Combination Treatment of Intense Pulsed Light Therapy and Meibomian Gland Expression for Evaporative Dry Eye

Abstract

Dry eye disease (DED) is most commonly caused by evaporative subtypes and mainly induced by meibomian gland dysfunction (MGD). Intense pulsed light (IPL) combined with meibomian gland expression (MGX) is a noninvasive treatment for improvement of ocular discomfort symptoms and MGD. In this prospective study between November 2020 and May 2022, the patients with MGD and abnormal meibomian expressibility that met the criteria of both ocular surface disease index (OSDI) ≥ 13 scores and standardized patient evaluation of eye dryness (SPEED) ≥ 8 scores were enrolled in Kaohsiung Veteran General Hospital. Three separate treatment sessions of IPL therapy combined with MGX were administered to the lower lids, with an interval of 28 days. Further tear film assessment included lipid layer thickness (LLT), tear meniscus height (TMH), noninvasive tear break-up time (NIBUT), and meibomian gland loss (MGL) either before or after first and third IPL therapy combined with MGX. In addition, lissamine green staining and pain scores were also recorded. We totally enrolled 37 patients of 74 eyes. Men accounted for 18.92% (7/37). The mean age was 54.51 ± 11.72 years. The mean OSDI scores were 58.12 ± 22, while the SPEED scores were 17.03 ± 5.98. The mean Schirmer’s test was 3.66 ± 2.43 mm. After three sessions of IPL treatment with MGX, the OSDI, SPEED, LLT, TMH, MGL, MGXS, and pain scores were significantly improved. For the MGX scores (MGXS) ≤ 20 group, lissamine green scores showed nearly significant improvements. For the MGXS > 20 group, TMH revealed statistical improvement. Noninvasive IPL therapy with MGX statistically improved not only dry eye symptoms, but also tear film assessments, including LLT, TMH, and MGL.

Keywords: dry eye; intense pulsed light therapy; meibomian gland; tear.

Figure 1

The improvement of mean OSDI scores (total, p < 0.001, paired t-test), mean lipid layer thickness (LLT) (total, p < 0.001, paired t-test), and mean tear meniscus height (TMH) (total, p = 0.014, paired t-test) after three sessions of IPL–MGX combined therapy in either two groups or totally. However, the improvement of mean noninvasive tear break-up time (NIBUT) was not significant (total, p = 0.333, paired t-test) but the values showed longer times after three sessions of IPL–MGX combined therapy. OSDI scores were overall higher in the MGXS ≤ 20 group (A). The mean NIBUT wasgradually improved in these three sessions in the MGXS ≤ 20 group but not inferior to pretreatment in the MGXS > 20 group. (B) The improvements of mean LLT werebetter after third treatments in the MGXS > 20 group (C). The improvements of mean TMH werebetter after third treatments in the MGXS ≤ 20 group (D). * means p < 0.05.