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

Meibomian gland dysfunction is typically managed with chronic therapies which often provide only partial or short-term relief from dry eye symptoms. Intense regulated pulsed light device emits multiple polychromatic light pulses that heat the eyelid skin, stimulate the meibomian glands, and reduce the release of anti-inflammatory mediators and tear cytokines. Open the I.C.P.program by SBM Sistemi onto the computer connected to the device.

Input the patient's data and select the appropriate exam in the menu. Instruct the patient to put their chin and the forehead in the correct position on the slit lamp with the instrument to perform non-invasive BUT examination. After non-invasive BUT, lipid layer thickness is examined.

For meibomian gland loss assessment, select the meibomian gland exam. Use a cotton swab to gently evert the lower eyelid and acquire an infrared image of the inner part of the lower eyelid to obtain a good-quality image of the meibomian glands. Draw the margins of the eyelid area on the touch screen, and click to fill the area.

The system will automatically calculate the percentage of meibomian gland area in relation to the total area of the eyelid. For intense pulsed light treatment, seat the patient comfortably and press the start button on the control unit to activate the device. To select the treatment for meibomian gland dysfunction, press the appropriate button the LCD touchscreen and use the up and down arrows to select the desired treatment energy level.

Press tick to confirm the choice and press the six icons one by one to validate each of the six safety features. Press tick to confirm that the procedure is performed in total safety, then press tick again to start the device. When the device is ready for the treatment, place the eye protector over the patient's eyes and don safety glasses.

Apply an at least one centimeter thick layer of optical gel over the patient's skin under the lower eyelid from the edge of the nose up to the temple. Remove the device handpiece from the central unit, and gently place the handpiece head in direct contact with the skin of the area to be treated. Press the start button on the handpiece to emit a single treating intense pulsed light pulse, followed by four additional intense pulsed light pulses across the gel-treated area as close as possible to the lower eyelid margin.

After the last pulse has been applied, gently remove the optical gel from the treated skin area and place a warm compress over the eyelids of both eyes for two to three minutes. In this study, 19 patients underwent intense pulsed light. Fifteen days after the third treatment session, non-invasive breakup times significantly increased, and the lipid layer thickness grade significantly improved.

No statistically significant changes were observed for meibomian gland loss, while tear osmolarity showed a trend of decrease after treatment. Seventeen patients demonstrated an improvement in ocular discomfort symptoms after the treatment, in direct correlation with the improved lipid layer thickness results in response to the intense pulsed light treatment. Intense regulated pulsed light treatment appears effective in improving dry eye sign and symptoms in patients affected by meibomian gland dysfunction.

Regular repeated treatments every six-eight months may be required after the three starting sessions to maintain the benefits of the procedure over the time.