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. 2025 Apr;48(2):102335.
doi: 10.1016/j.clae.2024.102335. Epub 2024 Nov 18.

LipiFlow for the treatment of dry eye disease: A Cochrane systematic review summary

Tsz Wing Yim  1 , Andrew D Pucker  2 , Erin Rueff  3 , William Ngo  4 , Anna A Tichenor  5 , John E Conto  6
Affiliations

LipiFlow for the treatment of dry eye disease: A Cochrane systematic review summary

Tsz Wing Yim et al. Cont Lens Anterior Eye. 2025 Apr.

Abstract

Purpose: To evaluate the effectiveness and the safety of LipiFlow for treating signs and symptoms of dry eye disease (DED) in adults.

Methods: The following databases were searched for randomized trials: CENTRAL, MEDLINE Ovid, Embase.com, PubMed, LILACS, ClinicalTrials.gov, and WHO ICTRP on 24 October 2022. The included studies were conducted in adults (≥18 years) with DED or meibomian gland dysfunction (MGD) as defined by the investigators. Standard Cochrane methodology was applied.

Results: This study included 13 trials that randomized a total of 1,155 participants (66 % female; age range = 19 to 86 years). Five trials compared LipiFlow with basic warm compresses. Analyzing symptom scores in these trials yielded conflicting evidence of a difference in symptoms between LipiFlow and basic warm compresses after 4 weeks. There was no evidence of a difference in meibomian gland expression, meibum quality, or tear breakup time when comparing LipiFlow with basic warm compresses. Another 5 trials compared LipiFlow with thermostatic devices. Analysis of symptom scores in these trials at 4 weeks showed that thermostatic devices had reduced Ocular Surface Disease Index (OSDI) scores by a mean difference of 4.59 as compared with LipiFlow. The remaining 3 included trials could not be grouped for comparisons. The overall evidence was of low or very low certainty, with most trials being assessed as having a high risk of bias. No trial reported any intervention-related, vision-threating adverse events.

Conclusions: LipiFlow performs similarly to other DED treatments. Further research with adequate masking and a standardized testing methodology is still needed.

Keywords: Cochrane Systematic Review; Dry Eye Disease; LipiFlow Thermal Pulsation System; Meibomian Gland Dysfunction; Randomized Trials.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Pucker has received research support from Alcon Research, LLC, Art Optical, ScienceBased Health, and the National Eye Institute. He has served as a consultant for Alcon Research, LLC, CooperVision, EpiTech, EyeGate Pharmaceuticals Inc., Kala Pharmaceuticals, Lexitas Pharma Services, Nevakar Inc., and Optikal Care Inc. Dr. Pucker is currently an employee of Lexitas Pharma Services. Dr. Pucker has never been involved in a dry eye device study, and Lexitas Pharma Services did not have active dry eye device studies during the conduct of this work. Ms. Yim reports a grant UG1 EY020522 from the National Eye Institute, National Institutes of Health, USA (payment to institution). Ms. Yim is a Cochrane methodologist but was not involved in the editorial process for this review.Dr. Rueff is a consultant for Johnson & Johnson Vision, Inc. Dr. Ngo is currently consultant for Alcon and Sun Pharma. Dr. Ngo was previously an employee at the Centre for Ocular Research & Education, where research funding has been received from the following companies: Alcon, Allergan, Allied Innovations, Aurinia Pharma, Azura Ophthalmics, Bausch Health Canada, Brien Holden Vision Institute, CooperVision, GL Chemtec, i-Med Pharma, Johnson & Johnson Vision, Lubris, Menicon, Nature's Way, Novartis, Ophtecs, Ote Pharma, PS Therapy, Santen, SightGlass, SightSage, and Visioneering Tech. Drs. Tichenor and Conto report no declarations of interest.

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