Heat and Pressure: What a Head-to-Head Trial Says About Thermal Pulsation for Blocked Oil Glands

If you have meibomian gland dysfunction (MGD), the tiny oil glands along the edges of your eyelids have become sluggish or blocked. Without enough healthy oil, tears evaporate too quickly and eyes can feel gritty, tired or blurry. Thermal pulsation treatments aim to warm the thickened oil and gently press it out of the glands. A 2026 randomised trial from China compared two ways of doing this, and it is worth looking at closely, both for what it found and for what it can't tell us.

What the researchers compared

The trial compared a new portable, hand-operated thermal pulsation device with LipiFlow, an automated system made by Johnson & Johnson Vision. Both apply constant heat of 42.5°C to the upper and lower eyelids. LipiFlow uses an inflatable, pulsing airbag while the patient lies down. The manual device warms the lid by contact and uses a pressing-and-rolling wheel to express the oil, with a magnified display so the operator can give extra attention to the worst-affected areas while the patient sits.

One important detail: the manual device was developed by the study's own authors, who write that they "developed a novel, portable cost-effective device". That makes this an inventor-led evaluation of their own device, and independent studies will be needed.

Who took part and what was done

Adults with dry eye symptoms (a SPEED questionnaire score above 6) and MGD in both eyes were enrolled between December 2022 and April 2023. Of 104 people screened, 84 were randomised, 42 to each device. Everyone had a single treatment session to both eyes and was reviewed at 1, 2 and 4 weeks. During that time they were asked to avoid other treatments such as warm compresses, lid massage, lid cleaning, IPL, antibiotics and steroids, so the devices could be judged on their own.

Eighty people completed follow-up, and the main results are reported for the 76 (38 per group) who followed the protocol. Only the clinician measuring the eyes was masked to which device had been used. Patients knew which treatment they had, and there was no sham (pretend) treatment group.

What they found

The main measure was the meibomian gland score (MGS), a grading of how well the glands release oil, where a fall means improvement. At 4 weeks the score had fallen by the same average amount in both groups: manual −5.82 ± 4.89 points and LipiFlow −5.82 ± 5.87 points. At 1 week the falls were −5.11 and −5.16 respectively.

The trial was designed to test "non-inferiority", meaning whether the new device was not unacceptably worse than LipiFlow. The researchers set the acceptable margin at −7.5 points on the gland score. The lower end of the 95% confidence interval for the difference between devices was −0.775, well inside that margin, so they concluded the manual device was non-inferior. A 95% confidence interval is the range of values the true difference plausibly lies in; here even the least favourable end of that range was much smaller than the margin the authors had chosen.

Tear film stability, measured as non-invasive break-up time (NIBUT), changed only slightly at 4 weeks in both groups (manual +0.58 and +0.18 seconds in the left and right eyes; LipiFlow +0.18 and +0.56 seconds). The difference between groups was not statistically significant (p > 0.05, meaning a gap this size could easily arise by chance), and this outcome also met the authors' non-inferiority margin of −2.5 seconds.

The paper also reports symptom scores, gland expressibility and corneal staining. Some of those printed values carry plus or minus signs that don't match the text describing them, so we have chosen not to quote them until they can be checked.

Side-effects were generally mild and short-lived. Device-related events occurred in 5 of 42 people (11.9%) with the manual device and 6 of 42 (14.3%) with LipiFlow, including temporary foreign-body sensation and redness. Two people in the manual group (4.8%) had a small scratch on the corneal surface. All device-related events settled within 24–48 hours without treatment, and there were no serious adverse events.

What the studies can't tell us

• How long benefits last. This was one treatment with 4 weeks of follow-up. MGD is usually a long-term condition, and the study says nothing about results over months or years.
• How much is placebo. There was no sham group, and patients knew which device they received.
• Whether the test was demanding. The −7.5 point margin is larger than the average improvement in either group (−5.82), so "non-inferior" was a relatively easy bar to clear. Analysing only the 76 people who followed the protocol, rather than all 84 randomised, can also make two treatments look more alike.
• Independence. The developers tested their own device, and a single investigator did all the clinical assessments. The funding and competing-interest statements were not in the text available to us, so we could not check them.
• Whether results apply elsewhere. The trial ran in China during the COVID-19 epidemic, and the authors note LipiFlow results here were lower than in some other studies.

In short, this study does not show that either device is better than the other. It suggests that, four weeks after a single session, the two produced similar changes in gland scores in this group of patients.

What this means for you

Whichever tool is used, the goal is the same: getting the meibomian glands flowing, and then keeping them flowing. A single in-clinic session is usually only one part of that. Home lid care, managing inflammation, addressing contributors such as Demodex mites or screen habits, and regular review all play a role. That is what we mean by treating the cause, not the symptom.

The right plan depends on a proper assessment of your glands, tear film and eye surface. You can read how a specialist dry eye workup is done, and explore the range of dry eye treatments clinicians draw on. At Rose Optometry in Hamilton, a DESG member practice, the optometry team, including Jagrut Lallu and Jacqueline Rowe, offers LipiFlow through its Dry Eye Clinic, with a paid Dry Eye Evaluation to work out whether it suits you. The manual device in this study is not offered there. To find a clinic near you, see the list of DESG member practices.

References

• Cheng X, Huang H, Fan Z, et al. Clinical efficacy of portable, cost-effective manual thermal pulsation for obstructive meibomian gland dysfunction and factors associated with therapeutic efficacy. BMJ Open Ophthalmol. 2026;11(2). PMID: 42349990. https://doi.org/10.1136/bmjophth-2026-002769