga, Spain
e
Q ision, Oph halmology Depa men , VITHAS Alme ia Hospi al, 04120, Alme ia, Spain
Su ge y Depa men , Oph halmology A ea, Uni e si y o Se ille, Doc o Fed iani, 41009, Se ille, Spain
ARTICLE INFO
Keywo ds:
D y eye disease
Meibomian gland dys unc ion
Eyelid wa ming comp ess
Mois u e chambe goggles
Wa m owel comp ess
ABSTRACT
Pu pose: To in es iga e he e icacy o eyelid wa ming de ices as i s -s ep ea men in pa ien s wi h meibomian
gland dys unc ion (MGD).
Me hods: A sys ema ic e iew wi h me a-analysis o RCTs, epo ing he e ec s eyelid wa ming de ices in 3
da abases, PubMed, Scopus and Web o Science, was pe o med acco ding o he PRISMA s a emen .
Resul s: Se en s udies including 367 pa ien s, and 440 eyes we e analysed. The o e all e icacy did no signi i-
can ly a o ei he g oup when compa ing eyelid wa ming de ices o he con ol g oups o wa m owel com-
p esses, no be ween mois u e chambe de ices and wa m comp ess de ices. Howe e , he change in OSDI
ques ionnai e (SMD 0.91; 95 % CI: 0.44 o 1.39; P =0.0002) and NIBUT (SMD 1.10; 95 % CI: 0.61 o 1.59; P <
0.0001) we e signi ican ly a o able o eyelid wa ming de ices compa ed o he con ol g oups. Simila esul s
we e ob ained o ea ilm s abili y (SMD 0.97; 95 % CI: 0.32 o 1.61; P =0.003) when compa ing eyelid
wa ming de ices o wa m owel comp esses. Speci ically, he sensi i i y analysis o hese g oups e ealed ha
changes in OSDI ques ionnai e (MD 9.41; 95 % CI: 1.70 o 17.13; P =0.02; I
2
=49 %) and NIBUT (MD 2.24; 95
% CI: 1.20 o 3.28; P <0.0001; I
2
=71 %) we e signi ican ly a o able o eyelid wa ming de ices. When
compa ing mois u e chambe de ices and wa m comp ess de ices, only he change in TBUT (SMD 0.75; 95 % CI:
0.23 o 1.28; P =0.005; I
2
=30 %) we e signi ican ly a o able o mois u e chambe goggles.
Conclusions: Despi e hei limi ed o e all e icacy, eyelid wa ming de ices signi ican ly educe OSDI ques ion-
nai e and imp o e NIBUT compa ed o con ols o wa m owel comp ess g oups. E idence emains insu icien o
con i m whe he mois u e chambe de ices p o ide be e ou comes han wa m comp ess de ices. Fu he well-
designed RCTs a e needed o con i m hese indings.
1. In oduc ion
Meibomian gland dys unc ion (MGD) is a ch onic, di use abno -
mali y o he meibomian glands (MGs), which may lead o al e a ions in
he ea ilm, symp oms o ocula i i a ion, in lamma ion and ocula
su ace disease [1,2]. Se e al s udies ha e epo ed ha he p e alence
o MGD in pa ien s wi h d y eye ange om 3.5 % o 70 % [3,4].
Consequen ly, MGD is o en ega ded as he leading cause o e apo a i e
d y eye, which is ecognized as he mos p e alen sub ype o DED
[5–7].
The p ima y cause o MGD is hough o be e minal duc obs uc ion
o he meibomian glands (MGs), esul ing om hype ke a inisa ion and/
o quali a i e/quan i a i e changes in meibum sec e ed by MGs [8,9].
Meibum is a complex mix u e o a ious pola and nonpola lipids,
including wax es e s, dies e s, iacylglyce ols, ee choles e ol, ee
a y acids, and phospholipids [10,11]. Due o i s composi ion, he
mel ing poin o meibum is no consis en [12,13]. E idence sugges s
ha meibum mel s wi hin a ange o 10 ◦C (heal hy meibum) o 45 ◦C
( oo hpas e-like meibum) [12–16]. Consequen ly, while heal hy mei-
bum emains luid a empe a u es below no mal body empe a u e
* Co esponding au ho . Reina Me cedes S ee , Uni e si y o Se ille, Se ille, Spain.
E-mail add esses: [email p o ec ed], [email p o ec ed] (A. Balles e os-S´
anchez).
Con en s lis s a ailable a ScienceDi ec
The Ocula Su ace
jou nal homepage: www.else ie .com/loca e/j os
h ps://doi.o g/10.1016/j.j os.2025.02.008
Recei ed 27 Oc obe 2024; Recei ed in e ised o m 29 Janua y 2025; Accep ed 19 Feb ua y 2025
The Ocula Su ace 37 (2025) 33–46
A ailable online 21 Feb ua y 2025
1542-0124/© 2025 The Au ho s. Published by Else ie Inc. This is an open access a icle unde he CC BY-NC-ND license ( h p://c ea i ecommons.o g/licenses/by-
nc-nd/4.0/ ).
≈37 ◦C [16], he mel ing poin o oo hpas e-like meibum equen ly
exceeds his h eshold, which could explain he solid s a e o meibum in
MGD [16,17].
Cu en ly, new in-o ice ea men s ha e eme ged as p omising
he apeu ic op ions o MGD, such as ec o ed he mal pulsa ion (VTP)
[18], in ense pulsed ligh (IPL) [19,20], low-le el ligh he apy (LLLT)
[21] and quan um molecula esonance (QMR) [22]. These ea men s
ha e been shown o imp o e he MGs unc ion by educing in lamma-
ion and p omo ing meibum lique ac ion [23,24]. As a esul , he e is an
inc ease in he lipid laye hickness ha educes ea ilm e apo a ion,
which helps o alle ia e he signs and symp oms o d y eye [23,24].
Howe e , he adop ion o hese ea men s is some imes limi ed, as hey
a e no equen ly co e ed by mos insu ance plans [25,26]. In addi ion,
hese ea men s o en equi e main enance, ypically on an annual o
bi-annual basis, which gene a es a cos ha is no accessible o he en i e
popula ion [27]. Mo eo e , a ecen me a-analysis compa ing he e i-
cacy o VTP wi h wa m comp esses has de e mined ha he long- e m
e icacy appea s o be compa able be ween bo h ea men s [28],
aising ques ions abou he cos -e ec i eness o in-o ice he apies o
MGD. The e o e, wa m comp ess he apy emains he i s -s ep ea -
men o MGD o many pa ien s, as ecommended by he ea Film and
Ocula Su ace Socie y (TFOS) D y Eye Wo kshop (DEWS) II manage-
men and he apy epo [29].
A s anda d ea men ecommenda ion in ol es soaking a ace owel
in ho wa e and applying i o he eyelid ma gins [30]. Howe e , pa-
ien s o en needed o change he owel du ing ea men o ensu e ha
he empe a u e was main ained be ween 40 and 45 ◦C [17,30]. To
add ess his limi a ion, se e al medical de ices, ha e been de eloped by
maximizing hea e en ion and deli e y o he eyelids [29,31,32]. These
de ices mainly consis o mois u e chambe goggles [33] o wa m
comp ess [34]. O e all, se e al s udies ha e de e mined ha hese de-
ices ha e signi ican posi i e e ec in he ea men o MGD [35–41].
Howe e , he lack o a clea s a egy ega ding hei applica ion com-
bined wi h he ecen in oduc ion o lipid-based a i icial ea s, has
limi ed hei b oade use [17,42,43]. Mo eo e , acco ding o he bes o
ou knowledge, he e is no sys ema ic e iew ha had analysed hei
e icacy. The e o e, his s udy aims o de e mine he e icacy o eyelid
wa ming de ices in he managemen o MGD. Fo his pu pose, hese
de ices we e compa ed wi h con ol and wa m owel comp ess g oups.
Addi ionally, di e en de ice designs we e e alua ed o de e mine he
mos e ec i e op ion.
2. Me hods
2.1. Da a sou ces and sea ch s a egy
This sys ema ic e iew wi h me a-analysis (PROSPERO ID:
CRD42024599131) was pe o med acco ding o he P e e ed Repo ing
I ems o Sys ema ic Re iews and Me a-Analyses (PRISMA) [44,45]. A
o al o 122 a icles published be o e Oc obe 15, 2024, we e iden i ied
h ough he ollowing da abases: PubMed, Scopus, and Web o Science.
The da a sea ch s a egy wi h Boolean ope a o s was as ollows:
(Mois u e chambe goggles OR Wa m comp ess OR Eyelid wa ming
de ices OR EyeGiene mask OR MGDRx EyeBag OR The apea l OR
B ude mois hea comp ess OR Meibopa ch OR Wa m owel OR Ho
owel) AND (D y eye disease OR DED OR E apo a i e d y eye OR EDE
OR Meibomian gland dys unc ion OR MGD). The e e ences o he
e ie ed a icles we e e iewed o iden i y o he ela ed s udies i hey
me he inclusion c i e ia.
2.2. S udy selec ion
All hose 122 a icles iden i ied h ough he sea ch s a egy we e
conside ed and analysed. Duplica e s udies we e emo ed by Mendeley
Re e ence Manage , e sion 2.122.1 (Else ie L d., Ams e dam,
Ne he lands) [46]. The emaining s udies unde wen addi ional
sc eening s ages, which included i le sc eening, abs ac sc eening, and
ull- ex sc eening. S udies un ela ed o he opic we e excluded om he
e iew du ing i le and abs ac sc eening. The sc eening o he ull- ex
s udies was pe o med by one in es iga o (ABS), who selec ed hem
acco ding o he inclusion and exclusion c i e ia. The inclusion c i e ia
we e as ollows: ull-leng h p ospec i e, andomized con olled ials
(RCTs) in humans ha epo ed on he e icacy o eyelid wa ming de-
ices in he ea men o MGD. Exclusion c i e ia included publica ions
in languages o he han English and/o non-indexed jou nals, s udies
whe e eyelid wa ming de ices we e applied o heal hy pa ien s and/o
hose wi h discom o ela ed o con ac lens wea , as well as s udies
compa ing eyelid wa ming de ices wi h ec o ed he mal pulsa ion.
The e we e no es ic ions placed on he coun y in which he s udy was
pe o med, he ollow-up pe iod, he sample size o esul s o he s udies.
The s udy selec ion p ocess o his sys ema ic e iew is p esen ed wi h a
lowcha diag am in Fig. 1.
2.3. Da a ex ac ion and quali y assessmen
The da a om each s udy we e collec ed and summa ized indepen-
den ly in ables designed by one esea che s (JMSG). The ollowing in-
o ma ion was ob ained om each a icle: (1) au ho and da e o
publica ion (yea ); (2) s udy design; (3) mean ollow-up o all pa ien s in
he whole p ocedu e (exp essed in mon hs); (4) numbe o pa ien s; (5)
mean age o he pa ien s (exp essed in yea s); (6) pa ien sex (male/ e-
male), (7) numbe o eyes in ol ed; (8) inclusion c i e ia o he s udies;
(9) s udy g oup in e en ion; (10) con ol g oup in e en ion and (11)
con lic s o in e es . Rega ding he esul s o he s udies, he ollowing
da e we e collec ed: (1) d y eye symp oms, including ocula su ace
disease index (OSDI) ques ionnai e and symp om assessmen in d y eye
(SANDE) ques ionnai e; (2) ea ilm s abili y, including ea ilm b eak-
up ime (TBUT) wi h luo escein and non-in asi e ea ilm b eak-up
ime (NIBUT); (3) ea ilm b eak-up ime wi h luo escein (TBUT); (4)
Schi me es wi hou anes hesia (ST); (5) Co neal luo escein s aining
(CFS); and (6) MG d opou .
The li e a u e ha emained a e ull- ex sc eening was examined
o assess he quali y o he s udies. To a oid he isk o bias, one
dependable au ho s (CRDL) c ea ed a synopsis based on he Coch ane
isk o bias ool [47], which includes he ollowing i ems: (1) andom
sequence gene a ion, (2) alloca ion concealmen , (3) masking o pa -
icipan s and pe sonnel, (4) masking o ou come assessmen , (5)
incomple e ou come da a, (6) selec i e epo ing and (7) o he sou ces
o bias. A hi d non-masked assesso (ABS) decided he quali y o he
s udies when disag eemen s occu ed be ween he wo assesso s.
2.4. Da a syn hesis and analysis
The da a we e ca ego ized in o 3 sec ions: (1) RCTs compa ing he
e icacy o eyelid wa ming de ices e sus con ols; (2) RCTs compa ing
he e icacy o eyelid wa ming de ices e sus wa m owel comp esses;
and (3) RCTs compa ing he e icacy o di e en eyelid wa ming de-
ices. In e ms o s udy ou comes, bo h in a-g oup and in e -g oup e-
sul s we e epo ed wi hin each sec ion, indica ing whe he he
di e ences we e s a is ically signi ican based on he s a is ical analysis
pe o med by he au ho s o each s udy. In a-g oup ou comes we e
p esen ed as “Las isi (LV) – Baseline (B) di e ences”, while in e -g oup
ou comes we e epo ed as ollows: “Eyelid wa ming de ice (Las isi –
Baseline) – Con ol g oup (Las isi – Baseline)” (Sec ion 1); “Eyelid
wa ming de ice (Las isi – Baseline) – Wa m owel comp ess (Las isi –
Baseline)” (Sec ion 2); and “Mois u e chambe de ices (Las isi – Base-
line) – Eyelid wa m comp ess de ices (Las isi – Baseline)” (Sec ion 3).
A me a-analysis was conduc ed o each sec ion o syn hesize he
in e -g oup ou comes o he s udies included in his sys ema ic e iew,
using Re iew Manage Web (Re Man Web), e sion 5.7 (The Coch ane
Collabo a ion, Ox o d, UK) [48]. Fo da a pooling, he esul s epo ed
by he s udies we e es ima ed as mean ±s anda d de ia ion (SD),
A. Balles e os-S´
anchez e al.
The Ocula Su ace 37 (2025) 33–46
34
ollowing he guidelines ou lined in he Coch ane Handbook o Sys-
ema ic Re iews o In e en ions (Supplemen a y Digi al Con en 1)
[49]. Du ing he analysis, i he e we e di e en da a measu emen
me hods among he s udies, s anda dized mean di e ences (SMD) we e
calcula ed o analyse he con inuous pa ame e s o d y eye symp oms,
NIBUT, TBUT, ST, CFS and MG d opou [50]. SMD is a measu e o he
size o he in e en ion e ec in each s udy wi h espec o he a iabili y
wi hin he s udy, which allows o analyse he esul s on a uni o m scale
[50]. On he o he hand, i he e we e no di e en da a measu emen
me hods among he s udies, he mean di e ence (MD) was calcula ed
[50]. The absolu e alue was in e p e ed oge he wi h he P alue and
95 % con idence in e als (CI) p esen ed on o es plo s. P <0.05 was
conside ed s a is ically signi ican . He e ogenei y o he included s udies
was analysed oge he wi h he Coch ane Q-s a is ics chi-squa e (chi
2
)
es and I-squa e (I
2
) es , which was g aded as low (50 %) [51]. I he e
was any signi ican he e ogenei y be ween s udies (I
2
es ≥50 % o chi
2
es wi h a P <0.1) a andom e ec s model was pe o med o pool he
da a, o he wise a ixed e ec s model was conduc ed [52,53]. In addi-
ion, sensi i i y analyses we e conduc ed o e alua e he obus ness o
he me a-analyses. These analyses we e applied in me a-analyses ha
included a leas 3 s udies, ensu ing ha he exclusion o any single
s udy o adjus men o assump ions did no comp omise he eliabili y o
he o e all esul s o he assessmen o a iabili y. O e all, he mea-
su emen me hods o d y eye symp oms and ea ilm s abili y di e ed
among he s udies. The e o e, sensi i i y analyses we e conduc ed o
include a consis en symp om assessmen me hod, speci ically he OSDI
ques ionnai e, as well as in asi e o non-in asi e a iables o e alua e
ea ilm s abili y, such as TBUT and NIBUT, espec i ely. Mo e de ailed
in o ma ion on he da a syn hesis and analysis is p o ided in Fig. 2.
3. Resul s
3.1. S udy cha ac e is ics
This sys ema ic e iew included 7 RCTs [35–41] published be ween
2014 and 2024, in ol ing 440 eyes om 367 pa ien s wi h a mean age o
46.4 ±11.3 yea s. The sex dis ibu ion was 264 emales (71.9 %) and
103 males (28.1 %). Pa ien ollow-up, exp essed in mon hs, anged
om 1.5 o 3 mon hs, wi h a mean ollow-up o 1.8 ±0.7 mon hs.
Rega ding s udy g oup in e en ion, all s udies applied eyelid wa ming
de ices, which included he MGDRx Eyebag® (The EyeBag Company,
Wes Yo kshi e, UK) [35,38,39], he EyeGiene® mask (Eyede ec Medi-
cal, CA, USA) [36], he B ude ® Eye Hyd a ing Comp ess (B ude
Heal hca e Company, GA, USA) [37], he OPTASE® Mois Hea Mask
(Scope Oph halmics L d., Dublin, I eland), he Wa myou® S eam Eye
Mask (Shanghai Wa myou Indus y Co., Shanghai, China) [41], The -
apea l® eye mask (Bausch & Lomb, NY, USA) and Blephas eam® (Thea
Pha maceu icals, Newcas le, UK) [36,40]. Howe e , he con ol g oup
ecei ed no in e en ion [38], non-hea ed comp ess [35] o wa m owel
comp ess [36,37,39,41]. Fou s udies had con lic s o in e es as hey
we e suppo ed by di e en pha maceu ical companies [37–40]. Mo e
de ailed cha ac e is ics o he s udies a e lis ed in Tables 1–3.
3.2. Eyelid wa ming de ices Vs. con ols
Rega ding he measu emen me hods, Bilkhu e al. [35] and Ngo
e al. [38] u ilized he OSDI ques ionnai e and NIBUT o assess d y eye
symp oms and ea ilm s abili y, espec i ely. Howe e , Bilkhu e al.
[35] assessed MG d opou using he Tomlinson scale [54], while Ngo
e al. [38] used he A i a scale [55].
In a-g oup and in e -g oup e icacy ou comes a e shown in Table 4.
Fig. 1. Flowcha s udy selec ion p ocess acco ding o he PRISMA s a emen .
A. Balles e os-S´
anchez e al.
The Ocula Su ace 37 (2025) 33–46
35
Rega ding in a-g oup ou comes, Bilkhu e al. [35] epo ed ha he
applica ion o he MGDRx eyebag® led o imp o emen s in d y eye
symp oms (−23.2 ±28.1 poin s; P <0.05), NIBUT (1.9 ±2.3 s; P <
0.05) and MG d opou (−0.8 ±0.9 poin s; P <0.05). In con as , he
con ol g oup showed only sligh imp o emen s in d y eye symp oms
(−3.2 ±3.8 poin s; P >0.05), whe eas he es o he a iables emained
unchanged. In he s udy pe o med by Ngo e al. [38], imp o emen s
we e also obse ed only in d y eye symp oms (−11.4 ±8.9 poin s; P =
0.02) ollowing he applica ion o he MGDRx eyebag®, while he con-
ol g oup showed a smalle imp o emen in d y eye symp oms (−5.7 ±
4.7 poin s; P =0.22).
Rega ding in e -g oup ou comes, Bilkhu e al. [35] and Ngo e al.
[38] showed a o able esul s o he MGDRx Eyebag® in alle ia ing d y
eye symp oms, wi h alues o −20 poin s (P <0.001) and −5.7 poin s (P
=0.68), espec i ely. In addi ion, Bilkhu e al. [35] epo ed ha he
MGDRx Eyebag® was mo e e ec i e in enhancing NIBUT and MG
d opou , wi h alues o 1.8 (P <0.001) and −0.7 poin s (P <0.05),
espec i ely.
3.2.1. Me a-analysis
Fo es plo s showing he e icacy o eyelid wa ming de ices Vs.
con ol is p esen ed in Fig. 3. Two s udies we e included in he me a-
analysis [35,38]. The o e all e icacy did no a o ei he g oup How-
e e , only he change in OSDI ques ionnai e (SMD 0.91; 95 % CI: 0.44 o
1.39; P =0.0002; I
2
=0 %) and NIBUT (SMD 1.10; 95 % CI: 0.61 o 1.59;
P <0.0001; I
2
=0 %) indica ed ha he MGDRx Eyebag® had signi -
ican ly be e ou comes han he con ol g oup.
Fig. 2. Flowcha o da a syn hesis and analyses.
Table 1
Summa y o included RCTs compa ing eyelid wa ming de ices Vs. con ol.
Au ho
(da e)
Design F/U
a
Pa ien s Age
b
Sex (F/M) Eyes Inclusion c i e ia Eyelid wa ming de ice Con ol CoI
Bilkhu e al.
[35] 2014
MN
SM
2 25 28.7 ±7.8 19/6 50 •OSDI sco e ≥13 poin s
•NIBUT sco e <10 s
•ST >5.5 mm a e 5 min
•MG quali y and exp essibili y sco e ≥1
MGDRx eyebag (Twice a day
5 min, empe a u e no
epo ed)
Non-hea ed comp ess
(Twice a day du ing 5 min)
No
Ngo e al.
[38] 2018
MN
SM
8 25 38 ±15 18/7 25 •OSDI sco e ≥23 poin s
•MG sco e ≤9 poin s
MGDRx EyeBag (Twice a day
10 min, 38.1 C◦)
No eyelid wa ming de ice
(Remain own DED
ea men )
Yes
CoI =Con lic o in e es ; SM =Single-masked; F =Female; F/U =Follow-up; M =Male; MG =Meibomian gland; MN =Monocen e ; NIBUT =Non-in asi e ea ilm
b eak-up ime; OSDI =Ocula su ace disease index; RCTs =Randomized con olled ials; ST =Schi me es wi hou anes hesia.
a
Exp essed as weeks.
b
Exp essed as mean ±SD (s anda d de ia ion).
A. Balles e os-S´
anchez e al.
The Ocula Su ace 37 (2025) 33–46
36
3.3. Eyelid wa ming de ices s. wa m owel comp esses
Rega ding he measu emen me hods, Mu phy e al. [39] (2019 A),
Mu phy e al. [39] (2019 B), and Wang e al. [41] u ilized he OSDI
ques ionnai e o e alua e d y eye symp oms, whe eas Sim e al. (2014 A)
[36] and Sim e al. [36] (2014 B) employed he SANDE ques ionnai e.
All he men ioned s udies assessed ST wi hou anes hesia, epo ing he
esul s as he we ing leng h o he s ip o e a 5-min pe iod. In addi ion,
hey also applied he Ox o d g ading scale o e alua e CFS. In e ms o
ea ilm s abili y, Tan e al. [37], Mu phy e al. [39] (2019 A), and
Mu phy e al. [39] (2019 B) pe o med NIBUT, while Sim e al. and
Wang e al. [41] used TBUT.
In a-g oup and in e -g oup e icacy ou comes a e summa ized in
Table 5. Rega ding in a-g oup ou comes, Sim e al. [36] (2014 A)
epo ed ha he applica ion o Blephas eam® esul ed in imp o emen s
in d y eye symp oms (−18.5 ±21.9 poin s; P no epo ed), ST (1.3 ±
1.5 mm; P no epo ed), and CFS (−1 ±1.2 poin s; P no epo ed).
Con e sely, he wa m owel comp ess g oup showed smalle imp o e-
men s in d y eye symp oms (−13.8 ±16 poin s; P no epo ed), wi h
simila imp o emen s in ST (1.8 ±2.1 mm; P no epo ed), while he
educ ion in CFS was g ea e (−2.5 ±2.9 poin s; P no epo ed).
Simila ly, Sim e al. [36] (2014 B) ound ha he use o he EyeGiene®
mask imp o ed d y eye symp oms (−6.7 ±6.5 poin s; P no epo ed),
ST (3.1 ±3 mm; P no epo ed), and CFS (−2.5 ±2.4 poin s; P no
epo ed). Howe e , he wa m owel comp ess g oup exhibi ed g ea e
imp o emen s in d y eye symp oms (−13.8 ±16 poin s; P no epo ed),
bu smalle imp o emen s in ST (1.8 ±2.1 mm; P no epo ed), while
he educ ion in CFS was simila (−2.5 ±2.9 poin s; P no epo ed).
Table 2
Summa y o included RCTs compa ing eyelid wa ming de ices Vs. wa m owel comp ess.
Au ho
(da e)
Design F/U
a
Pa ien s Age
b
Sex (F/M) Eyes Inclusion c i e ia Eyelid wa ming de ice Wa m owel
comp ess
CoI
Sim e al. [36]
2014A
MN
SM
12 45 53.6 ±11.5 34/14 45 •D y eye symp oms
•A leas one MG opening wi h pou ing
•A leas one obse able plugged MG
Blephas eam (Twice a day 10 min,
empe a u e no epo ed)
Wa m owel
comp ess (Twice a
day 10 min)
No
Sim e al. [36]
2014B
MN
SM
12 39 54.7 ±10.2 29/12 39 •D y eye symp oms
•A leas one MG opening wi h pou ing
•A leas one obse able plugged MG
EyeGiene (Twice a day 10 min,
empe a u e no epo ed)
Wa m owel
comp ess (Twice a
day 10 min)
No
Tan e al. [37]
2017
MN
SM
1 31 26.1 ±10 21/10 31 •OSDI sco e ≥13 poin s
•A leas one obse able plugged MG
B ude mois hea eye comp ess
(Only once 5 min, 40 C◦)
Wa m owel
comp ess (Only once
5 min)
Yes
Mu phy e al.
[39] 2019A
MN
SM
8 26 55.7 ±17 18/8 26 •MGD g ade ≥1 OPTASE mois hea eye mask
(Twice a day 10 min, empe a u e
no epo ed)
Wa m owel
comp ess (Twice a
day 10 min)
Yes
Mu phy e al.
[39] 2019B
MN
SM
8 28 58.6 ±15.1 19/9 28 •MGD g ade ≥1 MGDRx eyebag (Twice a day
10 min, empe a u e no epo ed)
Wa m owel
comp ess (Twice a
day 10 min)
Yes
Wang e al.
[41] 2024
MT
UM
12 134 41.6 ±13.7 100/34 134 •OSDI sco e ≥13 poin s
•NIBUT sco e <5 s
•ST ≥5 mm a e 5 min
•MG quali y and exp essibili y
abno mali ies
Wa myou S eam eye mask (Twice a
day 12 min, 41 C◦)
Wa m owel
comp ess (Twice a
day 12 min)
No
CoI =Con lic o in e es ; SM =Single-masked; F =Female; F/U =Follow-up; M =Male; MG =Meibomian gland; MN =Monocen e ; MT =Mul icen e ; NIBUT =Non-
in asi e ea ilm b eak-up ime; OSDI =Ocula su ace disease index; RCTs =Randomized con olled ials; ST =Schi me es wi hou anes hesia; UM =Unmasked.
a
Exp essed as weeks excep o Tan e al., 2017 [37], which was exp essed in hou s.
b
Exp essed as mean ±SD (s anda d de ia ion).
Table 3
Summa y o included RCTs compa ing mois u e chambe goggles Vs. wa ming comp ess de ices.
Au ho (da e) Design F/U
a
Pa ien s Age
b
Sex
(F/M)
Eyes Inclusion c i e ia Eyelid wa ming de ice Con ol CoI
Sim e al. [36]
2014C
MN
SM
12 41 52 ±10.7 25/16 41 •D y eye symp oms
•A leas one MG opening wi h pou ing
•A leas one obse able plugged MG
Blephas eam (Twice a day
10 min, empe a u e no
epo ed)
EyeGiene (Twice a day 10 min,
empe a u e no epo ed)
No
Ola sson e al.
[40] 2021
MT
UM
24 48 55.4 ±8.2 33/15 96 •NIBUT sco e <10 s
•ST ≥5 mm a e 5 min
•MG quali y and exp essibili y sco e ≥1
Blephas eam (Once a day
10 min, empe a u e no
epo ed)
The apea l eye mask (Once a
day 10 min, empe a u e no
epo ed)
Yes
CoI =Con lic o in e es ; SM =Single-masked; F =Female; F/U =Follow-up; M =Male; MG =Meibomian gland; MN =Monocen e ; MT =Mul icen e ; NIBUT =Non-
in asi e ea ilm b eak-up ime RCTs =Randomized con olled ials; ST =Schi me es wi hou anes hesia; UM =Unmasked.
a
Exp essed as weeks.
b
Exp essed as mean ±SD (s anda d de ia ion).
A. Balles e os-S´
anchez e al.
The Ocula Su ace 37 (2025) 33–46
37
Bo h s udies epo ed no signi ican changes in TBUT ac oss he wo
g oups. Howe e , Tan e al. [37] epo ed ha he applica ion o he
B ude ® mois hea eye comp ess esul ed in an imp o emen in TBUT
(3.3 ±3.8 s; P no epo ed), while i emained unchanged in he wa m
owel comp ess g oup. Mu phy e al. [39] (2019 A) indica ed ha he
use o he OPTASE® mois hea mask led o imp o emen s in d y eye
symp oms (−12.5 ±10.8 poin s; P =0.022) and CFS (−0.3 ±0.2 poin s;
P =0.035), while ST dec eased (−5 ±4.3 mm; P =0.570) and TBUT
emained unchanged. By con as , he wa m owel comp ess g oup
showed smalle imp o emen s in d y eye symp oms (−9.1 ±7.2 poin s;
P =0.038) and wo sening in TBUT (−1 ±0.8 s; P =0.954) and ST (−2
±1.6 mm; P =0.209), al hough he educ ion in CFS was g ea e (−0.8
±0.7 poin s; P =0.043). Mu phy e al. [39] (2019 B) epo ed ha he
applica ion o he MGDRx Eyebag® imp o ed d y eye symp oms (−23.1
±21.6 poin s; P =0.023), TBUT (1.7 ±1.6 s; P =0.870), and CFS (−0.7
±0.6 poin s; P =0.007), while ST dec eased (−5.7 ±5.3 mm; P =
0.935). In compa ison, he wa m owel comp ess g oup demons a ed
smalle imp o emen s in d y eye symp oms (−9.1 ±7.2 poin s; P =
0.038), wo sening o TBUT (−1 ±0.8 s; P =0.954), and a simila
educ ion in CFS (−0.8 ±0.7 poin s; P =0.043), along wi h a dec ease
in ST (−2 ±1.6 mm; P =0.209). Wang e al. [41] obse ed ha he
applica ion o he Wa myou® s eam eye mask led o imp o emen s in
d y eye symp oms (−20.7 ±42.1 poin s; P <0.05), TBUT (2.3 ±4.7 s; P
<0.05), ST (1.2 ±2.4 mm; P <0.05), and CFS (−1.3 ±2.6 poin s; P <
0.05). In con as , he wa m owel comp ess g oup exhibi ed smalle
imp o emen s in d y eye symp oms (−6.7 ±13.8 poin s; P <0.05) and
CFS (−0.5 ±1 poin s; P <0.05), while ST dec eased (−1.2 ±2.5 mm; P
>0.05) and TBUT emained unchanged.
Table 4
In a-g oup and in e -g oup di e ences ou comes o eyelid wa ming de ices Vs. con ol.
Au ho (Da e) Eyelid wa ming de ices Con ol In e -g oup di e ences
b
OSDI NIBUT MG d opou OSDI NIBUT MG d opou OSDI NIBUT MG d opou
Bilkhu e al. [35] 2014 Baseline 43.9 ±13.4 9.5 ±3.7 2.9 ±1.3 43 ±14.4 9.2 ±3.6 2.8 ±1.2
Las isi 20.7 ±8.7 11.4 ±3.5 2.1 ±1.2 39.8 ±12.7 9.3 ±3.5 2.7 ±1
Di e ence
a, c
¡23.2 ± 28.1*1.9 ± 2.3*¡0.8 ± 0.9*¡3.2 ± 3.8 0.1 ± 0.1 ¡0.1 ± 0.1 ¡20*1.8*
¡0.7*
Ngo e al. [38]
d
2018 Baseline 39.1 ±12.6 2.9 ±1.3 2.2 ±1.4 41.3 ±15.4 3.1 ±1.2 2.2 ±1.6
Las isi 27.7 ±14.6 3.0 ±0.9 2.2 ±1.4 35.6 ±23.2 3.1 ±0.9 1.8 ±1.4
Di e ence
a, c
¡11.4 ± 8.9*0.1 ± 0.07 0 ± 0.1 ¡5.7 ± 4.7 0 ± 0.1 ¡0.4 ± 0.3 ¡5.7 0.1
0.4
CFS =Co neal luo escein s aining; LLT =Lipid laye hickness; MG =Meibomian gland; NIBUT =Non-in asi e ea ilm b eak-up ime.
* S a is ical signi icance epo ed by s udies wi h P- alue <0.05.
a
De ined as “Las isi – Baseline.”
b
De ined as “Eyelid wa ming de ice
(Las isi – Baseline)
– Con ol g oup
(Las isi – Baseline)
.”
c
The s anda d de ia ion o he in a-g oup mean di e ence was es ima ed ollowing he guidelines o he Coch ane Handbook o Sys ema ic Re iews o In e en ions
[49].
d
The s anda d de ia ion o baseline and las isi ou comes was es ima ed ollowing he guidelines o he Coch ane Handbook o Sys ema ic Re iews o In e en ions
[49], based on he 95 % con idence in e als epo ed by Ngo e al. [38].
Fig. 3. O e all e icacy o eyelid wa ming de ices compa ed o he con ol g oups. Fo es plo showing he s anda dized mean di e ence (SMD), 95 % con idence
in e als (CI) and P alue o he change d y eye symp oms, non-in asi e ea ilm b eak-up ime (NIBUT) and meibomian gland (MG) d opou . A andom e ec s
model was pe o med, e ealing no s a is ically signi ican di e ence be ween eyelid wa ming de ices and he con ol g oup.
A. Balles e os-S´
anchez e al.
The Ocula Su ace 37 (2025) 33–46
38
Table 5
In a-g oup and in e -g oup di e ences ou comes o eyelid wa ming de ices Vs. wa m owel comp ess.
Au ho (Da e) Eyelid wa ming de ices Wa m owel comp ess In e -g oup di e ences
b
D y eye symp oms Tea ilm s abili y ST CFS D y eye symp oms TBUT ST CFS D y eye symp oms TBUT ST CFS
Sim e al. [36]
d
2014 A
Baseline 41.1 ±27.6 2 ±0.4 13 ±4.1 1.5 ±0.7 52.4 ±20.1 1.9 ±0.3 8.7 ±4.4 3.2 ±0.7
Las isi 22.6 ±17.7 2.8 ±0.5 14.3 ±11.2 0.5 ±0.3 38.6 ±20.5 2.3 ±0.4 10.5 ±11 0.7 ±0.2
Di e ence
a, c
¡18.5 ± 21.9 0.8 ± 0.6 1.3 ± 1.5 ¡1 ± 1.2 ¡13.8 ± 16.3 0.4 ± 0.6 1.8 ± 2.1 ¡2.5 ± 2.9 ¡4.7 0.4 ¡0.5 1.5
Sim e al. [36]
d
2014 B
Baseline 27.2 ±20.9 2.3 ±0.4 9.3 ±4.7 3.4 ±0.9 52.4 ±20.1 1.9 ±0.3 8.7 ±4.4 3.2 ±0.7
Las isi 20.5 ±18.4 2.5 ±0.3 12.4 ±10.5 0.9 ±0.4 38.6 ±20.5 2.3 ±0.4 10.5 ±11 0.7 ±0.2
Di e ence
a, c
¡6.7 ± 6.5 0.2 ± 0.5 3.1 ± 3¡2.5 ± 2.4 ¡13.8 ± 16.3 0.4 ± 0.6 1.8 ± 2.1 ¡2.5 ± 2.9 7.1 ¡0.2 1.3 0
Tan e al. [37]
2017
Baseline NR 8.7 ±8.1 NR NR NR 8.5 ±5.2 NR NR
Las isi NR 12.0 ±9.4 NR NR NR 8.7 ±6.6 NR NR
Di e ence
a, c
- 3.3 ± 3.8 - - - 0.2 ± 0.1 - - - 3.1 - -
Mu phy e al. [39]
d
2019 A
Baseline 39 ±20.3 4.1 ±0.9 19.3 ±6.9 0.5 ±0.6 24. 2 ±15.3 6.2 ±3.3 12.1 ±3.3 1 ±0.6
Las isi 26.5 ±17.2 4.6 ±0.6 14.3 ±3.2 0.2 ±0.2 15.1 ±12.8 5.2 ±1.9 9.4 ±1.8 0.2 ±0.2
Di e ence
a, c
¡12.5 ± 10.8*0.5 ± 0.4 ¡5 ± 4.3 ¡0.3 ± 0.2*¡9.1 ± 7.2*¡1 ± 0.8 ¡2 ± 1.6 ¡0.8 ± 0.7*¡3.4 1.5 ¡3 0.5
Mu phy e al. [39]
d
2019 B
Baseline 39.8 ±23.2 6.2 ±2.4 27.5 ±6.8 0.9 ±0.5 24. 2 ±15.3 6.2 ±3.3 12.1 ±3.3 1 ±0.6
Las isi 16.7 ±13.1 7.9 ±3.2 21.8 ±4.8 0.2 ±0.2 15.1 ±12.8 5.2 ±1.9 9.4 ±1.8 0.2 ±0.2
Di e ence
a, c
¡23.1 ± 21.6*1.7 ± 1.6 ¡5.7 ± 5.3 ¡0.7 ± 0.6*¡9.1 ± 7.2*¡1 ± 0.8 ¡2 ± 1.6 ¡0.8 ± 0.7*¡14 2.7 ¡3.7 0.1
Wang e al. [41]
2024
Baseline 27 ±13.7 2.7 ±1.7 11.3 ±9 1.8 ±2.4 25.9 ±13.3 2.9 ±1.7 10.6 ±9.3 1.9 ±3.0
Las isi 6.3 ±5.5 5 ±3 12.5 ±8.8 0.5 ±1.3 19.2 ±11.5 3.2 ±2.4 9.4 ±7 1.4 ±2.5
Di e ence
a, c
¡20.7 ± 42.1*2.3 ± 4.7*1.2 ± 2.4 ¡1.3 ± 2.6*¡6.7 ± 13.8*0.3 ± 0.6 ¡1.2 ± 2.5 ¡0.5 ± 1*¡14*2*2.4 ¡0.8*
CFS =Co neal luo escein s aining; OSDI =Ocula su ace disease index; ST =Schi me es .
* S a is ical signi icance wi h a P alue <0.05.
a
De ined as “Las isi – Baseline.”
b
De ined as “Eyelid wa ming de ice
(Las isi – Baseline)
– Wa m owel comp ess
(Las isi – Baseline).”
.
c
The s anda d de ia ion o he in a-g oup mean di e ence was es ima ed ollowing he guidelines o he Coch ane Handbook o Sys ema ic Re iews o In e en ions [49].
d
Baseline and las isi mean ±s anda d de ia ion was es ima ed ollowing he guidelines o he Coch ane Handbook o Sys ema ic Re iews o In e en ions [49], based on he median and in e qua ile ange epo ed by
Sim e al. [36] and Mu phy e al. [39] o TBUT, ST, and CFS.
A. Balles e os-S´
anchez e al.
The Ocula Su ace 37 (2025) 33–46
39
Rega ding in e -g oup ou comes, all s udies showed a o able esul s
o eyelid wa ming de ices in alle ia ing d y eye symp oms and
imp o ing TBUT, excep Sim e al. [36] (2014 B). Speci ically, Sim e al.
[36] (2014 A) ob ained a educ ion o −4.7 poin s (P =0.021) and in-
c ease o 0.4 s (P =0.612) in d y eye symp oms and TBUT, espec i ely.
Simila ly, Mu phy e al. [39] (2019 A) epo ed a educ ion o −3.4
poin s (P no epo ed) in d y eye symp oms and inc ease o 1.5 s (P no
epo ed) in NIBUT. In con as , Mu phy e al. [39] (2019 B) and Wang
e al. [41] showed la ge imp o emen s, bo h indica ing a educ ion o
−14 poin s (P no epo ed o Mu phy e al. [39]; P <0.05 o Wang
e al. [41]) in d y eye symp oms and inc eases o 2.7 (P no epo ed)
and 2 s (P <0.05) in TBUT, espec i ely. In addi ion, Tan e al. [37] also
epo ed a o able esul s o he eyelid wa ming de ices in enhancing
TBUT, wi h a alue o 3.1 s (P >0.05). Howe e , con as ing esul s
we e obse ed o ST and CFS be ween he s udies.
3.3.1. Me a-analysis
Fo es plo s showing he e icacy o eyelid wa ming de ices Vs. wa m
owel comp esses is p esen ed in Fig. 4. Fou s udies we e included in
he me a-analysis [36,37,39,41]. The o e all e icacy did no a o
ei he g oup. Howe e , only he change in ea ilm s abili y (SMD 0.97;
95 % CI: 0.32 o 1.61; P =0.003; I
2
=83 %) indica ed ha he eyelid
wa ming de ices had signi ican ly be e ou come han he wa m owel
comp ess g oup. In he sensi i i y analyses, o e all e icacy was also no
in a o o ei he ea men . Howe e , he change in OSDI ques ionnai e
(MD 9.41; 95 % CI: 1.70 o 17.13; P =0.02; I
2
=49 %) and NIBUT (MD
2.24; 95 % CI: 1.20 o 3.28; P <0.0001; I
2
=71 %) indica ed ha he
eyelid wa ming de ices had signi ican ly be e ou comes han he wa m
owel comp esses, while TBUT, ST and CFS showed no s a is ical sig-
ni icance be ween he wo g oups. Mo e de ailed esul s o he sensi-
i i y analyses a e p esen ed in he Supplemen al Digi al Con en 2 and
3.
Fig. 4. O e all e icacy o eyelid wa ming de ices compa ed o he wa m owel comp ess g oups. Fo es plo showing he s anda dized mean di e ence (SMD), 95 %
con idence in e als (CI) and P alue o he change d y eye symp oms, ea ilm b eak-up ime (TBUT), Schi me es (ST) and co neal luo escein s aining (CFS). A
andom e ec s model was pe o med, e ealing no s a is ically signi ican di e ence be ween eyelid wa ming de ices and wa m owel comp ess.
A. Balles e os-S´
anchez e al.
The Ocula Su ace 37 (2025) 33–46
40
3.4. Mois u e chambe de ices s. wa m comp ess de ices
Rega ding he measu emen me hods, Sim e al. [36] (2014 C) u i-
lized he SANDE ques ionnai e, whe eas Ola sson e al. [40] employed
he OSDI ques ionnai e. Bo h s udies e alua ed ST wi hou anes hesia,
wi h esul s epo ed as he we ing leng h o he s ip o e a 5-min
pe iod. Addi ionally, he Ox o d g ading scale was applied o assess
CFS. In e m o ea ilm s abili y, bo h s udies pe o med NIBUT.
In a-g oup and in e -g oup e icacy and sa e y esul s a e displayed
in Table 6. Rega ding in a-g oup ou comes, Sim e al. [36] (2014 C)
epo ed ha he applica ion o Blephas eam® esul ed in imp o emen s
in d y eye symp oms (−18.5 ±21.9 poin s; P no epo ed), ST (1.3 ±
1.5 mm; P no epo ed), and CFS (−1 ±1.2 poin s; P no epo ed).
Howe e , he EyeGiene® mask showed smalle imp o emen s in d y eye
symp oms (−6.7 ±6.5 poin s; P no epo ed), while ST (3.1 ±3 mm; P
no epo ed) and he educ ion in CFS was g ea e (−2.5 ±2.4 poin s; P
no epo ed). TBUT emained unchanged in bo h g oups. Simila ly.
Ola sson e al. [40] ound ha he use o Blephas eam® imp o ed d y
eye symp oms (−15.5 ±18.8 poin s; P no epo ed), TBUT (3.8 ±4.6 s;
P no epo ed) and ST (4.6 ±5.6 mm; P no epo ed), while CFS
emained unchanged. Con e sely, he The apea l® eye mask ob ained
lowe imp o emen s in d y eye symp oms (−11.7 ±13.5 poin s; P no
epo ed) and TBUT (1.9 ±2.2 s; P no epo ed), while ST (−1.8 ±2.1
mm; P no epo ed) and CFS (1 ±1.2 poin s; P no epo ed) showed a
wo sening.
Rega ding in e -g oup ou comes, bo h s udies showed a o able e-
sul s o he Blephas eam® in alle ia ing d y eye symp oms and
enhancing TBUT. Speci ically, Sim e al. [36] (2014 C) ob ained a
educ ion o −11.8 poin s (P no epo ed) in d y eye symp oms and
inc ease o 0.6 s (P no epo ed) in TBUT, while Ola sson e al. [40]
epo ed a educ ion o −3.8 poin s (P =0.92) in d y eye symp oms and
inc ease o 1.9 s (P =0.89) in TBUT. Howe e , con as ing esul s we e
obse ed o ST and CFS be ween he 2 s udies.
3.4.1. Me a-analysis
Fo es plo s showing he e icacy o mois u e chambe de ices Vs.
wa m comp ess de ices is p esen ed in Fig. 5. Two s udies we e included
in he me a-analysis [36,41]. The o e all e icacy did no a o ei he
g oup. Howe e , only he change in TBUT (SMD 0.75; 95 % CI: 0.23 o
1.28; P =0.005; I
2
=30 %) indica ed ha Blephas eam® had signi i-
can ly be e ou comes han he wa m comp ess eyelid de ices g oup.
3.5. Risk o bias
The isk o bias summa y o he included s udies is p esen ed in
Fig. 6A. Risk o bias assessmen was classi ied in o h ee e idence le el
g oups: (1) s udies wi h a low isk o bias (Bilkhu e al. [35], Sim e al.
[36], Ngo e al. [38] and Mu phy e al. [39]) (2) s udies wi h an unclea
isk o bias (Ola sson e al. [40] and Wang e al. [41]) and (3) s udies
wi h a high isk o bias (Tan e al. [37]). The o e all isk o bias summa y
o he domains used in each s udy is p esen ed in Fig. 6B. The i ems used
o assess he isk o bias showed an o e all isk o bias ha was low a >
50 %. The Rob is ool (NIHR, B is ol, UK) was used o c ea e isk o bias
assessmen igu es [47].
4. Discussion
MGD is he mos equen pa hogenic mechanism unde lying e ap-
o a i e d y eye, which is ecognized as he mos p e alen a ian o
DED [5–7]. New in-o ice ea men s ha e eme ged o imp o e d y eye
signs and symp oms. Howe e , due o he ch onici y o his disease and
he ele a ed cos s o hese ea men s [25,26], wa m comp ess he apy
emains as a i s -s ep ea men [29]. This sys ema ic e iew wi h
me a-analysis aimed o in es iga e he e ec i eness o eyelid wa ming
de ices in he ea men o MGD. To achie e his goal, eyelid wa ming
de ices we e compa ed o con ol g oups and wa m owel comp esses.
Table 6
In a-g oup and in e -g oup di e ences ou comes o mois u e chambe de ices Vs. wa m comp ess de ices.
Au ho (Da e) Mois u e chambe de ices Wa m comp ess de ices In e -g oup di e ences
b
D y eye symp oms TBUT ST CFS D y eye symp oms TBUT ST CFS D y eye symp oms TBUT ST CFS
Sim e al. [36]
2014C
Baseline 41.1 ±27.6 2 ±0.4 13 ±4.1 1.5 ±0.7 27.2 ±20.9 2.3 ±0.4 9.3 ±4.7 3.4 ±0.9
Las isi 22.6 ±17.7 2.8 ±0.5 14.3 ±11.2 0.5 ±0.3 20.5 ±18.4 2.5 ±0.3 12.4 ±10.5 0.9 ±0.4
Di e ence
a, c
¡18.5 ± 21.9 0.8 ± 0.6 1.3 ± 1.5 ¡1 ± 1.2 ¡6.7 ± 6.5 0.2 ± 0.5 3.1 ± 3¡2.5 ± 2.4 ¡11.8 0.6 ¡1.8 1
Ola sson e al. [40]
d
2021 Baseline 38.7 ±20.4 4.7 ±2.1 17.7 ±10.5 1.50 ±0.7 32.9 ±19.2 4.9 ±2.5 18.9 ±11.3 1.00 ±0.01
Las isi 23.2 ±21.7 8.5 ±4.5 22.3 ±12.5 1.50 ±1.8 21.2 ±14.8 6.8 ±3.7 17.1 ±9.5 2.00 ±1.2
Di e ence
a, c
¡15.5 ± 18.8 3.8 ± 4.6 4.6 ± 5.6 0 ± 0.1 ¡11.7 ± 13.5 1.9 ± 2.2 ¡1.8 ± 2.1 1 ± 1.2 ¡3.8 1.9 6.4 ¡1*
CFS =Co neal luo escein s aining; LLT =Lipid laye hickness; MG =Meibomian gland; TBUT = ea ilm b eak-up ime wi h luo escein; ST =Schi me es wi hou anes hesia.
* S a is ical signi icance epo ed by he s udies wi h P- alue <0.05.
a
De ined as “Las isi – Baseline.”
b
De ined as “Mois u e chambe de ices
(Las isi – Baseline)
– Eyelid wa m comp ess de ices
(Las isi – Baseline).”
.
c
The s anda d de ia ion o he in a-g oup mean di e ence was es ima ed ollowing he guidelines o he Coch ane Handbook o Sys ema ic Re iews o In e en ions [49].
d
The s anda d de ia ion o baseline and las isi ou comes was es ima ed ollowing he guidelines o he Coch ane Handbook o Sys ema ic Re iews o In e en ions [49], based on he 95 % con idence in e als epo ed
by Ola sson e al. [40].
A. Balles e os-S´
anchez e al.
The Ocula Su ace 37 (2025) 33–46
41
