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Bulgarian Review of Ophthalmology

Intense pulsed light (IPL): An innovative method for the treatment of Meibomian gland dysfunction in patients with dry eye disease

Monika Dimitrova, Boryana Irinkova, Alexandrina Gatseva, Iva Petkova, Irina Kuneva


Introduction: Meibomian gland dysfunction (MGD) is a leading cause of dry eye syndrome. They produce lipids that contribute to the integrity of the tear film and slow down its evaporation. When these glands become blocked, they can lead to symptoms associated with dry eye disease. Until recently, only tear substitutes containing lipid components, omega-3 fatty acids, warm compresses, and topical anti-inflammatory agents were used for treatment. Intense pulsed light (IPL) therapy is a new treatment option for dry eye syndrome due to meibomian gland dysfunction.

Aim: The aim of our study was to evaluate the efficacy and safety of IPL for the treatment of dry eye syndrome due to meibomian gland dysfunction in patients of different age groups by examining the non-invasive tear breakup time (NITBUT) and Schirmer’s test measured before IPL treatment and their change after two IPL procedures.

Material and Methods: ANTARES corneal topographer (CSO, ANTARES-2017) was used to measure the indicators. Intense pulsed light treatment was given to 61 patients in both eyes. Each patient had a second-degree MGD and underwent two procedures at an interval of two weeks. The tear breakup time (TBUT) and Schirmer’s test were assessed at baseline and two weeks after the last treatment. The analysis, by which the data were processed, is GLM Repeated Measures.

Results: The majority of tests documented an improvement in the clinically relevant parameters, including the tear breakup time, Schirmer’s test, meibum quality, and Standard Evaluation of Eye Dryness Questionnaire. Side effects were relatively rare, but included discomfort and skin erythema. Age, gender and the application of artificial tears did not have a significant effect on the described results.

Conclusion: Intense pulsed light shows therapeutic potential for MGD treatment, improving the quality of the tear film and reducing the symptoms of dry eye syndrome.


Meibomian gland dysfunction (MGD), tear breakup time (TBUT), Schirmer’s test, IPL, dry eye

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Nelson JD, Shimazaki J, Benitez-del-Castillo JM, Craig JP, McCulley JP, Den S, et al. The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930-7. doi: 10.1167/iovs.10-6997b.

Romero JM, Biser SA, Perry HD, Levinson DH, Doshi SJ, Terraciano A, Donnenfeld ED. Conservative treatment of meibomian gland dysfunction. Eye Contact Lens. 2004;30(1):14-9. doi: 10.1097/01.ICL.0000095229.01957.89.

Papageorgiou P, Clayton W, Norwood S, Chopra S, Rustin M. Treatment of rosacea with intense pulsed light: significant improvement and long-lasting results. Br J Dermatol. 2008;159(3):628-32. doi: 10.1111/j.1365-2133.2008.08702.x.

Raulin C, Greve B, Grema H. IPL technology: a review. Lasers Surg Med. 2003;32(2):78-87. doi: 10.1002/lsm.10145.

Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg. 2015;33(1):41-6. doi: 10.1089/pho.2014.3819.

Craig JP, Chen YH, Turnbull PR. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2015;56(3):1965-70. doi: 10.1167/iovs.14-15764.

Roberts WE. Skin type classification systems old and new. Dermatol Clin. 2009;27(4):529-33, viii. doi: 10.1016/j.det.2009.08.006.

Vora GK, Gupta PK. Intense pulsed light therapy for the treatment of evaporative dry eye disease. Curr Opin Ophthalmol. 2015;26(4):314–8. doi:10.1097/ICU.0000000000000166.

Vegunta S, Patel D, Shen JF. 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(3):318–22. doi:10.1097/ ICO.0000000000000735.

Yin Y, Gong L. Reversibility of gland dropout and significance of eyelid hygiene treatment in meibomian gland dysfunction. Cornea. 2017;36(3):332-337. doi: 10.1097/ICO.0000000000001042.

Arita R, Suehiro J, Haraguchi T, Maeda S, Maeda K, Tokoro H, et al. Topical diquafosol for patients with obstructive meibomian gland dysfunction. Br J Ophthalmol. 2013;97(6):725–29. doi:10.1136/ bjophthalmol-2012-302668;

Ahmed SA, Taher IME, Ghoneim DF, Safwat AEM. Effect of intense pulsed light therapy on tear proteins and lipids in meibomian gland dysfunction. J Ophthalmic Vis Res. 2019;14(1):3-10. doi: 10.4103/jovr.jovr_12_18.

Arita R, Fukuoka S, Morishige N. Therapeutic efficacy of intense pulsed light in patients with refractory meibomian gland dysfunction. Ocul Surf. 2019;17(1):104-10. doi: 10.1016/j.jtos.2018.11.004.

Choi M, Han SJ, Ji YW, Choi YJ, Jun I, Alotaibi MH, et al. Meibum expressibility improvement as a therapeutic target of intense pulsed light treatment in meibomian gland dysfunction and its association with tear inflammatory cytokines. Sci Rep. 2019;9(1):7648. doi: 10.1038/s41598-019-44000-0.

Liu R, Rong B, Tu P, Tang Y, Song W, Toyos R, et al. Analysis of cytokine levels in tears and clinical correlations after intense pulsed light treating meibomian gland dysfunction. Am J Ophthalmol. 2017;183:81-90. doi: 10.1016/j.ajo.2017.08.021.

Karaca EE, Evren Kemer O, Ozek D. Intense regulated pulse light for the meibomian gland dysfunction. Eur J Ophthalmol. 2020;30(2):289-92. doi: 10.1177/1120672118817687.

Gao YF, Liu RJ, Li YX, Huang C, Liu YY, Hu CX, et al. Comparison of anti-inflammatory effects of intense pulsed light with tobramycin/dexamethasone plus warm compress on dry eye associated meibomian gland dysfunction. Int J Ophthalmol. 2019;12(11):1708-13. doi: 10.18240/ijo.2019.11.07.

Godin MR, Stinnett SS, Gupta PK. Outcomes of thermal pulsation treatment for dry eye syndrome in patients with Sjogren disease. Cornea. 2018;37(9):1155-8. doi: 10.1097/ICO.0000000000001621.



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About The Authors

Monika Dimitrova
Zora Eye Hospital, Sofia

Department of Ophthalmology, Faculty of Medicine, Medical University of Sofia

Boryana Irinkova
Zora Eye Hospital, Sofia

Department of Ophthalmology, Faculty of Medicine, Medical University of Sofia

Alexandrina Gatseva
Zora Eye Hospital, Sofia

Iva Petkova
Zora Eye Hospital, Sofia

Department of Ophthalmology, Faculty of Medicine, Medical University of Sofia

Irina Kuneva
Zora Eye Hospital, Sofia