All relevant original articles with English full-text were included. Studies were identified through PubMed on the May 28, 2021, with the search terms: (warm* OR heat* OR thermal* OR towel OR wet towel) AND (meibomian OR MGD OR eyelid OR “dry eye” OR DED). To evaluate the literature on hot towels in MGD treatment and recommend a best-practice protocol for future research and patient treatment. However, the efficacy of this treatment is reliant on the methodology, and evidence-based best-practice recommendations are needed. The most accessible method for eyelid warming uses heated, wet towels. Heating the eyelids to soften and express meibum from the glands can be beneficial. Thickened meibum obstructs the glands and disrupts ocular surface health. Meibomian gland dysfunction (MGD) reduces quality-of-life and hinders work productivity of millions of patients, with high direct and indirect societal costs. As such, this method of WC application can be recommended for supplemental at-home therapy for meibomian gland dysfunction and any condition requiring that therapeutic heat of 40☌ be administered to the meibomian glands. The Bundle method, although the most labor intensive, increased lid temperatures above therapeutic levels, as reported in the literature, for all measured sections during the WC application. The chemically activated EyeGiene, MGDRx EyeBag, and MediBeads compresses resulted in the lowest temperature increase at the inner palpebral surface. Out of the eight methods tested, the bundled wet/moist towel method was the only compress that elevated the temperature of all three lid surfaces (external upper, external lower, and internal lower lids) to 40☌ or higher. The mean (±SD) age of the patients was 42.2 (☒0.3) years. Microwaved compresses were heated to 47 ± 1.0☌ two compresses were self-heating and thus not under investigator control. Each participant underwent each of the eight treatments under study. For both test and control eyes, the temperature of the external upper, external lower, and internal lower lids was measured at baseline and every 2 minutes for 10 minutes during application. A paired contralateral design was used each subject had a heated test eye and an unheated control eye. Various forms of contact and noncontact WC heating methods (dry, wet/moist, and chemically activated dry heat) were tested. Five patients were fully consented and enrolled. Inclusion criteria included the following: 18 years or older and willingness to participate in the study, no current ocular inflammation/disease, and no ocular surgery within the last 6 months. To investigate which warm compress (WC) methods used in a small case series are the most effective in providing heat to the inner eyelids for the supplemental treatment of meibomian gland dysfunction.
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