Prospective evaluation of intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction

Abstract

PurposeThe aim of this study was to estimate the efficacy of intense pulsed light (IPL), followed by meibomian gland expression (MGX), for reducing the number and severity of signs and symptoms of dry eye disease (DED) secondary to meibomian gland dysfunction (MGD).Patients and methodsIn a prospective study conducted in two sites, 40 subjects (80 eyes) with moderate to severe MGD were enrolled. Major inclusion criteria consisted of at least two of the following measures being compatible with DED in both eyes: tear breakup time (TBUT), meibomian gland score (MGS), corneal fluorescein staining (CFS), Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, and tear film osmolarity (TFO). Enrolled patients underwent four treatment sessions, 3 weeks apart. Each treatment included the administration of 10–15 pulses of IPL on the cheeks and nose, followed by MGX of the upper and lower eyelids. TBUT, MGS, CFS, SPEED, TFO, and lipid layer thickness (LLT) were measured at baseline (BL) and at 9, 12, and 15 weeks after BL.ResultsDue to different staining methods used for TBUT measurements, TBUT and CFS were analyzed separately for each site. From BL to the final follow-up, the number of signs compatible with DED decreased from 3.3±0.1 to 1.4±0.1. TBUT improved by +93% (n=38; P<0.0001) and +425% (n=42; P<0.0001) for sites 1 and 2, respectively. SPEED, MGS, and CFS improved by −55% (n=80; P<0.0001), −36% (n=80; P<0.0001), and −58% (n=38; P<0.0001), respectively. In 20 eyes with abnormally elevated TFO at BL, TFO improved by −7% (n=20; P<0.005). LLT did not change (n=38; P=0.88).ConclusionIn subjects with moderate to severe MGD, IPL combined with MGX reduced the number and severity of symptoms and signs of DED. Except for LLT, all examined outcome measures significantly improved after 15 weeks. These results support the efficacy of IPL + MGX in relieving both signs and symptoms of DED secondary to MGD.

Intense pulsed light for evaporative dry eye disease

“…More than a decade ago, Toyos et al noticed that facial skin rosacea patients treated with IPL reported a significant improvement in their dry eye symptoms 17. Since then, a number of studies confirmed that IPL therapy reduces both signs and symptoms of dry eye 18–23. In these studies, IPL therapy comprised several sessions given several weeks apart.…”

Dry eye syndrome: Therapeutic challenges and future trends

“…Since then, it has begun to be incorporated into dermatological practice for the treatment of rosacea, telangiectasia, acne, and other skin conditions. Its application improved in the following years, being proposed in 2002 possible bene its in ophthalmic diseases [3][4][5]. Ophthalmologist Rolando Toyos was the irst to suggest the use of IPL for the treatment of MGD, from the observation of objective and subjective improvement of DES symptoms in patients with periocular rosacea undergoing Pulsed Light therapy [8][9][10].…”

“…Historically, aqueous de iciency has represented for ophthalmology, the primary pathophysiological substrate in the genesis of the syndrome. However, new studies show that 80% of patients have evaporative or mixed-type dysfunction mechanisms [1,5]. Meibomian gland dysfunction (MGD) is the primary cause of evaporative dry eye and contributes to the development of the aqueous subtype.…”

“…Meibomian gland dysfunction (MGD) is the primary cause of evaporative dry eye and contributes to the development of the aqueous subtype. Glandular dysfunction generates tear ilm instability, resulting from hyperkeratinization and obstruction of external gland ori ices with abnormal production of the lipid layer in qualitative and quantitative terms [4][5][6]. The meibomian glands (acinar-tarsal) are modi ied sebaceous follicles present in the upper and lower eyelids.…”

“…For this reason, it is invested in the practice of dilation with an intraductal tube and continuous expression of the meibomian glands (EMG). EMG, although an invasive and painful procedure for the patient, has shown a long-term bene icial effect [2,5]. A recent alternative implemented in the treatment of MGD is the use of Intense Pulsed Light (IPL).…”