Technological Interventions for Dry Eye Disease: A Systematic Review and Random-Effects Network Meta-analysis of 3-Month Outcomes

Abstract

Introduction: In recent years, various technological therapeutic modalities have emerged aiming to target the underlying pathophysiology of dry eye disease (DED). Methods: A systematic search of PubMed, Scopus, and Embase was conducted through July 23, 2025, for randomized controlled trials (RCTs) evaluating technological interventions for DED, including intense pulsed light (IPL), thermal pulsation (LipiFlow), TearCare, iLux, low-level light therapy (LLLT), transcutaneous electrical stimulation (TES), and quantum molecular resonance (QMR) therapy. Eligible studies reported outcomes for tear break-up time (TBUT), Schirmer test, corneal staining, meibomian gland quality, or symptom severity at 2–4 months post-treatment. Data extraction followed PRISMA guidelines. A frequentist random-effects network meta-analysis was performed, with standardized mean differences calculated for comparative analyses and P-scores used to rank treatment efficacy. Results: Forty-seven RCTs involving 3581 patients from 16 countries were included. TearCare with meibomian gland expression (MGX) and IPL with a heated eye mask (HEM) ranked highest for TBUT improvement (P-scores 0.924 and 0.898, respectively). QMR therapy demonstrated the greatest efficacy for corneal staining (P-score 0.977). TearCare with MGX ranked first for meibomian gland secretion quality (P-score 0.999). IPL-based modalities showed consistent superiority in symptom relief, with IPL plus HEM achieving the highest improvement (P-score 0.910). No serious adverse events were reported. Conclusions: At 2–4 months, TearCare with MGX and IPL-based protocols demonstrated superior efficacy across objective and subjective DED outcomes compared with other technologies and conservative treatments. Further standardized long-term comparative studies are warranted.