Oct. 25, 2024
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. Study results were published in Cornea in 2016.
Joanne F. Shen, M.D., 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. All patients had a minimum of six months of follow-up after the first treatment and typically received 1 to 4 treatments spaced 4 to 6 weeks apart.
After four 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," says Dr. Shen. "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 first treatment, each patient underwent Fitzpatrick skin typing, and the IPL machine was set to appropriate settings — 1D, 2D or 4A. At each treatment, the eyelids were bilaterally closed and sealed shut with disposable eye shields. A generous amount of ultrasonic gel was applied to the treated skin. Then patients received about 30 pulses (with slight overlapping applications) from the right preauricular area, across the cheeks and nose to the left preauricular area, treating up to the inferior boundary of the eye shields.
Each treatment was followed by MGX with a cotton-tipped applicator and digital pressure to empty meibum from bilateral upper and lower eyelids. Patients used preservative-free ketorolac drops twice a day for two days after IPL treatment. Slit-lamp examination was performed before each treatment.
"Patients underwent four monthly examinations and IPL/MGX treatments or until symptoms were resolved to their satisfaction, treatments became intolerable or they were unable to continue the treatment protocol," says Dr. Shen.
After the first IPL/MGX treatment, patients who responded early experienced 5 to 7 days of symptomatic improvement followed by regression until the next treatment. After the second treatment, patients experienced 1 to 2 weeks of improvement. Slow responders did not see improvements until after the second or third treatment. After the fourth treatment, most patients had at least three months of sustained improvement.
"Interestingly, 63% of this IPL/MGX-responsive group previously failed to respond to LipiFlow thermal pulsation," says Dr. Shen. "However, these therapies are not a permanent fix. Once regression occurs, we recommend a single IPL/MGX treatment that varies between patients. In our patient population, a few patients are in remission, but most will require repeat single treatments every 3 to 6 months."
Use of topical and systemic medications usually can be discontinued after IPL/MGX. Since the Dry Eye Assessment and Management (DREAM) study results published in the New England Journal of Medicine in 2018, omega-3 fatty acids are no longer prescribed, but many new treatments have come to market such as varenicline nasal spray and perfluorohexyloctane artificial tears. "My philosophy is still focused more on restoring the ocular surface and tear film, and less with artificial tear substitutes," says Dr. Shen. There are newer IPL platforms since 2016 that have smaller sized application devices to handle the delicate eyelid area skin.
For more information
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.
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.
Refer a patient to Mayo Clinic.