Efficacy of eyelid warming therapies in contact lens-related dry eye and comfortable wearing time: a systematic review with meta-analysis

Ophthalmic Physiol Opt. 2026 Mar;46(1):101-115. doi: 10.1007/s44402-026-00024-4. Epub 2026 Feb 27.

ABSTRACT

PURPOSE: To analyse the efficacy and safety of eyelid warming therapies in the management of contact lens-related dry eye (CLDE) and their impact on comfortable contact lens (CL) wearing time.

METHODS: A systematic review with meta-analysis, reporting on the efficacy and/or safety of eyelid warming therapies for CLDE and/or comfortable CL wearing time in three databases, PubMed, Scopus and Web of Science, was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.

RESULTS: Four randomised controlled trials were included. Analyses revealed significant differences only between eyelid warming therapies and negative controls for ocular surface disease index scores (mean difference (MD): 19.57; 95% CI: 12.51-26.64; I2 = 0%; p < 0.001), with LipiFlow® and warm compresses showing comparable results (p = 0.53). Warm compresses did not achieve significant improvements in tear film break-up time (MD: 0.80; 95% CI: -0.29 to 1.88; I2 = 0%; p = 0.15), lipid layer thickness (MD: 4.54; 95% CI: -5.73 to 14.81; I2 = 0%; p = 0.39) or comfortable CL wearing time (MD: -0.06; 95% CI: -1.19 to 1.06; I2 = 0%; p = 0.91) when compared with positive controls, nor in the Schirmer test when compared with negative/positive controls (MD: -0.46; 95% CI: -4.17 to 3.25; I2 = 24%; p = 0.81). Regarding safety, most studies reported no adverse events and demonstrated a satisfactory tolerability profile for eyelid warming therapies. However, a meta-analysis could not be performed.

CONCLUSIONS: The efficacy of eyelid warming therapies for alleviating CLDE and improving comfortable CL wearing time is limited. Further randomised controlled trials following the consolidated standards of reporting trials (CONSORT) guidelines are needed to confirm these findings.

PMID:41893995 | DOI:10.1007/s44402-026-00024-4