Background: Meibomian gland dysfunction (MGD) is a common cause of dry eye disease (DED) for which patients and physicians often desire non-pharmacological treatments. We describe the efficacy of affordable eye warmers and warm compress that can be used at home in treating DED secondary to MGD.
Methods: This systematic review was conducted using the Distiller SR software. PRISMA statement guidelines were followed. Databases searched included Embase, Cochrane Library, MEDLINE (Ovid), and CINAHL. Grey literature searched included Web of Science, ProQuest Dissertations and Theses, ClinicalTrials.gov and abstracts from COS, AAO, and ARVO. Three stages of screening, including title, abstract and full-text screening were completed before quality assessment and data extraction. Meta-analysis was conducted using STATA 15.0.
Results: The database search and grey literature search resulted in 1438 studies. Following title screening, 116 studies remained and after abstract screening, 76 were screened for full-text. Eight studies (619 eyes) moved to data extraction. Meta-analysis indicated a significant increase in tear break-up time (TBUT) with use of EyeGiene (SMD = 0.64; CI:[0.38,0.90]), EyeBag (SMD = 0.53; CI:[0.29,0.77]), Eye Warmer (SMD = 0.96; CI:[0.70,1.22]) and warm compress with menthol (SMD = 0.89; CI:[0.50,1.28]). Overall, there was a significant increase in TBUT values using eye-lid warmer devices (SMD = 0.50; CI:[0.23,0.78]). 
Conclusions:  TBUT values increased significantly using warm compress and eye warmers. We believe that warm compress and eye warmers may play an important role in the management of DED secondary to MGD. More randomized controlled trials should be conducted to make concrete conclusions.

The use of warm compress and eye warmers in the treatment of dry eye disease, a systematic review and meta-analysis

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