Author Block: Mišo Gostimir, Larry Allen

Author Disclosure Block: M. Gostimir: None. L. Allen: None.

Title:A Systematic Review of the Role of Eyelid Wipes in the Management of Blepharitis and Meibomian Gland Dysfunction

Abstract Body:

Purpose: Eyelid hygiene is the mainstay of blepharitis management and while eyelid wipes are routinely recommended, the wide range of options available and remarkable variability in their use can be confusing for patients and physicians. Furthermore, routine and potentially life-long treatment with eyelid wipes does not come without financial cost and potential adverse effects. The purpose of this review was to provide a comprehensive summary of all existing evidence for the efficacy of eyelid wipes in the management of blepharitis.
Study Design: Systematic review.
Methods: A search of Medline and Embase (1946 to 2019) was conducted to identify all relevant studies which assessed the efficacy of eyelid wipes in patients with blepharitis. Studies of patients with demodex-associated blepharitis were also included. Studies that included other interventions as a combination treatment were excluded, as well as studies that evaluated warm compresses. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs, the MINORS tool for nonrandomized studies, and the modified Delphi tool for case series studies. An adverse effect analysis was performed as well as a cost (CAD) and availability (in Canada) assessment.
Results: Following the review of 1650 search results, 16 studies were included. Of these, 10 studies pertained to patients with blepharitis and 6 pertained to patients with demodex-associated blepharitis. A variety of eyelid wipes were studied among both groups of patients and included generic household products, tea tree oil (TTO)-based products, commercial solutions, and commercial wipes. Some degree of improvement was demonstrated within 1 or 2 months for all options that were studied. There was not enough evidence to determine the relative effectiveness of different options. There was significant heterogeneity and all non-generic options were limited to 1 study, which precluded meta-analysis. The risk of bias assessment revealed concerns regarding the quality of evidence, and notably, almost half of the studies were industry-supported or reported potential conflicts of interest.
Conclusions: While some efficacy has been demonstrated for several eyelid wipe options, including generic ones, there remains a lack of robust evidence to support their routine recommendation and there are concerns about the quality of evidence currently available. Long-term costs and potential adverse effects should not be overlooked. There is also not enough evidence to suggest the superiority of one option over others.