Intense pulsed light, gland expression may reduce dry eye symptoms
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Use of intense pulsed light may be beneficial in remedying the effects of dry eye disease-related meibomian gland dysfunction, according to findings published in Eye & Contact Lens.
Xiaoming Yan, MD, of the department of ophthalmology at Peking University First Hospital in China, and colleagues evaluated the efficacy of intense pulsed light (IPL) combined with meibomian gland expression (MGX) compared with instant warm compresses combined with MGX in treating dry eye disease due to meibomian gland dysfunction (MGD).
“The high and rapidly growing incidence of [dry eye disease] pushes forward the need for finding novel therapeutic approaches and more efficient management techniques of this chronic condition,” Yan and colleagues wrote.
The researchers conducted a prospective, multicenter, interventional study comprising data from 120 participants with dry eye disease due to MGD. They stratified participants into two groups; one using an IPL arm and a control arm.
Participants received treatment three times a week at 3-week intervals, Yan and colleagues wrote. The primary outcome measure was tear breakup time.
While investigators noted improved outcomes in both groups, there was a prominent improvement in the IPL arm. Further, there was a greater increase in tear breakup time in the IPL arm compared with the control arm (2.3 seconds vs. 0.5 seconds; P < .001).
Data showed reduced Standard Patient Evaluation of Eye Dryness scores in both the IPL and control arms (38% vs. 22%; P < .01). Additionally, Meibomian Gland Yielding Secretion Score improved by 197% in the IPL arm and 96% in the control arm.
Study results demonstrated reductions in corneal fluorescein staining in the IPL arm (51%) and the control arm (24%).
“Future randomized controlled trials are needed to shed more light on these issues,” Yan and colleagues wrote. “In addition, preclinical studies are need to elucidate the mechanism of action and perhaps further increase the benefits of this therapeutic approach.”
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Doug Rett, OD, FAAO
Many people reading this probably manage their patient’s dry eye symptoms as I do: in a way that is embarrassingly similar to the way we managed them 5 years ago despite new treatment options in this field.
In this randomized controlled trial, Yan and colleagues mention the Dry Eye Workshop Study (DEWS) II report on management and therapy of dry eye, which is quite long but well-written and worth your read. When you get to the section on MGD, the first two treatments recommended are ocular lubricants and warm compresses, which we can safely say are boxes we all check. But the very next step DEWS II recommends is if those first two don’t work there are “physical treatments,” and one of those physical treatments is intense pulsed light (IPL).
The authors have constructed a strong comparison study that finds IPL combined with MGX yields better clinical improvement than warm compresses combined with MGX. They admit that their study population was “predominantly Han Chinese,” so perhaps this nondiversity is a limitation of the study, but the authors address how varying skin types around the world can be adjusted for by changing the fluency of the IPL. Outside of eye care, IPL is used for (amongst other reasons) reducing telangiectasias from rosacea. We know that facial rosacea is strongly associated with MGD, and the article explores how IPL treatment can treat eyelid inflammation. Thus, it stands to reason that IPL may have clinical uses in eye care, and, indeed, IPL is being used more and more in eye clinics around the world.
The results from this study tell us, the clinicians, that if we have a patient who is still symptomatic despite the tired combination of ocular lubricants and warm compresses, then we have other options. As a profession, we need to better embrace these physical treatment options.
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