Intense Pulsed Light for the Treatment of Dry Eye Owing to Meibomian Gland Dysfunction

Summary

Dry eye disease is an increasingly common condition, which strongly impair patients' life quality. Recently, a new device employing intense pulsed light, specifically designed for the periocular area, has been shown to improve tear film stability and ocular discomfort symptoms in dry eye disease owing to meibomian gland dysfunction.

Abstract

Dry eye disease (DED) is an increasingly common condition and one of the most common complaints of patients. The vast majority of DED is caused by the so-called "evaporative" subtype, that is mainly caused by meibomian gland dysfunction (MGD). Intense pulsed light (IPL) devices employ high intensity pulses of polychromatic lights with a broad range of wavelength (515-1200 nm). IPL treatment has been utilized for years in the field of dermatology, and then its use was applied to ophthalmology for the treatment of MGD. Recently, a new device employing IPL was specifically designed for the periocular application. This procedure determines the thermal selective coagulation and ablation of superficial blood vessels and telangiectasias of the eyelids skin, reducing the release of inflammatory mediators and tear cytokines levels, and improving meibomian glands outflow. IPL treatment is noninvasive and easy to perform, lasts for only a few minutes and can be conducted in an office setting. In the present study, 19 patients underwent 3 sessions of IPL treatment. After treatment, both mean noninvasive break-up time and lipid layer thickness grade significantly increased, as a result of an improvement of tear film stability and quality, respectively. Conversely, no statistically significant changes were found for meibomian gland loss and tear osmolarity. Furthermore, the vast majority of the treated patients (17/19; 89.5% of the total) perceived an improvement of their ocular discomfort symptoms after IPL treatment. Although IPL treatment provides an improvement of both ocular surface parameters and ocular discomfort symptoms after one cycle of three sessions, regular repeated treatments are usually required to maintain the persistence over the time of its beneficial effects.

Introduction

Dry eye disease (DED) is an increasingly common condition and one of the most common reasons for clinical visits to an eye doctor¹. The main symptom complained by patients affected by DED differs from various grades of redness and ocular discomfort to a chronic foreign body sensation, stinging, burning, itching, excessive tearing, pain, recurrent infections and transient visual disturbances². The impact of DED on patients' quality of life has been compared to that caused by moderate to severe angina or dialysis treatment³, and is associated with a restriction in daily activities and a loss of ....

Protocol

All participants were provided both verbal and written informed consent before any study procedure. The protocol of the study was carried out in accordance with the Declaration of Helsinki and was approved by the local Institutional Review Board.

1. Automated Ocular Surface Workup

1. Noninvasive break-up time (BUT) and lipid layer thickness (LLT) evaluation
   1. "Install the "I.C.P." program by SBM Sistemi on the computer connected to the device.
   2. Apply the device on the slip lamp.
   3. Open the application and insert the patient’s data.
   4. Select the exam to be performed in the men....

Results

Nineteen patients (7 males and 12 females, mean age 39.3 ± 7.0 years) (mean ± standard deviation) underwent IPL treatment between September 2016 and June 2017. Fifteen days after the third IPL treatment session, noninvasive BUT significantly increased from 7.6 ± 0.6 s to 9.8 ± 0.7 s (mean ± standard error of the mean) (p = 0.017), and LLT grade significantly improved from 2.3 ± 0.1 to 3.4 ± 0.3 (p = 0.003). No statistically significant changes were found for MGL and tear osmolari.......

Discussion

Intense pulsed light devices employ xenon gas-filled flash lamps to produce non-laser high intensity pulses of polychromatic non-coherent lights in a broad wavelength spectrum, from visible (515 nm) to infrared (1200 nm)¹⁸. The light energy pulse is released by the head of the handpiece by means of a sapphire or quartz block, and so directly applied onto the skin surface.

The mechanism of action of IPL systems is based on the principle of selective thermolisis, accordin.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
I.C.P. Tearscope	SBM Sistemi, Turin, Italy	1340864/R	Device for noninvasvive break-up time and lipid layer thickness evaluation
I.C.P. MGD	SBM Sistemi, Turin, Italy	15006	Device performing infrared meibomography and meibomian gland loss evaluation
TearLab Osmolarity System	TearLab Corporation, San Diego, CA, USA	83861QW	Device for the measurement of tear osmolarity
E>Eye	E-Swin, Paris, France		Intense pulsed regulated light treatment device
BM 900 Slit Lamp Biomioscropy	Haag-Streit, Koeniz, Switzerland	BM 900	Slit Lamp Biomiscroscopy
Tobradex eye drops	Alcon Inc., Fort Worth, TX, USA	S01CA01	Eye drops instilled immediately after the procedure in office