Eyelid Exfoliation Treatment Efficacy and Safety in Dry Eye Disease, Blepharitis, and Contact Lens Discomfort Patients: A Systematic Review

Purpose:To determine the efficacy and safety of eyelid exfoliation treatment in dry eye disease (DED), blepharitis, and contact lens (CL) discomfort patients. Methods:A systematic review that included only full-length randomized controlled studies, reporting the effects of eyelid exfoliation treatment in 2 databases, PubMed and Web of Science, was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The search period was between October 29, 2022 and December 6, 2022. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. Results:A total of 7 studies were included in this systematic review. Eyelid exfoliation treatment influence on DED, blepharitis, and CL discomfort were analyzed in 6, 4, and 2 studies, respectively. Eyelid exfoliation treatment achieved a better improvement than control group interventions in all reported variables. The mean differences between both groups were as follows: Ocular Surface Disease Index score of -5.0 +/- 0.9 points, tear breakup time of 0.43 +/- 0.2 seconds, ocular surface staining of -1.4 +/- 1.5 points, meibomian glands secretions of 1.2 +/- 1.1 points, meibomian glands yielding liquid secretion of 0.6 +/- 0.3 points, microorganism load of -3.2 +/- 4.7 points, and Contact Lens Dry Eye Questionnaire-8 of -2.15 +/- 0.1 points. Minimal discomfort (n = 13) and eyelid irritation (n = 2) were the main complications after an eyelid exfoliation treatment. Conclusions:Eyelid exfoliation is a safe and effective treatment that should be indicated for DED, blepharitis, and CL discomfort.