RESUMO
PURPOSE: To demonstrate that intense pulsed light therapy (IPL) of the upper and lower eyelids with meibomian gland expression (MGX) is effective in improving dry eye disease due to meibomian gland dysfunction (MGD). METHODS: Patients with ocular discomfort (Ocular Surface Disease Index -OSDI- above 13) and signs of MGD were recruited. All patients underwent OSDI, visual acuity (VA), intraocular pressure, Schirmer test, meibography, non-invasive tear breakup time (NITBUT), slit-lamp examination (corneal and conjunctival staining, hyperemia, gland expressibility, and meibum quality), tear osmolarity and lipid layer thickness. IPL was performed with Optima IPL (Lumenis Ltd.) following a standardized protocol on upper and lower eyelids of both eyes, with inferior eyelid MGX. Patients received four sessions separated by two weeks each. Four weeks after, examinations were repeated. RESULTS: 160 patients (320 eyes) were included, of which 108 (67.5%) were women and mean age was 59.2 ± 15.08 (range 20-89). After four sessions, VA, OSDI, tear osmolarity, lipid layer thickness, NITBUT, hyperemia, corneal and conjunctival staining, gland expressibility, meibum quality, inferior eyelid Meiboscore and Schirmer test improved (all, p < 0.027). Changes in OSDI, initial and average NITBUT increased with dry eye disease severity (according to OSDI). Increased pre-treatment OSDI, hyperemia, corneal and conjunctival staining and Schirmer test were associated with an improvement in OSDI (all, p < 0.040). No adverse events were noted. CONCLUSIONS: The combination of IPL on upper and lower eyelids with MGX is safe and effective for the treatment of MGD. Patients with severe dry eye disease present greater improvements.
RESUMO
To describe the efficacy and safety of intense pulsed light (IPL) applied directly on the eyelids of patients with Meibomian gland dysfunction (MGD) without corneal shield protector. Observational retrospective single centre study where patients underwent 3 treatment sessions of IPL with 2 weeks of interval. The IPL was carried out with Lumenis OPT M22 with a double pass technique of 12 impacts on the infraorbital/lower eyelid region with the 15 × 35 mm guide light (step 1) and a double pass technique of 3 impacts over the upper eyelids with the 8 × 15 mm guide light (step 2). The follow up was conducted through Oculus Keratograph 5 M. 30 patients were enrolled in the study. Although there were no significant differences (p > 0.05), non-invasive tear break-up time, ocular redness, and OSDI questionnaire improved during the 3 IPL sessions. A significant improvement (p = 0.024) in the percentage of meibomian gland loss was also observed. Regarding tear meniscus, it was found similar measurements before and after treatment. No serious adverse effects were reported during the procedure or in subsequent follow-up. Preliminary results suggest that IPL therapy applied directly on the eyelids without corneal shield could be safe and effective in the treatment of MGD.