Intense pulsed light for treatment of dry eye disease

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In a retrospective study of patients with refractory dry eye who had exhausted conventional treatment and elected to receive intense pulsed light and meibomian gland expression (IPL/MGX), 58% of patients' symptoms improved from as much as 25% to more than 50% after treatment.

The initial study results were published in Cornea in 2016.¹

According to a Mayo Clinic news release, Joanne F. Shen, MD, director of the dry eye clinic at Mayo Clinic's campus in Phoenix, Arizona, and a research team studied 35 patients treated with IPL/MGX. The team reviewed demographics, ocular histories, Standard Patient Evaluation of Eye Dryness 2 (SPEED2) symptom survey scores, slit-lamp examinations and meibomian gland evaluations at baseline and at each visit before IPL/MGX treatments.²

All patients had a minimum of 6 months of follow-up after the first treatment and typically received 1 to 4 treatments spaced 4 to 6 weeks apart.

After 4 IPL/MGX treatments, a paired sample t-test showed a significant (p < 0.0001) decrease in SPEED2:

• 8 patients (23%) had a ≥ 50% decrease in SPEED2 scores.
• 23 patients (66%) had a 1% to 49% decrease in SPEED2.
• 1 patient (3%) had no change in SPEED2.
• 3 patients (9%) had an increase in SPEED2.

“The combination of IPL and MGX can significantly improve dry eye symptoms — in this retrospective analysis, in 89% of patients — and meibomian gland function, which in this study improved in 77% of patients in at least one eye,” Shen said in the news release. “The study confirms that IPL treatment for meibomian gland dysfunction can improve dry eye symptoms and is a reasonable option for patients who have not shown improvement with other therapies.”

IPL/MGX procedure

At the initial treatment session, each patient underwent Fitzpatrick skin typing, with the intense pulsed light (IPL) device set to the appropriate level (1D, 2D, or 4A). During each treatment, both eyelids were bilaterally closed and secured with disposable eye shields, and a generous amount of ultrasonic gel was applied to the treatment area. Approximately 30 pulses were administered, with slight overlap, from the right preauricular area, across the cheeks and nose, to the left preauricular area, covering up to the inferior edge of the eye shields.

Each treatment session concluded with meibomian gland expression (MGX) using a cotton-tipped applicator and digital pressure to express meibum from the upper and lower eyelids bilaterally. Patients were instructed to use preservative-free ketorolac drops twice daily for 2 days following each IPL treatment. A slit-lamp examination was conducted before each treatment session.¹

"Patients received four monthly IPL/MGX treatments or continued until symptom resolution, treatment intolerance, or inability to adhere to the treatment protocol," Shen noted.

Early responders typically experienced symptomatic relief for 5 to 7 days after the first treatment, with regression until the next session. Following the second treatment, improvement lasted 1 to 2 weeks, whereas slow responders began noticing benefits after the second or third treatment. After the fourth treatment, most patients experienced at least 3 months of sustained improvement.²

“Notably, 63% of the patients who responded to IPL/MGX therapy had previously failed to benefit from LipiFlow thermal pulsation,” Shen explained. “However, these treatments are not curative; when symptoms recur, a single IPL/MGX treatment is recommended, though frequency varies by patient. While a few patients enter remission, most require maintenance treatments every 3 to 6 months.”

Topical and systemic medications are often discontinued after successful IPL/MGX therapy. Since the publication of the Dry Eye Assessment and Management (DREAM) study in The New England Journal of Medicine in 2018, omega-3 fatty acids are no longer prescribed; however, new treatments, such as varenicline nasal spray and perfluorohexyloctane-based artificial tears, are now available.³

“I prioritize restoring the ocular surface and tear film over reliance on artificial tears," Shen concluded.

According to the Mayo Clinic news release, since 2016, newer IPL platforms with smaller application devices have been introduced to better treat the delicate skin of the eyelid area.²

References

1. Vegunta S, et al. Combination therapy of intense pulsed light therapy and meibomian gland expression (IPL/MGX) can improve dry eye symptoms and meibomian gland function in patients with refractory dry eye: A retrospective analysis. Cornea. 2016;35:318. Accessed October 29, 2024.

2. Intense pulsed light for treatment of dry eye disease - Mayo Clinic. www.mayoclinic.org. Published October 2024. Accessed "October 30, 2024. https://www.mayoclinic.org/medical-professionals/ophthalmology/news/intense-pulsed-light-for-treatment-of-dry-eye-disease/mac-20430229

3. Dry Eye Assessment and Management Study Research Group. n−3 fatty acid supplementation for the treatment of dry eye disease. New England Journal of Medicine. 2018;378:1681.