Thermal Pulsation May Improve DED, But Unbiased Studies Are Lacking

A single 12-minute thermal pulsation session may improve the signs and symptoms of meibomian gland dysfunction (MGD) and dry eye disease (DED), but a lack of independent, unbiased studies that are not supported by industry may cast doubt on these findings, according to a literature review published in Ophthalmology.

Researchers performed a literature search in the PubMed database in June 2022 and in March 2023 to identify investigations evaluating the efficacy of a single 12-minute thermal pulsation treatment for managing MGD and DED signs and symptoms. The panelists included 11 articles in the review and rated the quality of methodologies for each study using American Academy of Ophthalmology guidelines adapted from the 2011 Oxford Center for Evidence-Based Medicine (I, well-designed and well-conducted randomized
controlled trials and systematic reviews; II, well-designed cohort studies and non
randomized controlled cohort or follow-up trials; III, case series or lower-quality case-
controlled or cohort studies).

Among the studies included in the review, 8 received a level I rating and 3 received a level II rating. Overall, a majority of the studies (n=9) reported greater treatment efficacy with thermal pulsation compared with warm compress or eyelid hygiene treatments. However, the researchers report that 4 of these investigations had a relevant industrial conflict of interest. Neither of the 2 studies reporting similar efficacy between thermal pulsation and conservative management strategies had an industrial conflict of interest, according to the report. None of the investigations included in the review reported any serious adverse events with treatment.

“Thermal pulsation seems to be safe and may add to the therapeutic armamentarium for MGD and dry eye, and it may fill a void if regimented eyelid hygiene and warm compress therapy are not possible or not desirable,” according to the researchers. 

However, the team cautions that “[i]ndependent, unbiased studies of different thermal pulsation treatment frequencies and controlled studies of other thermal pulsation platforms in diverse populations are warranted.”

Study limitations include the assessment of only 1 type of thermal pulsation treatment and a lack of ethnic diversity within the study population.