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

Purpose: The 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 methods: In 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.

Results: Due 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).

Conclusion: In 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.

Keywords: dry eye; intense pulsed light; meibomian gland dysfunction.

Figure 1

Study flow diagram. Notes: Withdrawn case in site 2 received one IPL treatment but was withdrawn because it was discovered, after the treatment, that the patient has a history of migraines. Abbreviations: FU, follow-up; LFU, lost to follow-up; Tx, treatment session.

Figure 2

Longitudinal analysis of tear breakup time. Notes: Error bars: standard error of the mean values. ***Wilcoxon signed rank test against BL (P<0.001). (A) Site 1 and (B) site 2. Abbreviations: BL, baseline; FU, follow-up.

Figure 3

Forest plot of odds ratios for study measures. Notes: Outcome measures were dichotomized as detailed in Table 3. Open circles and bars represent ORs and 95% confidence intervals, respectively. Green, blue, and black symbols show FU1 vs BL, FU2 vs BL, and FU3 vs BL, respectively. ORs for which the 95% confidence interval do not cross OR =1 are statistically significant. Undefined ORs are missing from this plot. Abbreviations: BL, baseline; CFS, corneal fluorescein staining; FU, follow-up; LLT, lipid layer thickness; MGS, meibomian gland score; ORs, odds ratios; SPEED, Standard Patient Evaluation of Eye Dryness; TBUT, tear breakup time.

Figure 4

Subgroup analysis of TBUT (site 1). Notes: In each panel, the dotted line shows the TBUT data for the complete cohort (38 eyes). (A) Effect of age. Solid squares: patients aged <58 years (n=18); open circles: patients aged >58 years (n=20). (B) Effect of baseline skin rosacea. Solid squares: patients with no or mild skin rosacea at BL (n=24); open circles: patients with moderate or severe skin rosacea at BL (n=14). (C) Effect of BL TBUT. Solid squares: eyes with TBUT ≥6 s (n=20); open circles: eyes with TBUT <6 s (n=18). (D) Effect of gender. Solid squares: females (n=16); open circles: males (n=22). Abbreviations: BL, baseline; FU, follow-up; TBUT, tear breakup time.