IPL, gland expression improves MGD-related dry eye
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The combination of intense pulsed light and meibomian gland expression could be “safe and useful” for improving signs of dry eye disease in those with moderate to severe symptoms, according to a study in PLoS ONE.
Intense pulsed light (IPL) has been found to be useful for dermatological applications such as capillary and venous malformations, telangiectasia and erythema of rosacea.
“It is therefore reasonable to expect that IPL, which is extremely effective for improving rosacea, could be useful for management of MGD [meibomian gland dysfunction] as well,” Rolando Toyos, MD, medical director and founder of the Toyos Clinic, and colleagues wrote.
The researchers sought to show the merits of IPL treatment for dry eye caused by MGD and show that the procedure, combined with meibomian gland expression, is superior to expression alone.
Study participants were 22 to 85 years old and had signs and symptoms of dry eye disease resulting from MGD. Eighty-eight eligible participants were randomly assigned to receive either IPL then expression (n = 45) or sham IPL followed by expression (n = 43). The treatment regimen consisted of four sessions 2 weeks apart, and IPL treatment was provided with a Lumenis M22 system. Considering participants lost to follow-up, researchers were able to collect study data on 43 participants in the control arm and 39 in the treatment arm.
According to the study, the primary outcome measure was fluorescein tear breakup time (TBUT). Researchers also evaluated Ocular Surface Disease Index (OSDI) questionnaire, Eye Dryness Score (EDS), Meibomian Gland Score (MGS), daily use of artificial tears and daily use of warm compresses. They also counted the number of expressible glands in both eyelids and graded the quality of meibum and level of discomfort.
Toyos and colleagues found that TBUT increased from 3.8 ± 0.2 to 4.5 ± 0.3 seconds in the control arm and from 4.0 ± 0.2 to 6.0 ± 0.3 in the study arm, a statistically significant difference.
Improvement was seen in several signs and symptoms in both arms but was greater in the treatment arm and included MGS (P < .001), EDS (P < .01), number of expressible glands in the lower lids (P < .0001) and upper lids (P < .0001), predominant meibum quality in the lower lid (P < .0001) and upper lid (P < .0001), and level of pain due to expression (P < .0001). There were no serious adverse events.
Toyos and colleagues concluded that treatment with IPL and meibomian gland expression in patients with moderate to severe symptoms, “could be a safe and useful approach for improving signs of dry eye disease due to MGD,” and added that future studies should evaluate the application of these findings to different disease severity levels.
Perspective
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The advantages and disadvantages of dry eye disease treatments differ, and effectiveness may vary across different disease severities. IPL (followed by meibomian gland expression) as compared with control (expression only) has been shown in this study to be a promising dry eye disease treatment for some patients, as it showed increased improvement in clinical signs including TBUT change along with meibomian gland functionality signs (number of expressible glands and quality of meibum). However, the mechanism of action is yet to be elucidated. Additionally, the reported symptoms using the OSDI questionnaire and daily artificial tear use improved similarly in the IPL and control groups with no significant difference between both groups. Thus, it is important to set the correct expectations regarding IPL increased treatment effectivity that may be noticeable on the clinical signs more than the subjective symptomatic level as compared to the traditional solo meibomian gland expression.
Future research is needed to determine which MGD severity levels and skin types benefit the most from IPL treatment along with determining the best time period in between treatments. Until then, recommending IPL followed by expression for MGD-related dry eye disease patients as approved by the FDA seems appropriate in addition to artificial tear use.
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Toyos R, et al. PLoS ONE. 2022;doi:org/10.1371/journal.pone.0270268.
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