Article

Intense Pulsed Light Treatment for Dry Eye Disease Due to Meibomian Gland Dysfunction; A 3-Year Retrospective Study

Authors:
  • Monalco Research
  • Toyos Clinic and Southern College of Optometry
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Abstract

Objective: The purpose of this study was to determine the clinical benefits of intense-pulsed-light therapy for the treatment of dry-eye disease caused by meibomian gland dysfunction (MGD). Background data: MGD is the leading cause of evaporative dry eye disease. It is currently treated with a range of methods that have been shown to be only somewhat effective, leading to the need for advanced treatment options. Methods: A retrospective noncomparative interventional case series was conducted with 91 patients presenting with severe dry eye syndrome. Treatment included intense-pulsed-light therapy and gland expression at a single outpatient clinic over a 30-month study. Pre/post tear breakup time data were available for a subset of 78 patients. For all patients, a specially developed technique for the treatment of dry eye syndrome was applied as a series of monthly treatments until there was adequate improvement in dry eye syndrome symptoms by physician judgment, or until patient discontinuation. Results: Primary outcomes included change in tear breakup time, self-reported patient satisfaction, and adverse events. Physician-judged improvement in dry eye tear breakup time was found for 68 of 78 patients (87%) with seven treatment visits and four maintenance visits on average (medians), and 93% of patients reported post-treatment satisfaction with degree of dry eye syndrome symptoms. Adverse events, most typically redness or swelling, were found for 13% of patients. No serious adverse events were found. Conclusions: Although preliminary, study results of intense-pulsed-light therapy treatment for dry eye syndrome caused by meibomian gland dysfunction are promising. A multisite clinical trial with a larger sample, treatment comparison groups, and randomized controlled trials is currently underway.

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... Preservative-free drops, omega-3 fatty acid supplementation, topical cyclosporine, serum tears, topical azithromycin, oral doxycycline, cholinergics, lacrimal plug, lid massage and expression, warm compresses, amniotic membrane biologic corneal bandage lens, intense pulse light (IPL) have been demonstrated to improve the signs and symptoms of DE [26]. However, treatment discontinuation often leads to relapse of signs and symptoms DED as the positive effects of these treatments are not sustained for long period of time [27,28]. ...
... Maximum staining score for each area was 3 point and the minimum were 0 points. Scores from all 3 sections were then added and reported on a scale of 0 (normal) to 9 (severe) [16,21,27]. ...
... The Toyos protocol was used in all treatments [27]. All patients had a minimum of 2 treatments, each separated by 3 weeks. ...
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Background Inadequate meibomian glands (MGs) secretion can lead to dry eye signs and symptoms. Tear film lipid layer (TFLL) secreted by MGs protects and prevents rapid evaporation of tear film. The purpose was to assess TFLL alteration and function in patients with evaporative dry eye (EDE) using tear interferometry after optimal pulse light technology (OPT) intense pulsed light (IPL). Methods This prospective randomized examiner-masked sham- controlled study included 86 participants (142 eyes) with DED. IPL or sham procedure was performed on day 0, 21, and 42. Ocular Surface Disease Index (OSDI), non-invasive breakup time (NITBUT), interferometric fringe pattern determined TFLL quality, fluorescein staining (FS), and meibum gland (MG) were assessed at day 0, 21, 42 and 3-month. Results At 3-month, TFLL, NITBUT, MG drop-out, MG quality, MG expressibility, FS and OSDI improved significantly (P < 0.05) in the IPL group, while the sham group had no significant improvements. Except for Meibo-score and FS, all parameters significantly correlated with the improvement in TFLL following IPL treatment. Additionally, artificial tears usage was significantly less in the IPL group from D-42 onwards. Conclusion IPL treatment demonstrated the ability to improve TFLL quality and clinically reduced sign and symptoms of DED thereby reducing the frequency of artificial tears use.
... IPL is widely used in treating dermatological conditions, including facial rosacea, acne, dyspigmentation and dermal vascular lesions. 2,[8][9][10][11][12][13] In 2002, Toyos et al 14 reported a significant improvement in dry eye symptoms in patients treated for facial rosacea with IPL. Although the exact mechanism of action remains unknown, many studies since then have reported significant improvements in dry eye symptoms, tear break-up times, lipid layer grade and thickness, and/or meibomian gland function, with limited adverse events. ...
... Although the exact mechanism of action remains unknown, many studies since then have reported significant improvements in dry eye symptoms, tear break-up times, lipid layer grade and thickness, and/or meibomian gland function, with limited adverse events. 2,[15][16][17][18][19][20][21][22][23] These studies have used a variety of IPL devices, including M22™ (Lumenis, Israel), 17,20,22 Quadra Q4 (DermaMed Solutions, USA), 2,14 E>Eye (E-SWIN, France), 15,16,18,21 and customized treatment protocols, ranging in energy levels, treatment frequencies, number of treatment sessions and treatment durations. ...
... The 12-item CDEA questionnaire is a modification of the validated Ocular Surface Disease Index (OSDI) used to determine the severity of dry eye symptoms. 27,28 Total scores range from 0 to 48 and symptoms are interpreted as normal (<5), mild (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), moderate (21)(22)(23)(24)(25)(26)(27)(28)(29)(30), or severe (31-48). 28 The question "How much do your eyes bother you?" within the CDEA was evaluated independently and named the patient subjective assessment (PSA). ...
Article
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Background: BroadBand light intense pulsed light (BBL-IPL) therapy has shown to reduce hordeolum and blepharitis frequency. This study aims to evaluate the efficacy and safety of BBL-IPL therapy in patients with dry eye disease (DED) from meibomian gland dysfunction (MGD). Methods: This is a retrospective, consecutive case series of 48 patients with DED from MGD who underwent BBL-IPL therapy from October 2016 to January 2019 at a single, outpatient clinic in Ontario, Canada. Clinical outcomes included first and average non-invasive keratograph tear break-up times (NIKBUT), bulbar redness (BR) scores, tear meniscus heights (TMH), visual acuity (VA) and meibograph grades. Patient-reported outcomes included the Canadian dry eye assessment (CDEA) questionnaire and patient subjective assessment (PSA) scores. Outcomes were measured at baseline and after completion of 4 monthly BBL-IPL sessions. Results: The mean severity of dry eye symptoms as measured by the CDEA and PSA decreased significantly from 19.78 ± 9.62 to 12.08 ± 7.40 (p<0.001) and from 7.65 ± 1.74 to 4.77 ± 2.03 (p<0.001), respectively. Twenty-five percent of patients reported no dry eye symptoms after treatment. The meibograph grade improved significantly in both eyes (p<0.001). Approximately 71.0% and 80.1% of patients had an improved meibograph grade in the right and left eye, respectively. Near-significant improvements were observed for BR scores and VA. There was also a trend towards improved first/average NIKBUT and TMH scores. No adverse events were noted. Conclusion: BBL-IPL appears to be an effective and safe treatment modality in improving dry eye symptoms and meibomian gland function in patients with DED from MGD.
... Intense pulsed-light (IPL) treatment has been applied for hypertrichosis, cavernous hemangiomas, venous malformations, telangiectasia, port-wine stains, and other pigmented lesions [5]. Toyos et al. [6] first introduced IPL treatment in the field of ophthalmology, and patients with facial rosacea had significant improvements in dry eye (DE) symptoms after IPL treatment. Many previous studies demonstrated that IPL treatment is effective for the improvement of both subjective symptoms and objective findings in patients with mild-to-moderate MGD or DE [7][8][9][10]. ...
... The M22 Optima device (Lumenis, Yokneam, Israel) is one of the most widely used IPL machines for MGD treatment [6,[13][14][15][16][17][18][19][20]. The M22 has various filters and can be used according to the treatment purpose, and a novel dual-band filter (vascular filter, wavelengths 530-650 nm and 900-1200 nm), designed particularly for fine telangiectasia treatment, was introduced recently. ...
... There are studies that have successfully treated facial acne vulgaris safely with an acne filter [26,27]. Many studies report the successful treatment of MGD patients using the M22 device [6,[13][14][15][18][19][20]28,29]. However, all these studies used the existing 590 nm filter, and studies reporting the use of the novel dual-band filters in the treatment of IPL in MGD patients are rare. ...
Article
Background: This study evaluates the effect of intense pulsed-light (IPL) treatment in patients with meibomian gland dysfunction (MGD) using a novel dual-band filter (vascular filter, 530-650 nm and 900-1200 nm) and compares it with the effect and discomfort during treatment using a conventional filter. Methods: The medical records of 89 patients (89 eyes) with MGD who underwent IPL treatment were reviewed. Patients treated with the vascular filter or conventional 590 nm filter were designated as Group A or Group B, respectively. Patients underwent IPL treatment four times every four weeks. Ocular surface disease index (OSDI) scores, dry eye (DE), and MGD parameters were determined before the first IPL treatment and after the fourth IPL treatment. Visual analog scale (VAS) scores were obtained at every IPL treatment. OSDI, DE and MGD parameters, and VAS were compared between the groups. Results: OSDI, DE, and MGD parameters improved after the four IPL treatments in both groups. There were no significant differences, between the groups, in OSDI, DE, and MGD parameters, before the first IPL treatment and after the fourth IPL treatment. VAS at each of the IPL treatments was lower in Group B than in Group A. Conclusion: IPL treatment using the novel vascular filter for patients with MGD is effective compared with conventional IPL treatment for MGD patients.
... Since IPL therapy was accidentally found to treat dry eye due to MGD during its use for the treatment of facial rosacea, IPL has been used as an effective and well-tolerated treatment option for improvement of subjective symptoms and objective findings of mild to moderate MGD or dry eye. 4,5,13,14,15,16 This relatively novel treatment modality utilizes non-coherent, polychromatic light in a wavelength spectrum of 500-1200 nm applied to the periocular skin for selective thermolysis. The light absorbed by chromophores (e.g., melanin), hemoglobin, and water in the skin transforms into heat, causing thrombosis and ablation of superficial blood vessels. ...
... 35,36,37,38,39 Other side effects are transient blistering, cheek swelling, conjunctival cyst, floaters, hair loss on the brow and forehead, light sensitivity, redness of face, purpura, and hyperpigmentation. 16,33,40 We observed no adverse effects in any of our patients. ...
... Toyos et al. 16 reported that tear break-up time (TBUT) and meibum secretion were improved in 86% and 94% of patients with MGD-associated dry eye disease treated with IPL and meibomian gland expression (MGX), and the rate of patient satisfaction with treatment was 93%. Gupta et al. 41 showed a significant decrease in meibum viscosity and OSDI score and a significant increase in meibum flow and TBUT in MGD patients who underwent IPL therapy. ...
Article
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Objectives: We aimed to evaluate the efficacy of periocular intense pulsed light (IPL) therapy in the treatment of moderate to severe acute blepharitis or blepharoconjunctivitis. Materials and methods: This was a retrospective study performed in one institution. Eleven patients who received bilateral periocular IPL therapy using an IPL device (E>Eye, ESwin, Paris, France) were retrospectively evaluated. The following findings obtained at baseline and 10 weeks after the treatment were recorded: slit-lamp examinations; symptom scores of the Compression of the Eyelid (COTE) grading system and Ocular Surface Disease Index (OSDI); ocular surface staining with Oxford grading scale (OXFORD) scores; lipid layer thickness (LLT); and non-invasive tear meniscus test (TMH), non-invasive break up time measurement (NIBUT), and meibography performed by using I.C.P. Ocular Surface Analyzer (SBM System, Turin, Italy). Results: Significant improvements in OSDI symptom scores (p<0.0001), LLT (p<0.0001), and meibography (p<0.0001) were obtained at 10 weeks after bilateral periocular IPL therapy. COTE and ocular surface staining scores decreased by 59.72% and 57.14% respectively, while NIBUT and TMH increased by 47.34% and 22.16%, respectively. In parallel to the improvement in OSDI, LLT, and meibography, findings of acute blepharitis or blepharoconjunctivitis improved in slit-lamp examination. There were no adverse effects. Conclusion: Serial IPL therapy improves the clinical signs and symptoms of moderate to severe acute blepharitis or blepharoconjunctivitis, meibomian gland morphology, and secretion quality.
... It is therefore reasonable to expect that IPL, which is extremely effective for improving rosacea, could be useful for management of MGD as well. Indeed, although the mechanism of action is still not well understood [21], since the pioneering work of Toyos and colleagues [22] a large number of studies have indicated that IPL can reduce both signs and symptoms of dry eye [23][24][25][26]. In its staged management algorithm, the TFOS DEWS II recommended this technology as a second step for treatment of DED, after lid hygiene and ocular lubricants of various types [10]. ...
... In the control arm, IPL was generated by the same system, but all light signals were blocked with an aluminum plate instead of the 560/590 cut-off filter. based on the double-pass protocol described in a previous publication by Toyos and colleagues [22]. The treatment area included the malar region (from tragus to tragus, including the nose) and the peri-ocular area up to the lower edge of the eye protection, positioned along the lower lid margin inferior to the lash line. ...
... The mechanism of action of IPL, with respect to DED due to MGD, is not yet fully understood. One possibility is that IPL closes abnormal telangiectasia and blocks the inflammatory mediators they secrete [22]. As a result, a major source of inflammation of the peri-orbital area is removed. ...
Article
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Purpose: To compare the safety and efficacy of intense pulsed light (IPL) followed by meibomian gland expression (MGX), against monotherapy of MGX. Methods: Patients with moderate to severe meibomian gland dysfunction (MGD) were 1:1 randomized to 4 sessions of intense pulse light + MGX at 2-week intervals, or 4 sessions of Sham + MGX at 2-week intervals. Both patients and examiners were blinded to the allocation. Outcome measures, evaluated at the baseline (BL) and at a follow-up (FU) conducted 4 weeks after the last IPL session, included fluorescein tear breakup time (TBUT) as the primary outcome measure, OSDI (Ocular Surface Disease Index) questionnaire, Eye Dryness Score (EDS, a visual analog scale (VAS)-based questionnaire), Meibomian gland score (MGS, a score of meibum expressibility and quality in 15 glands on the lower eyelid), daily use of artificial tears, and daily use of warm compresses. In addition, during each treatment session, the number of expressible glands was counted in both eyelids, the predominant quality of meibum was estimated in both eyelids, and the level of pain/discomfort due to MGX and IPL was recorded. Results: TBUT increased from 3.8±0.2 (μ±standard error of mean (SEM)) to 4.5±0.3 seconds in the control arm, and from 4.0±0.2 to 6.0±0.3 in the study arm. The difference between arms was statistically significant (P < .01). Other signs/symptoms which improved in both arms but were greater in the study arm included MGS (P < .001), EDS (P < .01), the number of expressible glands in the lower eyelids (P < .0001) and upper eyelid (P < .0001), the predominant meibum quality in the lower eyelid (P < .0001) and upper eyelid (P < .0001), and the level of pain due to MGX (P < .0001). Outcome measures which improved in both arms with no significant differences between the two were OSDI (P = .9984), and the daily use of artificial tears (P = .8216). Meibography, daily use of warm compresses, and severity of skin rosacea did not show statistically significant changes in either arm. No serious adverse events were observed. There was a slight tendency for more adverse events in the control group (P = 0.06). Conclusions: The results of this study suggest that, in patients with moderate to severe symptoms, combination therapy of intense pulse light (IPL) and meibomian gland expression (MGX) could be a safe and useful approach for improving signs of dry eye disease (DED) due to meibomian gland dysfunction (MGD). Future studies are needed to elucidate if and how such improvements can be generalized to different severity levels of MGD.
... Conventional management of MGD includes eyelid hygiene, topical lubricants, topical and systemic antibiotics with antiinflammatory properties and topical steroids. 19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57 However, there are current and emerging treatment approaches such as various devices (see Section Eyelid hygiene) 54,55,56,57 or topical and systemic therapies. 19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41 ,42,43,44,45,46,47,48,49,50,51,52,53 Eyelid hygiene Eyelid hygiene is regarded as the cornerstone or mainstay treatment of MGD. ...
... A trial study was conducted to compare the LipiFlow with an eyelid warming device for the management of MGD 30 and although both techniques were found to be effective by increasing the number of functional meibomian glands at three months of treatment, the LipiFlow treatment showed a rapid improvement within the first month of treatment. 28,29 Intense pulsed light therapy is another non-invasive treatment that uses high-intensity light from a broad-spectrum source (400 nm -1200 nm) 31,32,33,34 to excite melanin and haemoglobin in the skin and thereby induce coagulation and ablation of blood vessels. Intense pulsed light therapy is generally administered for the treatment of dermatological conditions, but patients with MGD may benefit from its use. ...
... The mechanism of IPL in MGD is putatively related to the thermocoagulation of vascular telangiectasia and antimicrobial effects. 31,32,33,34 It causes closure of abnormal blood vessels, which are thought to secrete inflammatory mediators that cause malfunction of the meibomian glands. Based on results of a randomised, controlled, double-masked clinical study on long-term effects of IPL combined with meibomian gland expression in the treatment of MGD, 33 it was found that the IPL therapy could be a potential standard treatment option for MGD. ...
Article
Full-text available
Background: Meibomian gland dysfunction (MGD) is one of the leading causes of evaporative dry eye disease and one of the most common ophthalmic conditions found in clinical practice. Meibomian gland dysfunction tends to be overlooked because its signs and symptoms do not cause blindness. Meibomian gland dysfunction is characterised by the obstruction of the meibomian gland terminal ducts resulting in tear film instability. Aim: The purpose of this article was to provide an update on MGD’s diagnosis and treatment. Method: A literature review was conducted using search engines such as Google Scholar, Medline and ScienceDirect databases. Keywords such as MGD diagnosis and management and treatment of MGD were used to search the databases. Results: A total of 44 relevant papers were reviewed. These papers were then curated to include only those concerning diagnosis of meibomian gland dysfunction, treatment of meibomian gland dysfunction and management options of meibomian gland dysfunction. The references of individual papers from the curated results were checked to yield a further 13 papers. Conclusion: Meibomian gland dysfunction is not a single entity but is multifactorial in origin; however, our understanding of the condition is evolving rapidly because of newer imaging technology. There is no gold standard treatment option for MGD, but many options are available that include medications and other procedures.
... Therefore, there is a need for new treatment alternatives, and intense pulsed light (IPL) is one of them. Recently, several studies have reported the effectiveness of IPL for MGD treatment, even for the refractory type [15][16][17][18]. ...
... However, lid telangiectasia did not show significant improvement in both eyelids [21]. That study involved treatment only on the lower eyelid according to the protocol first described by Toyos [15]. The present study had an important clinical implication regarding lid telangiectasia that was significantly improved by changing into the acne filter. ...
... The present study had an important clinical implication regarding lid telangiectasia that was significantly improved by changing into the acne filter. Such improvements in telangiectasia could prevent the secretion of the inflammatory mediator and bacterial overgrowth [15]. As a result, clinical signs such as TBUT and SICCA and Oxford staining scores significantly improved, as did subjective symptoms. ...
Article
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Evaluate the improvement in clinical signs and symptoms in patients with moderate-to-severe meibomian gland dysfunction (MGD) treated with intense pulsed light (IPL) using an acne filter. A retrospective chart review of 70 eyes of 35 patients with moderate-to-severe MGD treated with IPL using the acne filter was performed. IPL treatment was administered using the acne filter four times at 2- to 3-week intervals to upper and lower eyelids. We evaluated tear break-up time (TBUT), matrix metalloproteinase (MMP)-9, Sjögren’s International Clinical Collaborative Alliance (SICCA) staining score, and Oxford staining grade. We performed Schirmer’s test I without topical anesthesia, slit-lamp microscopic examination of lid margin and meibomian gland, and patient’s symptom score assessment and evaluated the incidence of adverse effects in the ocular and periocular areas at baseline and 30 days after the final treatment. Significant improvements (P < 0.001) were observed in TBUT, SICCA staining score, Oxford staining grade, quality of meibum, consistency of meibum, lid margin telangiectasia, MGD grade, and patient’s symptom scores after acne filter IPL treatment. Furthermore, the positivity (100 to 71.43%, P = 0.002) and level (2.43 ± 0.98 to 1.14 ± 0.78, P < 0.001) of MMP-9 significantly decreased after treatment. However, there was no significant improvement in Schirmer’s test I (P = 0.224). No systemic or regional adverse effects were observed in any patient. IPL treatment using the acne filter is an effective and safe therapeutic modality for treating moderate-to-severe MGD, especially for lid margin telangiectasia and MMP-9.
... Intense pulsed light (IPL) therapy has been used since many years ago in dermatology for the treatment of a great variety of conditions, including pigmented lesions, benign cavernous hemangiomas, telangectasias or facial rosacea [1]. The analysis of the outcomes of IPL treatment in this last condition led to the discovery of the potential of this therapeutic option for the treatment of dry eye due to Meibomian gland dysfunction (MGD) [2][3][4]. Since then, a great variety of studies have been conducted to demonstrate the efficacy of IPL for the treatment of dry eye associated to MGD without [5][6][7][8][9][10][11][12][13][14][15][16] and with the combined meibomian gland expressibility (MGX) [17][18][19][20][21][22]. The American Academy of Ophthalmology have recently published a report on the efficacy of IPL treatment for MGD, concluding that the existing body of the scientific literature demonstrates improvements in the signs of symptoms of this condition, although methodological limitations and potential conflicts of interest were present in some studies [23]. ...
... A layer of conductive gel for IPL was placed afterwards following the path of the skin on the lower eyelids from temple to temple, including the nose. A total of 5 impacts were then made in each region (right and left), with a total of 10 impacts in each application without overlapping then [2,20]. The terminal was always placed on the gel, without squeezing the skin. ...
... Change in OSDI with therapy was found to be significantly related to some baseline data obtained according to the following expression (p = 0.001; R 2 ...
Article
Full-text available
This non-comparative prospective case series was conducted to characterize the clinical impact of intense pulsed light (IPL)-based treatment in dry eyes associated to Meibomian gland dysfunction (MGD), defining the predicting factors for a successful outcome with this therapy in a large case series. A total of 390 eyes (195 patients, range: 23–93 years) received four sessions of Optima IPL system (Lumenis, Yokneam, Israel). Significant changes were observed in tear film osmolarity in both eyes (p < 0.001) and in meibum quality (p < 0.001), with more eyes showing clear or yellow secretions after therapy. Mean change in the ocular surface disease index (OSDI) was −8.61, ranging from −27.00 to 11.00. This change was significantly correlated with the baseline value of OSDI (r = −0.489, p < 0.001). The change in osmolarity correlated significantly with the baseline osmolarity in both eyes (right r = −0.636, left r = −0.620, p < 0.001). A linear predicting model of the change in OSDI with therapy was obtained: change OSDI = 10.99 − 0.35 × OSDI − 1.03 × NIBUTRE-LE (mean non-invasive break up time of right and left eye) −2.03 × Meibum quality grade (p = 0.001; R2: 0.325). In conclusion, the improvement in symptomatology achieved with an IPL-based therapy can be predicted at baseline using a linear model considering the level of MGD and the magnitude of OSDI and NIBUT (non-invasive break-up time).
... Only initial meiboscore before treatment was determined. Lacrystim ® shows similar results to previously published studies and other IPL devices [23][24][25][26][27]. NIBUT values comparison from one study to another is difficult because analysers use very different image analysis systems. ...
... Lacrydiag ® detects the very first tear film break-up time whereas other analysers detect an average NIBUT. This explains why we found lower NIBUT values compared to other studies [23,25,27,28]. It is therefore NIBUT evolution before and after treatment that must be taken into account. ...
Article
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Background Meibomian gland dysfunction is the most common etiology of dry eye disease worldwide and intense pulsed light appears to be a promising treatment with encouraging results. Lacrystim® is a new IPL device (CE marking in 2019) and no studies have yet been published on it. We propose the first study on this device with an objective assessment of its efficacy and an extended follow-up over 6 months. Methods Patients presenting with a dry eye disease (DED) with stable mild to moderate MGD and having received Lacrystim® treatment between june 2019 and june 2020 were included. 3 IPL sessions were performed at D0, D15 and D45 with 4 shots per side at a fluence of 8 mJ/cm2. DED clinical evaluation was performed at D0, D15, D45, 3rd month and 6th month: Oxford scale and break up time, Schirmer test and Ocular Surface Disease Index (OSDI) questionnaire. Lacrydiag® imaging device carried out an objective examination of tear film: interferometry, meibography, tear meniscus height and non-invasive break up time (NIBUT). The primary endpoint was the evolution in NIBUT between the first visit D0 and 3rd month. Data collection was done retrospectively. Statistical analysis was done using a linear mixed-effects model and a non-parametric linear mixed-effects model (R software). Results Forthy five consecutive patients were included. NIBUT significantly increased between D0 and 3rd month: mean difference of 1.63 seconds, IC95% [0.51; 2.62], ( p = 0.002) with a prolonged effect at 6th month. OSDI and OXFORD scores and interferometry were also significantly improved at 3rd month and 6th month. There was no significant change in BUT, Schirmer test and tear meniscus height. No adverse event was noted. Conclusions IPL delivered by Lacrystim® appears effective and safe to treat MGD although a randomized controlled trial is needed to validate its results. Trial registration This work was approved by a local ethics committee “Terre d’éthique” (institutional review board number: IRBN672019/CHUSTE) and registered on the clinicaltrial.gov website ( NCT04147962 , 01/11/2019).
... Chalazion patients commonly present with coexisting blepharitis or acne rosacea, which are associated with telangiectasias and superficial angiogenesis that produce inflammatory mediators that may travel to the eyelids (31). Several studies have reported that IPL-MGX treatment can relieve dry eye symptoms in refractory MGD cases (16,17,31). ...
... Chalazion patients commonly present with coexisting blepharitis or acne rosacea, which are associated with telangiectasias and superficial angiogenesis that produce inflammatory mediators that may travel to the eyelids (31). Several studies have reported that IPL-MGX treatment can relieve dry eye symptoms in refractory MGD cases (16,17,31). Studies on IPL use for acne vulgaris have shown a reduction in inflammatory infiltrates around the area of meibomian glands and sebaceous glands (32,33). ...
Article
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Purpose High recurrence rate of chalaziosis and serious side effects of repeated surgical excision may help increase awareness of recurrent and refractory chalaziosis as a serious disorder affecting many aspects of life. This present study was aimed to investigate the efficacy and safety of intense pulse light (IPL) therapy and meibomian gland expression (MGX) in cases of recurrent chalaziosis after excision surgery. Methods Forty-two consecutive recurrent chalaziosis cases (35 patients) treated with IPL-MGX were enrolled. All patients initially underwent excision with curettage. One week after lesion excision, IPL-MGX were performed at least 3 times. Another set of age- and sex-matched consecutive cases of recurrent chalaziosis, who received excision with curettage, but went without IPL-MGX treatment, were collected to calculate recurrence rate. Treatment efficacy and safety were measured before IPL-MGX treatment and 1 month after the final treatment. Results The majority of patients received 4 sessions of IPL-MGX therapy (20 patients; 57.1%) or 3 sessions of IPL-MGX therapy (10 patients; 28.6%), resulting in a lower recurrence rate of 11.4% compared to that of recurrent chalaziosis without IPL-MGX cases (45.6%, P < 0.001). The NIBUT was significantly prolonged from 3.9 ± 1.8 to 5.1 ± 1.7 s at 4 weeks after the final treatment ( P = 0.001). Similarly, mean TMH score improved and was statistically significant when compared with baseline (0.17 ± 0.07 vs. 0.21± 0.09; P = 0.008). Furthermore, meibum quality and expressibility scores significantly improved at 4 weeks following the final treatment (both P < 0.001). Other variables, such as intraocular pressure and visual acuity, remained unaffected following treatment. Conclusion The combination of IPL treatment and MGX offers a low risk and effective option in decreasing the recurrence rate of recurrent chalaziosis by improving meibomian gland function. IPL-MGX may be considered for first-line treatment in recurrent or refractory cases post excision.
... MGD is the leading cause of evaporative dry eye, and when DED and MGD occur as comorbidities increase disease severity and have a significant adverse impact on patients' life quality [20][21][22] . In 2009, Toyos treated patients with rosacea with IPL, improving their dry eye symptoms 25,26 . This discovery has led to the commercial development and promotion of IPL devices that are specific for dry eye treatment. ...
... Typically, three or four IPL sessions are applied over approximately three to four months. The results are promising, decreasing DED symptomatology and clinical signs by approximately 90% 26,33,34 ; nevertheless, evidence is scarce for few clinical trials 36 . IPL is safe and does not damage eye structures; the biggest concern is the local effect on the skin 36 . ...
Article
Full-text available
Intense pulsed light (IPL) are medical-esthetical procedures that emit light at a wavelength of 500 – 1200 nm, interacting with epidermal and dermal tissues. IPL is a relatively new treatment of growing popularity thanks to its versatility and efficacy, mainly in dermatology and recently also in ophthalmology. These devices are used to treat dry eye disease, meibomian gland dysfunction, rosacea, and periocular lesions with outstanding results.
... This review found 23 studies examining the efficacy of IPL in treating MGD (Table 5). IPL improved symptoms, tear stability, and meibomian gland function in 96% (22/23), 58-79 87% (20/23), [58][59][60][61][62][63][64][65][66][68][69][70][71][72][74][75][76][77][78][79] and 87% (20/23) of studies reviewed, [58][59][60][61][63][64][65][66][67][68][69][70][71][73][74][75][76][77][78][79] respectively. Two studies reported adverse events related to using IPL. ...
... Two studies reported adverse events related to using IPL. 72,80 Notably, pigment in the iris absorbs light that is emitted by the IPL, therefore inappropriate eye protection while using IPL could lead to adverse events. A few case reports and reviews have documented ocular complications such as anterior uveitis, iris atrophy, pupillary defects and long-lasting pain and photophobia associated with IPL use. ...
Article
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Brandon Bzovey,1 William Ngo2,3 1Centre for Ocular Research & Education, School of Optometry & Vision Science University of Waterloo, Waterloo, Ontario, Canada; 2School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada; 3Centre for Eye and Vision Research (CEVR), Hong Kong, People’s Republic of ChinaCorrespondence: William Ngo, School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, N2L 3G1, Canada, Tel +519-888-4567 x 40857, Email wngo@uwaterloo.caAbstract: Meibomian gland dysfunction (MGD) is characterized by the obstruction and/or inflammation of the meibomian glands that result in decreased and altered meibum secretion. This results in deficiencies in the tear film lipid layer which contributes to increased evaporation and destabilization of the tear film. One of the mainstay therapies for MGD is medical devices that apply heat and/or pressure to the eyelids and promote the liquification and outflow of meibum into the tear film. Over the past two decades, there have been a surge of interest in diagnosing and managing MGD. As a result, numerous medical devices have been developed and each have their own unique approach to treating MGD. This narrative review was conducted to summarize the current state of knowledge on eyelid warming devices, specifically warm eye coverings, devices that direct heat and/or pressure to the eyelids, moisture chamber goggles, and light-based therapy. This review summarized 58 human clinical studies and found that most eyelid warming devices were efficacious in improving signs and symptoms in a wide range of MGD severities and were generally safe to use.Keywords: dry eye, meibomian gland dysfunction, warm compresses, thermal pulsation, moisture chamber goggles, intense pulsed light
... Previous studies using monthly IPL therapy without LLLT have shown that four treatment sessions were required to obtain a statistically significant increase in TBUT [15]. Our data show that four treatments, administered once weekly, improve the symptoms of MGD considerably; however, we only followed the patients for one week after the end of the protocol and therefore do not know how long the benefits last. ...
... In our study, we did not observe any side effect. Previous studies reported discomfort, redness, or swelling in up to 13% of treated patients [15]. ...
Article
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Background and Objectives: Evaporative dry eye disease is frequently associated with meibomian gland dysfunction. Patients are often unhappy because of daily drops, care burden, and suboptimal conventional treatments. In this study, we assessed the efficacy of a novel device, the Eye-light®, a combination of intense pulsed light therapy and low-level light therapy, as a novel treatment for meibomian gland dysfunction and dry eye disease. Materials and Methods: This was a retrospective, single-center study carried out over a 6-week period, in which 22 eyes from 11 patients were included. Each patient received four combined light therapy treatment sessions, once weekly over 4 weeks. Patients underwent a clinical examination and filled out a standardized questionnaire to evaluate symptoms one week prior to treatment, and one week after the fourth session. Results: Combined light therapy improved several ocular surface outcome measures in our patients. This study demonstrates that this adjunctive treatment significantly improves the ocular surface and quality of life of patients with dry eye disease and meibomian gland dysfunction. Conclusions: Combined light therapy may be included in meibomian gland dysfunction treatment protocols as an adjunctive rescue treatment.
... IPL has traditionally been used to treat dermatological conditions and has been newly developed to alleviate the ocular discomfort and irritation associated with MGD [16,17]. A broad wavelength of light provided by the IPL, ranging from 500 to 1200 nm [18], is flashed upon the skin to trigger the coagulation of superficial blood vessels has been proven to be a reliable and effective therapy [19]. IPL was proved to have confirmed effects on reducing ocular inflammation, repairing corneal epithelium and tear film, increasing tear break-up time [16,17]; however, the efficacy of IPL for the treatment of nociceptive pain still remains unknown. ...
... The 7-item generalized anxiety disorder (GAD-7) scale is a validated, reliable, and efficient measurement tool for GAD screening and assessing its severity in clinical practice and research. In the GAD-7 scale, four levels of anxiety severity are classified: none (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), and severe (15)(16)(17)(18)(19)(20)(21) [27]. ...
Article
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Purpose: To investigate the efficacy of intense pulsed light (IPL) combined with deproteinized calf blood extract (DCBE) eye drops for dry eye disease (DED) patients with nociceptive ocular pain. Methods: In this prospective, one-center, interventional study, 23 subjects with DED and ocular pain were treated with a combination of IPL and DCBE eye drops for four sessions at a four-week interval. Subjective and objective assessments on nociceptive pain and dry eye were examined and analyzed. Results: The visual analog scale (VAS), ocular surface disease index, ocular pain assessment survey (OPAS), patient health questionnaire-9 items, generalized anxiety disorder (GAD-7), Athens insomnia scale, corneal fluorescein staining score, meibomian gland secretion quality, and expressibility scores were significantly reduced after the treatment. Tear break-up time and Schirmer I test increased significantly. The brand density of corneal nerves and neuropeptide substance P also significantly increased. OPAS, GAD-7, meibomian gland secretion quality, and expressibility scores were essential factors affecting the VAS changes. Conclusions: IPL combined with DCBE drop therapy was effective for DED patients with ocular pain. With such treatment, both DED symptoms and the sensation of ocular pain may be improved.
... Intensive pulsed light (IPL) therapy is used for cosmetic and therapeutic treatment of hypertrichosis, vascular lesions such as benign cavernous hemangiomas, telangiectasises, venous malformations, and pigmented lesions [6]. Corresponding trials have shown that in patients with mild to moderate MGD or dry eye, IPL therapy successfully enhanced subjective symptoms and objective results [7]. ...
... In the current study, also, abnormalities of eyelid margin (telangiectasias and irregularities) were improved. This agreed with previous studies [2,7,23]. ...
Article
Background Meibomian gland dysfunction (MGD) is an abnormal chronic state of meibomian glands in which there is quality and quantity alternations in the meibum glandular secretion or terminal duct obstruction. Patients with MGD show imbalance in the tear film components because of the lipid layer deficiency. Objectives The aim of this study was to assess the changes in the tear film after using intense pulsed light and low-level light therapy (IPL-LLLT) according to the Dry Eye Workshop classification. Patients and methods The study enrolled 80 eyes of 40 patients of both sexes with dry eye disease caused by MGD, with age range from 23 to 74 years. They showed symptoms of unilateral or bilateral dryness, diagnosed as MGD, with a meibum grade more than or equal to 1 and with a Fitzpatrick skin type of two to five appearance dependent and sensitivities to sun light. They were studied by comparing the pretreatment and posttreatment session values. Results The Dry Eye Workshop score showed a significant reduction after 4 weeks of the IPL-LLLT treatment in comparison with the baseline (P
... Destroying telangiectatic eyelid blood vessels, meibum liquefaction, antimicrobial effect, and intracellular photomodulation have been suggested as mechanisms by which IPL improves MGD [11,12]. Recent studies have shown that IPL improved subjective and objective findings of MGD, with no significant adverse effects [13][14][15]. ...
... When IPL treatment for MGD was first introduced, a protocol involving only the lower eyelid was proposed [15]. Then, meibomian gland expression after IPL treatment improved clinical findings compared with IPL treatment alone [16]. ...
Article
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Purpose We investigated the subjective and objective outcome after intense pulsed light (IPL) treatment and meibomian gland expression on the upper and lower eyelids compared with those after IPL treatment on the lower eyelid alone in patients with moderate-to-severe meibomian gland dysfunction (MGD). Methods Patients who underwent four IPL treatment sessions with meibomian gland expression were divided into upper and lower treatment group and conventional treatment group treated with lower eyelid alone. All patients underwent an ophthalmologic examination and answered a symptom questionnaire before the first treatment and 1 month after the last treatment. An ophthalmologic examination included tear break-up time (TBUT), fluorescein staining score, Schirmer’s test, matrix metalloproteinase-9 (MMP-9), meibum grade, color, consistency, and lid margin telangiectasia. Additionally, visual acuity and adverse effects were checked on every visit. Results Of 115 patients, 75 in the upper and lower treatment group and 40 in the conventional treatment group were included. TBUT, fluorescein staining score, subjective symptom, and meibum grade were significantly improved in both groups. Additionally, meibum color and consistency of upper and lower eyelids significantly decreased post-treatment in both groups. The lid margin telangiectasia of the upper and lower eyelids significantly decreased post-treatment in the upper and lower treatment group. MMP-9 positivity and grading scores significantly decreased post-treatment in both groups, and no severe adverse effects occurred during the follow-up period. Conclusion Additional IPL treatment on the upper eyelid using a protective device was proven safe and provided an additive improvement in treating moderate-to-severe MGD.
... Intense pulsed light (IPL) therapy has been used in dermatology, especially in the cosmetic industry, to treat various skin conditions. IPL has been shown to improve subjective symptoms, stability of the tear film, inflammation of the eyelids, and meibomian gland secretion in patients with MGD and dry eye [4][5][6][7][8][9][10][11][12][13][14][15]. The TFOS DEWS II Management and Therapy Report recommended IPL as a second step therapy after education, lid hygiene, and different types of ocular lubricants [16]. ...
... IPL therapy has been mainly applied to the lower eyelids to avoid the possibility of damaging intraocular tissues by broad-spectrum light [15]. Recently, several studies have reported the safety of IPL application on the upper eyelids [4,5,7,10]. Mild transient pain and skin redness as well as partial eyelash loss was reported after IPL treatment to both upper and lower eyelids, with a larger lightguide and a lid plate [5]. ...
Article
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The purpose of this study was to compare the efficacy of Intense Pulsed Light (IPL) therapy for meibomian gland dysfunction (MGD) using the new AQUA CEL (AC, Jeisys) device and the traditional M22 (Lumenis) device. A total of 59 eyes of 59 patients with MGD (12 men and 47 women, mean age 49 ± 12 years) were enrolled. They randomly received four sessions of IPL therapy every three weeks either with AC (30 eyes) or M22 (29 eyes). Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire score, noninvasive breakup time (NIBUT), lid margin abnormalities, corneal and conjunctival fluorescein staining, fluorescein breakup time (FBUT), Schirmer’s test, meiboscore and meibum grade were evaluated before treatment and one month after treatment. Before IPL, no significant differences were seen in age, gender, or measured parameters between the AC and M22 groups (p > 0.05, respectively). SPEED score, NIBUT, lid margin abnormalities, fluorescein staining, FBUT, and meibum grade improved significantly in both groups after IPL compared to before IPL (p < 0.001, respectively). There were no significant differences in measured parameters between the two groups after IPL (p > 0.05, respectively). IPL therapy with AC and M22 devices has been shown to be equally effective for the treatment of MGD.
... The goal of MGD treatment is to improve the flow of meibomian gland secretions by liquefying materials that otherwise cause obstruction and by stimulating the function of meibomian glands. Theoretically, this goal could be reached by combining two different procedures in the same session: an eye mask producing heating and vibration could liquefy and release the meibum [9], while IPL could improve the function of meibomian glands through different mechanisms, including ablation of blood vessels, fluidification of meibum, Demodex eradication and reduction of inflammatory cytokines, among others [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. ...
... The rational of combining an eye mask producing heating and vibration with IPL treatment in patients with MGD originates from the specific function of each procedure: the former is able to reach a therapeutic level of heat that liquefies meibum (phase I) that is then released thanks to the mechanical force exerted on the eyelid by the vibrating function (phase II) [9]; the latter improves the function of meibomian glands through different mechanisms previously demonstrated, such as ablation of blood vessels, fluidification of meibum, Demodex eradication and reduction of inflammatory cytokines [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. ...
Article
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Background To evaluate the effects on ocular surface signs and symptoms of serial sessions of heating and vibrating eye mask followed by intense pulsed light (IPL) therapy for the treatment of dry eye disease owing to meibomian gland dysfunction (MGD). Methods Consecutive patients with MGD whose signs and symptoms were not satisfactorily controlled with conventional therapy were included. Patients received 3 treatments performed at day 1, 15, and 45 incorporating a session with a newly-developed eye mask (Activa, SBS Sistemi, Turin, Italy) immediately followed by IPL therapy (E > Eye device, E-Swin, Paris, France). Patients were examined before the first session (T0) and 30 days after the last session (T1) for the measurement of: noninvasive break-up time (NIBUT); lipid layer thickness (LLT); tear meniscus height (TMH); meibomian gland loss (MGL); tear osmolarity. Ocular discomfort symptoms were ascertained by ocular surface disease index (OSDI) questionnaire. Results Thirty patients were ultimately included in the study. At T1, all objective ocular surface parameters improved significantly, except for TMH: NIBUT and LLT increased from 6.4 ± 1.7 to 8.6 ± 1.7 s and from 57.7 ± 15.5 to 81.3 ± 12.0 μm (all P < 0.001), while MGL and tear osmolarity decreased from 21.1 ± 17.3 to 17.0 ± 14.1% and from 302.0 ± 8.5 to 295.7 ± 6.9 mOsm/L (respectively, P = 0.004 and P < 0.001). In parallel, OSDI score decreased significantly from 49.8 ± 13.5 to 29.8 ± 10.6 ( P < 0.001). In the historical control group of patients who underwent only IPL, NIBUT, LLT, tear osmolarity and OSDI improved significantly but not MGL and TMH. Conclusions Serial sessions incorporating the application of an eye mask producing heating and vibration immediately followed by IPL therapy are able to improve all ocular surface parameters as well as ocular discomfort symptoms in MGD patients.
... As an established commercial technology, IPL treatment is broadly used in diseases involving facial rosacea. It has been shown that IPL is effective for the treatment of the eyelid sebaceous gland, also termed MG (16)(17)(18). Thus, IPL is a promising new therapy for MGD. ...
Article
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So far, intense pulsed light (IPL) has been widely used in the treatment of meibomian gland dysfunction (MGD), but there was still a lack of research on its specific mechanism. Determining whether there was a correlation between liposome changes and remission of clinical signs in patients with MGD treated with IPL was of great significance in the clinical evaluation of efficacy in patients with MGD. Our study enrolled the 10 healthy subjects and 26 adult patients, who were diagnosed with MGD and had not received any alternative treatments for at least 3 months. Each patient received a series of three treatments at 3-week intervals. The meibum was collected before the first treatment (T0) and the third treatment (T2). The significant changes in ocular surface parameters before and after IPL treatment were analyzed. The results showed that IPL significantly improved the symptoms of MGD, including ocular surface disease index (OSDI), tear breakup time (TBUT), redness of conjunctival (CR), corneal fluorescein staining (CF), the meibomian gland expressibility (MGE), and meibum quality (all p < 0.05). Lipidomics analysis of the meibum characterized the changes in lipid profiles induced by IPL. A total of 323 lipid species compounds were identified in the spectrum. A total of 41 lipid species were significantly different in patients with MGD (T0) vs. healthy controls. Following IPL treatment (T2), 24 lipid species were significantly different compared with T0: TG (10 lipid species), LPC (6 lipid species), OAHFA (4 lipid species), Cer (2 lipid species), SM (1 lipid species), and PE (1 lipid specie). Among these lipids, 4 of the lipids was a high correlation with TBUT, 5 was TH, 6 was CR, and 11 was meibum quality. In a ward, IPL treatment can achieve the therapeutic effect by changing the alternations of tear film lipids in patients with MGD. The changes in lipid expression profiles are potential indexes to evaluate the therapeutic effectiveness of IPL treatment or other treatments on MGD.
... As an established commercial technology, IPL treatment is broadly used in diseases involving facial rosacea. It has been shown that IPL is effective for the treatment of the eyelid sebaceous gland, also termed MG [14][15][16] . Thus, IPL is a promising new therapy for MGD. ...
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Importance: Aside from the clinical index, there is no established criterion for assessing the effectiveness of intense pulsed light (IPL) in treating meibomian gland disease. Objective:To determine if there is an association between changes in the meibum lipidomic profiles and alleviation of clinical signs in patients with meibomian gland dysfunction (MGD) who are treated with IPL. To provide predictive, preventive and and personalized medical programs for MGD patients. Design: This is an observational Study. Patients were followed for up for 6 months from January 1, 2019. Setting: This is a single center, human-oriented clinical and basic research study. Participants: Adult patients, who were diagnosed with MGD and had not received any alternative treatments for at least 3 months, were enrolled in the study. Exposures: Each patient received a series of three treatments at 3-week intervals. The meibum was collected before the first treatment (T0) and the third treatment (T2). All enrolled patients completed the whole examination and treatment. The meibum of randomly assigned 26 patients and 10 healthy volunteers was chosen for performing the lipid analysis using LC-MS/MS. Main Measures: The following information from each patient was recorded: tear break-up time (BUT), average tear BUT, tear meniscus height, assessment of the lid margin, bulbar redness, meibomian gland opening position, corneal fluorescein staining, meibomian gland drop, meibomian gland expressibility, and meibum quality. Results: A total of 191 patients’ right eyes were enrolled in the study, including 95 females (49.7%) and 96 males (50.3%), with a median age of 53 years (range: 28–85 years). IPL increased the BUT (P<0.0001, t=7.9, df=380), average tear BUT (P<0.01, t=2.774, df=374.5), and tear meniscus height (P<0.01, t=2.642, df=367.1). At the same time, IPL improved bulbar redness (P<0.0001, t=12.95, df=380) and corneal fluorescein staining (P<0.0001, t=4.147, df=380). Furthermore, following IPL treatment, the meibomian gland expressibility (MGE) and meibum quality were significantly improved (from 1.342±0.05815 to 0.9354±0.03922, P<0.0001, t=5.798, df=380 and from 1.266±0.04969 to 0.8639±0.03318, P<0.0001, t=6.733, df=380, respectively). Lipidomic analysis of the meibum characterized the changes in lipid profiles induced by IPL. Conclusion: IPL treatment offers a novel approach to markedly improve the treatment of patients with MGD due to correction of altered lipid profiles. The changes in lipid expression profiles are potential indexes to evaluate the therapeutic effectiveness of IPL treatment or other treatments on MGD. The lipid changes that are pertinent include: LPC(18:2)+HCOO, OAHFA(18:1/34:1)-H, TG(16:0/18:2/20:5)+H, and etc.. Therefore, accurate evaluation of the changes of lipid expression profile in patients with MGD can be used as a predictive, preventive, and personalized medical method.
... IPL helps by improving the dysfunction of the meibomian glands. [31][32][33][34][35][36] The various proposed mechanisms are the following: 1. Meibomian gland warming to melt and express the meibum [37] 2. Functional improvement of the meibomian gland [38] 3. Intravascular thrombosis of the small blood vessels, telangiectasia of the eyelid margin, reducing the levels of proinflammatory mediators that contribute to dry eye [32,33] 4. N e u r o t r o p h i c e f f e c t o n t h e c o r n e a a n d a neuroimmunomodulatory effect on the meibomian glands [39,40] 5. Decreasing tear osmolarity, helping to control the inflammation of the ocular surface [41] 6. Alleviating cellular functions such as collagen biosynthesis, fibroblasts regeneration, and motility in immunoregulatory cells [42,43] 7. Reduction of inflammation by reducing the load of Demodex mites. [44] Mechanical and therapeutic devices ...
Article
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Dry eye is a multifactorial disease of the tear film and ocular surface that manifests with symptoms of irritation, heaviness, visual acuity disturbance, and tear film instability with substantial damage to the ocular surface. It is characterized by inflammation of the ocular surface and increased osmolarity of the tear film. Due to the multifactorial and wide spectrum of etiology, it is often challenging to treat dry eyes. Comprehensive knowledge of pathophysiology, factors contributing to the disease process, and etiology of dry eye disease leads to more efficient management and treatment of the disease process. However, the treatment is marked by regional variation and differs among clinicians and ocular societies in terms of treatment options and diagnostic modalities available. Our previous review article was an intricate review of dry eye definition, epidemiology, classification, causes, diagnostic tests, management, and future trends of dry eye disease. This article will detail all the surgical management options available for dry eyes and recent upcoming modalities. This review aims to enlist all the surgical management options in a nutshell so that all the treating ophthalmologists, clinicians, cornea specialists, and dry eye experts have a detailed idea of the same and this article serves as a reference for better patient care.
... 4,5 However, these devices have some limitations; for example, the thermal pulsation device activator does not fit in patients with small palpebral fornixes (especially Asian individuals), intense pulsed light might not be effective in patients who have very dark brown to black skin. 6 To our knowledge, there have been few studies 5,7 regarding the effectiveness of quantum molecular resonance. Therefore, we have investigated potential novel minimally invasive devices for treatment of MGD. ...
Article
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Purpose: To study the effectiveness and safety of upper and lower eyelid treatment with combined application of three modes of 2940-nm erbium-doped yttrium aluminium garnet (Er:YAG) and 1064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers in patients with baggy eyelids (formed by intraorbital fat herniation) who exhibited meibomian gland dysfunction (MGD). Patients and methods: In this prospective cohort study, patients with baggy eyelid who exhibited MGD received combined laser treatment at baseline, as well as at the 4-, 8-, and 12-week follow-ups. The primary endpoint was meibum quality score at 16- and 24-week follow-ups; secondary endpoints were ocular surface index scores, tear film lipid layer thicknesses, tear break up times (TBUTs), Oxford scheme grades, and meibography grades at 16- and 24-week follow-ups. Adverse events, uncorrected visual acuities, best-corrected visual acuities, and intraocular pressures were also recorded. Results: Sixteen patients (four men and 12 women; mean age, 56.38 ± 8.64 years) were included. Meibum quality scores at the 16-week follow-up were significantly lower than scores at baseline (p=0.043) and at the 24-week follow-up (p=0.015). TBUT was significantly exacerbated at the 24-week follow-up, compared with baseline (p=0.001) and the 16-week follow-up (p=0.006). There were no significant changes in other parameters. All adverse events were mild and resolved without additional treatment. Conclusion: Combined application of three modes of 2940-nm Er:YAG and 1064-nm Nd:YAG lasers on upper and lower eyelids significantly improved meibum quality in patients with MGD; it ameliorated symptoms and signs of dry eye disease at 4 weeks after completion of laser treatment.
... IPL uses a wavelength ranges between 500-1200nm. Intense pulse light therapy is delivered by various instruments such as Lumenis M22 (Lumenis Ltd., Yokneam, Israel), 10 Dermamed Quadra 4 IPL (Lenni, PA), 11 Diamond Q4 (DermaMed Solutions), 12 E>Eye (E-swin), 13 Pulsed laser light (Intense Pulsed Light Regulated [IRPL ® ]), 14 Solari (Lutronic, Ilsan, Korea). 15 Although it is safe and effective in treating the dry eye it causes the hypopigmentation, skin burn and blistering of the skin. ...
Article
: We aimed to examine the effectiveness of eye-light therapy in improving the dry eye symptoms. : The retrospective case series where patients who underwent eye-light therapy between March 2019 to May 2020 were analyzed. Twenty patients aged ≥18 years with dry eyes were included. Patients with ocular infections, complications, contact lens users and missing data were excluded. OSDI scores and tear parameters such as noninvasive break up time (NIBUT), lipid layer thickness (LLT), tear meniscus height, meibography of upper and lower lid were evaluated pre and post one month Eye-Light therapy. : Twenty patients with mean±SD age of 43.55±20.53 years and mean spherical equivalent refractive error of 0.69±1.79 diopters were analyzed. OSDI was significantly associated with NBUT (r=-0.50, P = 0.02), lipid layer thickness (r=-0.45, P=0.047) and tear height (r =-0.45, P=0.046). OSDI was positively associated with upper lid meibography (r=0.74, P=<0.001) and lower lid meibography (r=0.45, P=0.045). Post-therapy, reduction in OSDI score post-therapy was present, NBUT was similar, lipid layer thickness and tear height were increased, meibography of upper lid was reduced, and meibography of lower lid did not alter much. Eye-light therapy is effective in reducing dry eye related symptoms with minimal immediate effect on tear film parameters post therapy. Eye-light therapy acts as an adjunct to ameliorate MGD. MGD being a chronic disease requires sustained therapy with environmental changes. Long term evaluation is required to assess the tear film changes and the pattern of efficacy of light therapy.
... Although the precise mechanism of IPL is not clearly understood, it has been hypothesized that thermal heating of the glands causes melting of the thickened meibum and dilates the glands to facilitate effective clinical expression. 32,33 Studies evaluating the safety and effectiveness of IPL reported significant improvement in meibum quality, tear breakup time, and ocular surface symptom scores at 4 to 8 weeks after three to eight treatment sessions. 32,[34][35][36] Although the results suggest IPL to be effective, the reported time to efficacy may be longer than desired for patients needing quick relief or preparing for surgery. ...
Article
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Objectives: To assess 1-week and 1-month efficacy of Systane iLux thermal pulsation treatment for meibomian gland dysfunction (MGD). Methods: This prospective, nonrandomized, open-label, multicenter study enrolled 30 adult patients (60 eyes) who had a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire score greater than 6 and total meibomian gland secretion (MGS) score equal to or less than 12 in each eye. All participants received thermal pulsation treatment bilaterally. Primary efficacy measures included MGS score (sum of grades for 15 glands graded on a scale of 0-3; 0 [no secretion], 1 [inspissated], 2 [cloudy], and 3 [clear liquid]) and tear breakup time (TBUT). Secondary efficacy measures were SPEED and Ocular Surface Disease Index (OSDI) scores. Results: The mean age of patients was 52.9±11.9 years. After 1 week, the mean MGS score improved significantly from 4.1±3.1 to 15.8±7.1 (right eye, OD) and 3.7±3.1 to 16.7±7.6 (left eye, OS); mean TBUT improved significantly from 4.9±4.1 to 8.4±3.6 (OD) and 5.2±4.2 to 8.9±3.9 (OS); and mean SPEED and OSDI scores improved significantly from 16.1±5.3 to 7.2±6.1 and 45.2±21.3 to 19.0±16.8, respectively (all P<0.001). After 1 month, the mean MGS score improved to 18.3±8.2 (OD) and 18.6±7.3 (OS); mean TBUT improved to 9.7±3.8 (OD) and 9.6±3.5 (OS); and mean SPEED and OSDI scores improved to 7.0±5.6 and 16.7±14.5, respectively (all P<0.001). No adverse events were reported. Conclusions: Systane iLux thermal pulsation treatment for MGD resulted in a statistically significant increase in meibomian gland secretion, improvement in tear film stability, and reduction in dry eye symptoms as early as both 1 week and 1 month.
... 12 Eligible participants for the treatment of MGD in this study were patients who did not receive any dry eye treatment for at least 1 month before the study and were required to be aged 18 or older. 14,21 They showed at least one of the following findings: reporting symptoms of ocular surface discomfort such as grittiness, dryness, irritation, itching, and pain and had an Ocular Surface Disease Index (OSDI) score ≥13; fluorescein tear break-up time (FTBUT) <10 s, fluorescein staining of the ocular surface, and clinical signs of MGD (MG capping and drop out, lid margin redness, telangiectasia, and irregularity). 18 Patients presenting with active ocular infection or disease other than dry eye, a history of ophthalmic surgery, any systemic disease including diabetes and autoimmune disease, or use of systemic, photosensitizing, or ocular medications except unpreserved lubricants 1 month before and during the study, eyelid disorders affecting blinking, any diagnosed sleep disorder, mood disorders, and taking sleep medications and antidepressants, and contact lens use within 3 months of or during the study were excluded. ...
Article
Purpose: To assess the therapeutic efficacy of a combinational therapy, including conventional treatment and intense pulsed light (IPL) technique on sleep quality of patients with meibomian gland dysfunction (MGD). Methods: Fifty participants with a clinical diagnosis of MGD were enrolled in this study. Participants underwent three sessions of IPL therapy. There was a 2-week interval between IPL sessions 1 and 2 and 1 month between sessions 2 and 3. Treatment was supplemented with conventional home-based therapy (including lid hygiene, warm compress, eyelid massage, and lid margin scrub) for MGD. Dry eye symptomatology, tear film, and ocular surface parameters were evaluated at baseline (day 0) and days 15, 45, and 75. Sleep quality was assessed before and after the study using Pittsburgh Sleep Quality Index (PSQI). Results: PSQI components improved significantly at day 75 in comparison with the baseline (all P < 0.05). Ocular Surface Disease Index (OSDI) score, noninvasive Keratograph tear break-up time (NIKBUT), fluorescein tear break-up time (FTBUT), meibomian gland expressibility, meibum quality score, and tear osmolarity improved at follow-up visits (P < 0.05). Younger patients showed more improvement in NIKBUT, sleep quality, and duration (P = 0.024, P = 0.047, and P = 0.008). Sleep latency decreased with increased NIKBUT and FTBUT and decreased OSDI score (P = 0.001, P = 0.005, and P = 0.041). Conclusions: The treatment of MGD is effective for improving sleep quality. Younger patients may preferentially benefit from the treatment.
... According to Foulks et al. [50], severity of DE symptoms appears to correlate to lipid layer thickness. Therefore, DE treatments that replenish or enhance meibum production have been found to improve signs and symptoms of DED [51,52]. In addition, lipids expressed by the meibomian gland have been documented to be antimicrobial, impair gram-positive and gram-negative bacterial growth and further fortify the ocular surface [53]. ...
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IntroductionLaser in situ keratomelieusis (LASIK) is one of the most frequently performed refractive treatments. Dry eye (DE) is common in patients after LASIK and can be bothersome postoperatively. Therapies such as intense pulsed light (IPL), sodium hyaluronate (SH) and heated eye mask (HEM) have been reported to improve signs and symptoms of DE .AimThe purpose of this prospective study was to evaluate and compare the effects of IPL and 0.1% SH (IPL group, 50 eyes) and IPL in combination with 0.1% SH and HEM (IPL + group, 50 eyes) in participants with persistent post-LASIK DE.Methods The final analysis included 100 patients (100 eyes) who had LASIK for myopic correction and had been experiencing moderate to severe DE following LASIK for over a year. Participants were randomly assigned to either the IPL group (2 IPL sessions) or IPL + group (2 IPL sessions and daily HEM for 4 weeks), and both groups continued the use of daily 0.1% SH (HYLO-COMOD®) preservative-free eye drops. Non-invasive tear break-up time (NITBUT), tear film lipid layer (TFLL), lower tear meniscus height (LTMH), meibomian gland quality (MGQ), meibomian gland expressibility (MGEx), corneal fluorescein staining (CFS), ocular surface disease index (OSDI) and artificial tear usage (ATU) survey were assessed at baseline (BL) and follow-up at 2 (F1) and 4 weeks (F2).ResultsFollowing the treatment protocol, all dry eye (DE) parameters assessed in this study improved significantly (P < 0.05) in both groups at F2 compared with their respective BL measurements. Inter-group comparison at F2 found significant differences in their NITBUT (IPL: 6.06 ± 0.59 vs. IPL +: 6.67 ± 0.86, P < 0.001), TFLL (IPL: 1.90 ± 0.65 vs. IPL +: 1.60 ± 0.64, P = 0.021), LTMH (IPL: 0.186 ± 0.053 vs. 0.204 ± 0.034, P = 0.003), MGQ (IPL: 1.48 ± 0.54 vs. IPL +: 1.26 ± 0.56, P = 0.026), MGEx (IPL: 1.62 ± 0.53 vs. IPL +: 1.44 ± 0.50, P = 0.038) and OSDI (IPL: 32.54 ± 6.85 vs. IPL +: 29.76 ± 4.74, P = 0.001), while CFS score (IPL: 4.02 ± 0.65 vs. IPL +: 3.96 ± 0.73, P = 0.652) and ATU (IPL: 1.88 ± 0.63 vs. IPL +: 1.72 ± 0.50, P = 0.159) showed no significant difference.Conclusion Post-LASIK DE signs and symptoms can be improved by combining therapies such as IPL, HEM and 0.1% SH. Increased TFLL due to a combination of IPL, 0.1% SH and HEM had a greater positive impact on the subjective and objective DE measurements in participants with persistent post-LASIK DE.
... Since the treatment for MGD using RF, LipiFlow Thermal Pulsation System, or IPL treatment is considered to be effective due to the thermal effect on the eyelid, the clinical improvement could be attributed to the melting of the abnormal meibum lipids [24][25][26][27]. We hypothesized that heat transfer to both the outer and inner eyelid surface is required to melt the abnormal meibum lipids and designed an RF thermal treatment system that could e ciently deliver RF energy to both the outer and inner eyelid surfaces simultaneously. ...
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Purpose: To evaluate the safety and efficacy of a low-level radiofrequency thermal treatment in obstructive MGD rabbit model. Materials and Methods: Meibomian gland orifices of central two-thirds of upper and lower eyelid margins were coagulated 2 times at 2-week intervals using a 5-MHz high-frequency electrosurgical unit. Sixteen eyes of 8 rabbits were treated with 1 session of radiofrequency thermal treatment (radiofrequency group) and 8 eyes of 4 rabbits were followed up without treatment (Control group). We evaluated lid margin abnormality and corneal staining scores, histologic examination of eyelids and meibomian gland, and meibography images before meibomian gland orifice closure, 4 weeks after meibomian gland orifice closure, and 4 weeks after radiofrequency thermal treatment. Results: There were significant improvements in lid margin abnormality score for upper and lower eyelids after radiofrequency thermal treatment (P<0.001 for upper and lower eyelids). Corneal staining score remained unchanged in radiofrequency group. However, it increased at the final follow-up in control group. Mean area of secretory acini showed a significant improvement, almost to the baseline levels, in radiofrequency group (P=0.004). On meibography, an improvement was seen in meibomian gland loss rate in radiofrequency group. Conclusions: Low-level of radiofrequency thermal treatment for heating the inner and outer eyelid surfaces is safe and effective for the treatment of obstructive MGD in a rabbit animal model of MGD.
... Toyos protocol was followed for all IPL treatment sessions. 43 Each participant in the IPL group received a minimum of two treatments separated by 3 weeks at day 0 (D0) and day 21 (D21). The Lumenis M22 system (M22; Yokneam, Israel) is a next-generation IPL device that combines Optimal Pulse Technology (OPT) with a modular laser multi-application platform to provide uniform and reproducible fluence throughout each flash. ...
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Background: Contact lens-related dry eye (CLDE) is common in contact lens (CL) wearers and can lead to ocular pain, decreased visual quality, and reduced quality of life. Objective: The purpose of this prospective, randomized, examiner masked study was to compare the effectiveness of intense pulsed light (IPL) and heated eye mask (HEM) for relieving CLDE. Methods: The final analysis included 60 patients (30 in the IPL group and 30 in the HEM group) who were using CL and had been suffering contact lens discomfort for more than a year. The IPL treatment group had two IPL treatments spaced 3 weeks apart, whereas the HEM group received HEM daily for 6 weeks (42 days). Non-invasive tear break-up time (NITBUT), tear-film lipid layer (TFLL), conjunctival fluorescein staining, meibum gland quality and expression, conjunctival redness score, ocular surface disease index (OSDI), best-corrected visual acuity, endothelial cell count, and intraocular pressure were assessed at baseline: first visit (V1), second visit (V2), and third visit (V3). Results: The mean age of the IPL group was 28.6 ± 4.3 years (16 females, 53%) and that of the HEM group was 28.6 ± 4.2 years (16 females, 53%). Mean NITBUT for the IPL group at V2 was 5.53 ± 0.77 sec (p < 0.001) and at V3 was 7.72 ± 0.88 sec (p < 0.001); the IPL group demonstrated a clinically and statistically significant improvement in mean NITBUT. In addition, the HEM group showed a clinically and statistically significant improvement in mean NITBUT at V3 (5.86 ± 0.76 sec, p < 0.001). At V3, the C-OSDI, TFLL score, and meibum gland quality and expressibility all increased considerably (p < 0.05) in both groups. Conclusions: Our results imply that IPL or HEM treatment of CLDE can be safely used to relieve symptoms of CLDE. In addition, IPL treatment is more effective in improving the general stability of the tear-film and decreasing the need for artificial tears in CLDE.
... According to published studies, improvements in the OSDI after IPL are negatively correlated with the baseline MG expression, that is, the higher the baseline MG expression capacity, the smaller the improvement in OSDI. [35] Therefore, we speculated that the MG expression capacity in patients with mild MGD was better than that in those with severe MGD, resulting in smaller improvements in OSDI in patients with mild MGD after IPL. Furthermore, the main efficacy evaluation in this study was based on improvement in OSDI. ...
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To observe the clinical outcomes of intense pulsed light (IPL) for meibomian gland dysfunction (MGD) and identify its influencing factors. Forty-eight eyes of 48 patients with MGD were included. Subjects were followed up 5 times on day 1, day 15, day 30, day 45, and day 120, and underwent 3 sessions of the IPL treatment on day 1, day 15 and day 30. Gender, age, duration of MGD, time of video display terminal usage, and severity of MGD were recorded at baseline. At every visit, Ocular Surface Disease Index (OSDI), eyelid margin abnormality score, tear film breakup time, Schirmer I test (S ɪ t) and corneal fluorescein staining were recorded. The clinical parameters before and after 3 IPL treatments were compared. Univariate and multivariable logistic regression analyses were performed to explore influencing factors. Compared with baseline, the tear film breakup time was increased and the corneal fluorescein staining score and OSDI were significantly decreased on day 45 and day 120 (all P < .001). In univariate analysis, among the patients with a younger age (18–39 years), moderate MGD, higher baseline S ɪ t and higher baseline OSDI, the IPL treatment had a higher effective rate (P = .032, .004, .024, and .014 respectively). The MGD severity was strongly associated with effective IPL, and patients with moderate MGD had an OR of 22.454 compared with the severe MGD patients (OR = 22.454, 95% CI: 2.890-174.436, P = .003). IPL effectively improves clinical symptoms and some signs in MGD patients. Age, MGD severity, baseline S ɪ t and baseline OSDI are potential factors that may influence the clinical outcomes of IPL. MGD severity is an independent influencing factor.
... IPL refers to a mature technology of dermatology for the treatment of skin telangiectasia, erythema, pigmentation, skin aging, and other diseases, and widely used for its good therapeutic effect. Toyos [19] et al. found that IPL improved patients' ocular surface with facial acne, and they proposed IPL as a potential treatment for MGD. Previous studies have indicated that IPL can be absorbed selectively by melanin and heme in deep skin tissues, causing the destruction and decomposition of pigment groups, the coagulation of blood vessels, and the elimination of abnormal telangiectasia, reducing vascularization of the palpebral edge of MGD patients [20] . ...
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Purpose: To observe the therapeutic effect on recurrent corneal erosion syndrome (RCES) by intense pulsed light (IPL) combined with meibomian gland massage. Methods: We recruited 30 patients (30 eyes) with RCES as the RCES group and 31 patients (31 eyes) as the control group. Both the groups received eyelash sampling, Demodex count, meibomian gland infrared photography, and the blepharolipin score. The RCES group was divided into the treatment group and the observation group again. Results: Parameters in the RCES group were higher than those in the control group. The parameters of the treatment group were decreased compared with the observation group. During the follow-up period, one patient in the treatment group relapsed. Conclusion: Meibomian gland dysfunction and Demodex infection may be associated with RCES. IPL combined with meibomian gland massage can significantly improve meibomian gland function, reduce the number of Demodex, and effectively control the relapse of RCES.
... T-BUT is mostly affected by the amount and quality of the tear film layers. As the decrease in MG secretion affects the lipid layer in the tear film leading to a shorter T-BUT, the measurement of MG secretion can also be used as a diagnostic indicator of MGD [13][14][15]. As mentioned above, the existing methods do not directly provide quantitative information about eyelid tissues with MGs that are affected by inflammatory MGD, as they are based on morphological structural examination of MGs or measurement of the secreted components. ...
Article
Herein, to investigate a new diagnostic method for Meibomian gland dysfunction (MGD) induced by eyelid inflammation, optical properties and deoxy-hemoglobin (Hb) concentrations in rodent eyelid tissues, including Meibomian glands(MGs), were measured using spatial frequency domain imaging (SFDI). Complete Freund's adjuvant solutions were injected into the eyelid margins of Sprague-Dawley rats to induce MGD. After three weeks, the optical properties and Hb of the MG and non-MG regions of the eyelids were measured ex-vivo using an SFDI system. The comparison of Hb showed that the MGD group exhibited significantly higher values than those of the control group in both regions. The optical properties at 730 and 850 nm for the MG regions in the MGD group were significantly different from those in the control group. In addition, the 630 nm absorption coefficients of both regions were significantly higher in the MGD group than in the control group. Thus, the SFDI technique can detect the increased Hb concentration and changes in the optical properties of the eyelids due to inflammatory MGD in a noncontact manner and has the potential to be used as a novel quantitative diagnostic method for the occurrence of MGD.
... Intense Pulsed Light (IPL) therapy was developed and has been widely used to treat dermatologic diseases, but casual observations of its effects on Meibomian glands and symptoms of DED suggested that it could also be effective for this condition. 5 This technique consists in the application of a series of pulses of non-coherent polychromatic light in the periorbital region, with a wavelength spectrum ranging 500-1200 nm. This produces a selective thermal effect on the irradiated tissue, leading to coagulation and ablation of blood vessels and thus reducing vascularization. ...
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Purpose: To assess the effectiveness of a combination of intense pulsed light and low-level light therapy (IPL/LLLT) for the treatment of dry eye. Study design: Retrospective before-after single-center clinical study. Materials and methods: Patients diagnosed with dry eye, refractory to conventional treatment, underwent four sessions of combined IPL/LLLT over 3 months. The Ocular Surface Disease Index (OSDI) questionnaire, non-invasive breakup time (NIBUT), tear film osmolarity and meniscus height were measured 6 months before intervention, at baseline, post-intervention (3 months), 9 and 15 months. Results: NIBUT, osmolarity and meniscus height significantly worsened during the 6 months before treatment, whereas symptoms did not change. OSDI scores significantly improved at post-intervention (MD = -44.0, 95% CI -38.1, -50.0), and then increased again until the at last follow-up, but still significantly different from baseline (MD = -30.0, 95% CI -23.4, -36.8). The three clinical signs showed a similar pattern, with one-year improvements of 3.6 seconds for the NIBUT (95% CI 3.1, 4.2, p <0.001), 28 mOsm/L for osmolarity (95% CI 23.6, 32.4, p <0.001) and 0.03 mm for meniscus height (95% CI 0.02, 0.04, p <0.001). No adverse effects were observed. Conclusion: IPL/LLLT is safe and produces an important reduction in symptoms and signs of dry eye disease, still relevant one year after the end of treatment in a sample with high symptoms' severity. Therefore, it represents a promising treatment option for patients who do not improve with conventional treatment. Randomized trials are needed to determine the added benefit provided by LLLT.
... [37] Thermal pulsation and intense pulsed light therapy are also used to treat posterior blepharitis due to meibomian gland dysfunction. [31] Blepharitis has good prognosis; however it is sporadically associated with recurrent episodes due to the pathogenic susceptibility of the patient. [38,39] Conjunctivitis Conjunctivitis or inflammation of the conjunctiva is the most common cause of acute red eye. ...
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Patients with ocular infections are at increased risk of vision impairment and may require immediate medical care to preserve their vision. Management of ocular bacterial infections has evolved in recent years and includes a pragmatic selection of broad-spectrum antibiotics based on the causative bacteria. Nevertheless, the treatment of bacterial ocular infections is increasingly becoming a challenge, as the causative bacterium acquires resistance to antibiotics through intrinsic and acquired methods. From an Indian perspective, along with the challenges of antibiotic resistance, there are other factors such as lack of knowledge on epidemiology, and lack of data on local susceptibility patterns of ocular pathogens that have significant impact on the management of ocular infections. This narrative review summarizes the available knowledge on prescribing antibiotics for five common ocular infections in India. It further highlights the significance of the understanding of antimicrobial susceptibility patterns across India as a cornerstone to promote rational use of ocular antibiotics. This review indicates that large-scale antimicrobial resistance surveillance studies can facilitate the synchronization of ophthalmic antimicrobial prescription policies with local antibiotic resistance patterns. Further, establishment of an antimicrobial stewardship program in ophthalmology can potentially increase the efficacy of diagnostic tools, and implement earlier adoption of effective antibiotics. Overall, this review provides consolidated information and key considerations for treatment decision-making of common ocular infections in India.
... The physician continuously moves the electrode over the gel-covered skin around the eyelid to deliver the RF energy during treatment. Since the treatment for MGD using RF, LipiFlow Thermal Pulsation System, or IPL treatment is considered effective due to the thermal effect on the eyelid, clinical improvement could be attributed to the melting of abnormal meibum lipids [24][25][26][27]. We hypothesized that heat transfer to both the outer and inner eyelid surface is required to melt the abnormal meibum lipids and subsequently designed an RF thermal treatment system that efficiently delivers RF energy to the outer and inner eyelid surfaces simultaneously. ...
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This study aimed to evaluate the safety and efficacy of a low-level radiofrequency thermal treatment in an obstructive MGD rabbit model. Meibomian gland orifices of the central two-thirds of the upper and lower eyelid margins were coagulated twice at 2-week intervals using a 5-MHz high-frequency electrosurgical unit. Sixteen eyes of eight rabbits were treated with one session of radiofrequency thermal treatment (radiofrequency group) and eight eyes of four rabbits were followed up without treatment (control group). Lid margin abnormality and corneal staining scores, histologic examination of the eyelids and meibombian gland, and meibography imaging were evaluated just before and 4 weeks after meibomian gland orifice closure and 4 weeks after radiofrequency thermal treatment. Lid margin abnormality score improved significantly for the upper and lower eyelids after radiofrequency thermal treatment (P < 0.001 for both eyelids). Corneal staining score remained unchanged in the radiofrequency group; however, the control group saw an increase at final follow-up. There was a significant improvement to almost baseline levels in the mean area of secretory acini in the radiofrequency group (P = 0.004). Additionally, meibography indicated an improvement in meibomian gland loss rate in the radiofrequency group. Low-level radiofrequency thermal treatment heating the inner and outer eyelid surfaces is safe and effective to treat obstructive MGD in a rabbit animal model of MGD. Graphical abstract
Article
Purpose of review: Dry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited to, lacrimal gland hypofunction, meibomian gland dysfunction (MGD), ocular surface inflammation, and corneal nerve dysfunction. Current DED treatments target some facets of the disease, such as ocular surface inflammation, but not all individuals experience adequate symptom relief. As such, this review focuses on alternative and adjunct approaches that are being explored to target underlying contributors to DED. Recent findings: Neuromodulation, stem cell treatments, and oral royal jelly have all been studied in individuals with DED and lacrimal gland hypofunction, with promising results. In individuals with MGD, devices that provide eyelid warming or intense pulsed light therapy may reduce DED symptoms and signs, as may topical Manuka honey. For those with ocular surface inflammation, naturally derived anti-inflammatory agents may be helpful, with the compound trehalose being farthest along in the process of investigation. Nerve growth factor, blood-derived products, corneal neurotization, and to a lesser degree, fatty acids have been studied in individuals with DED and neurotrophic keratitis (i.e. corneal nerve hyposensitivity). Various adjuvant therapies have been investigated in individuals with DED with neuropathic pain (i.e. corneal nerve hypersensitivity) including nerve blocks, neurostimulation, botulinum toxin, and acupuncture, although study numbers and design are generally weaker than for the other DED sub-types. Summary: Several alternatives and adjunct DED therapies are being investigated that target various aspects of disease. For many, more robust studies are required to assess their sustainability and applicability.
Article
Introduction. Dry eye disease (DED) associated with meibomian gland dysfunction (MGD) is one of the most frequent eye diseases, with a prevalence from 10% of the western population to 70% in Asian countries. Today there is no fully effective treatment and alternatives such as intensive pulsed light (IPL) are being sought. The results with IPL highlights show subjective improvement of the patients when the treatment is carried out with 3 or 4 sessions and with parameters adapted to ophthalmological use. Most studies show improvement in 80-90% of the cases. Regarding the mechanisms of action, there are several possible effects of IPL and the most of them have a common denominator, the reduction of inflammation on ocular surface and around the meibomian glands, favoring tissues regeneration and neuro-trophism who are responsible for the improvement reported by patients. Areas covered: We analyze possible mechanisms of action of IPL such as the importance of the parameters used for ophthalmological use. Expert opinion: Still having doubts about the exact mechanism of IPL action, the good clinical results obtained (efficacy and safety) encourage us to think that the incorporation of this new technology can help to improve these patients especially the symptoms they suffer.
Article
Résumé Introduction Le dysfonctionnement des glandes de Meibomius (DGM) est la cause la plus fréquente de syndrome sec oculaire. L’objectif de cette étude est d’évaluer l’efficacité d’un traitement combiné par lumière intense pulsée (LIP) et thérapie par lumière de faible niveau (TLFN) dans le DGM symptomatique. Matériels et méthodes Il s’agit d’une étude rétrospective analysant les données de 30 patients présentant un DGM responsable de symptômes de sécheresse oculaire non soulagés par le traitement médical et traités par LIP et TLFN. Le critère de jugement principal était le score OSDI (Ocular Score Disease Index) à 1 mois, puis 1 an. Les critères de jugements secondaires étaient l’acuité visuelle, la pression intraoculaire, le break-up time, le test de Schirmer, le score d’Oxford et le score meibographique par infrarouge 1 mois après la fin du traitement. Résultats Le score OSDI moyen a régressé de 43 ± 19 à 17 ± 12 (1 mois ; p < 0,0001), puis à 29 ± 11 (12 mois ; p = 0,013) ; 63 % des patients avaient un score de meibographie grade ≥ 2 avant et 7 % après traitement (compris entre 1 et 4) (p = 0,009) ; 75 % des patients avait un score d’Oxford ≥ 1 avant traitement contre 41 % après traitement (compris entre 1 et 3) (p = 0,004). Aucune différence significative sur les autres critères secondaires n’a été notée. Conclusion Le traitement par LIP et TLFN semble améliorer dans le temps les patients présentant un DGM symptomatique résistant au traitement médical.
Article
Laser based devices are ubiquitous in many fields which has resulted in an increase in ocular injuries from laser exposure. Glasses for laser protection are available but contact lenses that block certain wavelengths could be a less bulky alternative. Here, we focus on developing a contact lens for protecting eyes from accidental exposure to a green laser by incorporation of gold nanoparticles that exhibit a local maximum in absorbance as a tunable wavelength due to the localized surface plasmon resonance (LSPR) effect. The particles are incorporated in a poly vinyl alcohol (PVA) contact lens because PVA offers the twin benefits of stabilizing gold nanoparticles during manufacturing by Turkevich method and excellent biocompatibility and high-water content. The monodispersed gold nanoparticles of the desired size (11.75 ± 1.09 nm) were prepared by Turkevich method with PVA as the stabilizer. The particles were separated out by anti-solvent precipitation and then redispersion to achieve the desired concentration, and finally crosslinked by freezing-thawing cycling to form a PVA lens loaded with gold nanoparticles (PVA GoldinLens). The gold nanoparticles remain well-dispersed in the lens for all gold nanoparticle loadings (0, 0.25, 0.5, 1, 2 and 4%, wt% in dried lenses). The transmittance spectra of the PVA GoldinLenses exhibit a minimum at 520 nm due to the LSPR effect of the 12 nm gold nanoparticles. The transmittance was reduced in the entire wavelength range, as is typical in laser protection glasses but the decrease is more pronounced around 520 nm. The laser protection efficacy enhances with particle concentration but becomes relatively independent of particle loading at higher concentration reaching a maximum value of 66.7%. To further improve the laser protection, we explore an alternative approach of manufacturing the gold particles inside two commercial contact lenses (Acuvue TruEye and Moist) by soaking the lenses in gold precursor solution (0.25 - 1%, wt%) followed by reduction by soaking in solution of 5% (wt%) sodium borohydride to form the particles. This process leads to formation of about 100 nm size particles in the lenses. Incorporation of particles in both commercial lenses offers superior absorption compared to the PVA lens at comparable loadings with >90% blocking of laser at about 3% (wt% in dried lens) loading. However, the absorbance is not tuned to the green laser due to the larger particle sizes and particle aggregates which result in light transmittance decreasing significantly in the entire wavelength range. Based on comparing the absorption spectra and laser blocking of the lenses with commercial laser blocking glasses, the TruEye GoldinLens with 0.75% particles appears to be a good potential alternative. In all cases, absorption of laser leads to localized heating which could damage tissue but on the other hand could potentially also be useful in treating indications in which warming eyelids is beneficial such as dry eyes. Laser exposure increases temperature to higher than the melting point of the meibomian lipids which is critical for treating the gland dysfunction (MGD) dry eye disease by local heating. This work advances the field of incorporation of gold nanoparticles in contact lenses and other similar gels for a broad set of applications including laser-protection, and treatment of dry eyes and color blindness.
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Purpose: This review aimed to evaluate the efficacy and safety of intense pulsed light treatment (IPLT) combined with meibomian gland expression treatments(MGXT) in meibomian gland dysfunction. Methods: We conducted a meta-analysis of randomized controlled trials that compared the efficacy of IPLT and MGXT in the treatment of dry eye disease (DED). The meibomian gland yielding secretion score was the primary outcome, whereas the secondary outcomes included the Meiboscore, tear breakup time in seconds, Standard Patient Evaluation for Eye Dryness and Corneal Fluorescein Staining . Results: This study consisted of 6 trials with 326 patients. Significantly greater improvement was observed in meibomian gland yielding secretion score at 1 month [MD: 13.69 (95% CI, 11.98, 15.40)] and at 3 months [MD: 11.03 (95% CI, 10.27, 11.80)], low meibomian gland yielding secretion score at 1 month [MD: 6.92 (95% CI, 5.49, 8.34)] and at 3 months MD: 6.80 (95% CI, 5.01, 8..59)], up meibomian gland yielding secretion score at 1 month [MD: 6.41 (95% CI, 4.12, 8.70)] and at 3 months [MD: 8.06 (95% CI, 5.70, 10.42)] and tear breakup time at 1 month [MD: 2.38 (95% CI, 1.83, 2.92)] and at 3 months [MD: 1.82 (95% CI, 1.48, 2.19)] in the IPL-MGX group than in the MGX group. Conclusions: IPL-MGX is safer and more efficacious as compared to the MGX alone in the treatment of patients with MGD-related dry eye. We recommend discussing the decision with the ophthalmologist for an appropriate choice.
Chapter
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The high and increasing prevalence of Dry Eye Disease (DED) highlights the need for new treatment treatments and more effective management strategies for this chronic disease. After training, lid grooming, and various ocular lubricants, the Tear Film & Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Management and Therapy Subcommittee recently proposed Intense Pulsed Light (IPL) as the second phase of therapy. Brief flashes of non-coherent light (400–1,200 nm) are delivered to the skin’s surface using IPL technology. Toyos et al. found in 2005 that rosacea sufferers who were treated with IPL in the periocular region had a significant increase in their dry eye symptoms.
Article
Clinical relevance Meibomian gland dysfunction is the main cause of evaporative dry eye disease and can lead to ocular discomfort and ocular surface damage. Early diagnosis and management of this condition can prevent its impact on patients ‘visual health and quality of life. Background In the last decade, intense pulsed light therapy (IPL) has been introduced as a therapeutic option for patients with meibomian gland dysfunction (MGD). Various treatment modalities and protocols have been reported to increase the efficacy of this technique. This study aimed to assess the efficacy of a novel five-flash IPL technique in combination with home-based therapy and to compare it with conventional home care alone in patients with MGD. Methods In a randomised controlled trial, 100 symptomatic MGD patients were enrolled. The treatment group underwent three sessions of a five-flash IPL therapy. For all participants, eyelid warming, lid hygiene and lubricant therapy was prescribed. Ocular surface parameters were compared for control and treatment groups. Results Ocular Surface Disease Index (OSDI), non-invasive keratograph tear break up time (NIKBUT), fluorescein TBUT, MG expressibility, meibum quality and tear osmolarity were improved at follow up visits in both groups (p < 0.05). On day 75, NIKBUT was significantly higher in the IPL group (p = 0.045). The IPL treatment effect was not statistically significant (p > 0.05), except for bulbar and limbal hyperaemia (p = 0.02 and p = 0.02). In both groups, younger patients showed more improvement in NIKBUT (p = 0.02, r = −0.32; p < 0.001, r = −0.52). Conclusion IPL therapy combined with conventional home-based therapy, and home care alone are both effective for patients with MGD. IPL may have an additional role in the improvement of ocular hyperaemia.
Chapter
Oral tetracyclines can improve clinical signs and symptoms of chronic blepharitis through multiple mechanisms. The manuscript discussed herein provides clinical and mechanistic evidence for tetracycline treatment for blepharitis.
Chapter
The treatment of patients with dry eye disease is based upon the severity of the patient's disease and symptoms. In addition, since there are several factors that can contribute to dry eye symptoms, it is critical to address the underlying cause including evaporative dry eye, aqueous deficiency, and inflammation. The treatment of dry eye should follow a stepwise approach based upon the patient's symptoms and the underlying physiology of their condition. The goals of treating dry eye disease are to improve patients' symptoms and quality of life, decrease inflammation, and prevent ocular surface damage. There has been a large expansion in treatment modalities available to treat the different causes of dry eye disease. For patients with symptoms that are refractory to conservative measures and lubricants, there are several prescription medications that can be utilized including antiinflammatory agents and antibiotics. In addition, blood products are increasingly being used that have shown relief in symptoms and signs of dry eye disease. In-office procedures can also play a helpful role in managing evaporative dry eye disease. For patients with advanced disease, contact lenses, amniotic membrane transplant, and neurostimulation can be considered. Furthermore, surgical procedures can help ameliorate symptoms for certain patients. Lastly, there is ongoing research on devices and novel therapeutics that are currently in clinical trials. While dry eye disease affects millions of patients, the advances that have been made in treating dry eye disease help decrease the burden of disease on patients' lives.
Chapter
The treatment of meibomian gland dysfunction (MGD) first requires both proper diagnosis of the condition and identification of contributory ocular surfaces disorders that may confuse proper attribution of both patient symptoms and signs. Nomenclature remains confusing as many clinicians alternate between diagnosing patients with dry eye, evaporative dry eye, MGD, ocular rosacea, or, more generically, ocular surface disease. While all of these terms are valid descriptors of ocular surface disease, this chapter will focus on treatment of MGD, to be understood as the evaporative dry eye caused by the tear film dysfunction created by stagnant and/or dysfunctional meibum as well as ocular surface inflammation, whether present within occluded glands in the eyelid, conjunctival and corneal epithelium, and the tear film itself.
Resumen Objetivo Investigar la eficacia y la seguridad del protocolo de luz pulsada intensa (IPL) combinando el protocolo de tratamiento con IPL para la disfunción de las glándulas de Meibomio/enfermedad de ojo seco con IPL aplicada directamente en los párpados, asociada a la expresión de las glándulas de Meibomio (GM) para el tratamiento del chalación. Material y métodos Estudio retrospectivo de serie de casos. Los pacientes que presentaron chalación, recibieron un tratamiento combinado de terapia con IPL que consistió en usar el protocolo habitual de IPL para disfunción de las glándulas de Meibomio/enfermedad de ojo seco empleando una fluencia de acuerdo al tipo de piel según Fitzpatrick, seguido de una segunda fase (en la misma sesión) de aplicación IPL directamente sobre los párpados de ambos ojos empleando una fluencia de 10 J/cm². A continuación, todos los pacientes recibieron expresión de las GM, higiene de los párpados, antibiótico tópico y medicación ocular antiinflamatoria tópica. Los efectos adversos relacionados con este protocolo se evaluaron en cada sesión de IPL. Resultados Se incluyeron 26 chalaciones de diecinueve pacientes (24 ojos) con una edad media de 49,89 ± 20,43 años. Fueron necesarias 2,07 ± 0,97 sesiones de IPL de media para la resolución del chalación. El tratamiento combinado de protocolo IPL y expresión de GM mostró un 96,15% de eficacia y no se observaron efectos adversos. Conclusiones El tratamiento combinado de IPL para disfunción de las glándulas de Meibomio/enfermedad de ojo seco con IPL aplicado directamente sobre los párpados y expresión de GM podría ser eficaz y seguro para el tratamiento de los chalaciones.
Article
Objective: To investigate the efficacy and safety of an intense pulsed light (IPL) combined IPL treatment protocol for meibomian gland dysfunction (MGD)/dry eye disease (DED) with IPL applied directly to the eyelids, associated with meibomian gland (MG) expression for the treatment of chalazion. Material and methods: Retrospective case series study. Patients presenting with chalazion received a combined IPL therapy treatment consisting of using the usual IPL protocol for DGM/EOS using a fluence according to skin type according to Fitzpatrick, followed by a second phase (in the same session) of IPL application directly on the eyelids of both eyes using a fluence of 10J/cm2. All patients then received GM expression, eyelid hygiene, topical antibiotic and topical ocular anti-inflammatory medication. Adverse effects related to this protocol were assessed at each IPL session. Results: Twenty-six chalazions from nineteen patients (24 eyes) with a mean age of 49.89±20.43 years were included. An average of 2.07±0.97 IPL sessions were required for chalazion resolution. The combined treatment of IPL protocol and GM expression showed 96.15% efficacy and no adverse effects were observed. Conclusions: Combined IPL treatment for MGD/DED with IPL applied directly onto the eyelids and MGX could be effective and safe for the management of chalazions.
Article
Currently, the main applied physiotherapeutic methods of treatment, whale, as well as the features of their application are considered. The basis of the meibomian glands dysfunction treatment is the hygiene of the eyelids. There are many modifications to the application of eyelid hygiene, but its basic principle is the use of warm compresses and eyelid massage. There are many modifications of warm compresses. Using them, it is necessary to remember about the possibility of the appearance of the cornea with various types of thermal effects on the eyelids when dysfunction of the meibomian glands is detected, therefore it is important to carefully dose the time of thermal exposure and temperature regime, which allows you to avoid side effects. The classic tool that a doctor uses to treat MGD — eyelid massage on a glass rod, has now been replaced by many high-tech devices for heating, moisturizing and massage of the eyelid. All commercial devices for the treatment of MGD on the world market can be divided into several groups, according to their effect: device for light therapy. The most high-tech devices include the LipiFlow® device (combined heat and eyelid massage) and the device for IPL therapy with intense pulsed light. many studies aimed at studying the effectiveness of various research methods. It should be noted that it is not by chance that in modern ophthalmological practice the range of new methods for studying MGD has expanded so much. This is due to the annual number of patients suffering from this pathology. Therefore, the urgent task is to search for new methods of treatment aimed at restoring the functional activity of the meibomian glands.
Article
Periorbital rejuvenation is a common reason for patients to seek cosmetic treatment. There are several nonsurgical light and energy-based devices available to treat various aspects of periorbital rejuvenation without risks of an invasive, surgical procedure. Although ablative laser resurfacing appears to offer the most impressive clinical improvements, nonablative devices result in noticeable cosmetic improvement with more favorable side-effect profiles and shorter recovery times. The specific modality selected for periorbital rejuvenation should be tailored to patients' individual characteristics, preferences, and aesthetic goals. With continued advancements, additional nonsurgical light and energy-based devices will become available in the future for periorbital rejuvenation.
Article
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The goals of the subcommittee were to review the current practice and published evidence of medical and surgical treatment options for meibomian gland dysfunction (MGD) and to identify areas with conflicting, or lack of, evidence, observations, concepts, or even mechanisms where further research is required. To achieve these goals, a comprehensive review of clinical textbooks and the scientific literature was performed and the quality of published evidence graded according to an agreed on standard, using objective criteria for clinical and basic research studies adapted from the American Academy of Ophthalmology Practice Guidelines1 (Table 1). It should be noted that, in many of the clinical textbooks and previous reports, terminology is often interchanged and the management of anterior and posterior blepharitis and/or meibomitis is often considered concurrently. Thus, a broad scope of documents was reviewed in this process. Consistency in terminology and global adoption of the term “meibomian gland dysfunction” would significantly aid clinical research and clinical care in MGD going forward.
Article
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Supported by the Tear Film and Ocular Surface Society (TFOS; http://www.tearfilm.org); individual author support is listed in the Appendix of the Introduction. Disclosure: Each Workshop Participant's disclosure data can be found in the Appendix of the Introduction.
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To evaluate the use of topical cyclosporine, 0.05% (Restasis; Allergan Inc, Irvine, California), for the treatment of mild, moderate, and severe dry eye disease unresponsive to artificial tears therapy. This was a prospective clinical study. One hundred fifty-eight consecutive patients with dry eye disease unresponsive to artificial tears therapy were divided into 3 groups of disease severity: mild, moderate, and severe. Patients were evaluated using the Ocular Surface Disease Index for symptomatic improvement, tear breakup time, fluorescein staining, lissamine green staining, and Schirmer testing. Patients were observed for 3 to 16 months. The main outcome measure was improvement in disease. Forty-six of 62 patients with mild dry eye disease (74.1%), 50 of 69 with moderate disease (72.4%), and 18 of 27 with severe disease (66.7%) showed improvement, with 72.1% improving overall. Topical cyclosporine shows beneficial effects in all categories of dry eye disease. Symptomatic improvement was greatest in the mild group and the best results in improvement of disease signs were in patients with severe dry eye disease.
Article
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This review examines the impact of moderate to severe dry eye disease on daily life and medical-resource utilization. The results suggest that current treatment paradigms can lead to unacceptable costs in both quality of life and progressive use of healthcare resources. Evidence linking this disease to T-cell-mediated inflammatory processes lays the foundation for understanding the clinical benefits of topical cyclosporine, an immunomodulatory and anti-inflammatory agent.
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To develop current treatment recommendations for dry eye disease from consensus of expert advice. Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome. A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease. Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.
Article
To evaluate in a general clinic-based cohort of patients with dry eye disease (DED) the distribution of patients with aqueous-deficient or evaporative subtype of DED. Schirmer tests and meibomian gland dysfunction (MGD) (Foulks-Bron scoring) were evaluated in both eyes of 299 normal subjects and DED patients (218 women and 81 men) across 10 sites in the European Union and the United States. Using the more severe measurement of the 2 eyes, subjects were considered to have pure aqueous-deficient dry eye (ADDE) with Schirmer values of <7 mm and MGD grades of ≤5. Patients were classified as purely evaporative dry eye with MGD grades of >5 and Schirmer values of ≥7 mm. Subjects were placed into the mixed (hybrid) category if they exhibited both a low Schirmer value of <7 and evidence of MGD with a grade >5. Of the 224 subjects classified with DED using an objective, composite, disease severity scale, 159 were classified into 1 of 3 categories: 79 were classified with only MGD, whereas only 23 were classified as purely aqueous deficient, and 57 showed evidence of both MGD and aqueous deficiency. Overall, 86% of these qualified DED patients demonstrated signs of MGD. The remaining 65 patients showed evidence of DED through other clinical signs, without overt evidence of MGD or ADDE, possibly because of the inherent variability of these signs. The proportion of subjects exhibiting signs of evaporative dry eye resulting from MGD far outweighs that of subjects with pure ADDE in a general clinic-based patient cohort.
Article
The purposes of this study were to determine (1) the pressure required to express the first nonliquid material from nonfunctional lower lid meibomian glands, (2) the pressure required to evacuate all of the expressible material from the glands (simulating the authors' methodology for therapeutic meibomian gland expression), and (3) the level of pain associated with these procedures. All patients (n=28) were recruited from those presenting for ocular examinations at a single practice. Custom instrumentation exerting pressures from 1.0 to 150.0 psi was developed to quantify the pressure applied during expression. The instrument was applied to the inner surface of the lower lid. The lid was then compressed between the thumb and the contact surface of the instrument. The applied pressure was displayed on a digital meter. The first procedure evaluated the pressure required to obtain the first nonliquid material from nonfunctional glands. The second evaluated the pressure required for evacuating all expressible gland contents. The pain response was monitored throughout the procedure. The pressure to obtain the first nonliquid material ranged from 5 to 40 psi (mean=16.1±8.2 psi) and for the evacuation of expressible contents, from 10 to 40 psi (mean=25.6±11.4 psi). Only 7% of the patients could tolerate the pressure necessary to administer complete therapeutic expression along the entire lower eyelid. Forces of significant magnitude are required for therapeutic expression. Pain is the limiting factor for the conduct of this treatment.
Article
A new and previously unpublished thermodynamic treatment device, which for the first time applies heat directly to both inner eyelid surfaces with a precision-controlled resistive heater while pulsating pressure is simultaneously applied to the outer eyelids using an inflatable air bladder, was used to restore meibomian gland functionality for a subject with severe evaporative dry eye. The subject, a 39-year-old white woman of light complexion with severe symptoms and corroborating objective signs of dry eye, had been unsuccessfully treated for 3 years by 7 practitioners. Using a new standardized meibomian gland expression device, a diagnosis of nonobvious meibomian gland dysfunction, where none of the approximately 24 meibomian glands of the right lower eyelid and 1 meibomian gland of the left lower eyelid were functional, was made. The patient underwent a single 12-minute treatment per eye with the treatment device. The treatment restored the functionality of 8 glands in each eye, doubled the fluorescein break-up time (FBUT) from 5 to 10 seconds, and decreased the symptom scores by approximately 80% for the entire follow-up period of 3 months.
Article
To determine (1) if the number of meibomian glands yielding liquid secretion (MGYLS) is correlated with dry eye symptoms and (2) the mean number of MGYLS in the nasal, central, and temporal regions of the lower eyelid in a random clinical sample. Subjects presenting for routine eye examinations were recruited (n = 133; 90 females, 43 males; mean age = 50.3 +/- 14.7 years). The sample included symptomatic and asymptomatic individuals using the Standard Patient Evaluation of Eye Dryness questionnaire. Meibomian gland evaluations were performed using a standardized technique and diagnostic instrument. The mean number of MGYLS in the lower eyelid correlated with dry eye symptoms, p = 0.0002. The mean numbers of MGYLS in each third of the lower eyelid were significantly different, p <or= 0.0001: temporal = 0.27 +/- 0.06, central = 2.14 +/- 0.13, and nasal = 3.10 +/- 0.15. The temporal third of the lower lid was 14 times as likely as the nasal third to have zero MGYLS; 86% of temporal versus 6% of nasal thirds had zero MGYLS. This is the first report to document the following: (1) a correlation between the number of MGYLS in the lower eyelid and dry eye symptoms; (2) the number of MGYLS varies significantly across the lower eyelid, with the highest number of MGYLS in the nasal third and the lowest number of MGYLS in the temporal third of the lower eyelid; and (3) instrumentation to standardize diagnostic meibomian gland expression is desirable if not mandatory for the evaluation of meibomian gland function.
Article
Warm-compress therapy applied to the skin of the closed eyelids has been recommended as a treatment for meibomian gland dysfunction (MGD). Previous studies have evaluated the effects of warm-compress therapy on tear-film fluorescein break-up time and tear evaporation rate. The purpose of this study was to determine if tear-film lipid layer thickness (TFLLT) was altered following 5, 15, and 30 minutes of warm, moist compress therapy. Twenty patients with a diagnosis of dry eye associated with MGD and a baseline TFLLT of <or= 90 nm (baseline difference between experimental and control eyes <or= 25 nm) were studied. The skin of the closed eyelids of one eye of each subject was treated for a total of 30 minutes with a compress saturated with warm (40.0 +/- 2.0 degrees C) water used as a compress; and the skin of the closed eyelids of the contralateral control eye was treated for a total of 30 minutes with a compress saturated with room-temperature (24.0 degrees C +/- 1.0 degrees C) water used as a compress. The subjects' eyes were randomized into experimental and control eyes. TFLLT was measured at the following time points: 5, 15, and 30 minutes during the 30-minute treatment period, and after 5 minutes following the 30-minute treatment period. The mean baseline TFLLT of the experimental eye prior to treatment with a warm, moist compress was 57.8 +/- 12.9 (standard error) nm; after 5 minutes of treatment, TFLLT was 105.8 +/- 23.7 nm; after 15 minutes of treatment, 117.8 +/- 26.4 nm; after 30 minutes of treatment, 121.5 +/- 27.1 nm; and after 5 minutes following the 30-minute treatment, 96.0 +/- 21.5 nm. The mean baseline TFLLT of the control eye prior to treatment with a room temperature, moist compress was 63.0 +/- 14.1 nm; after 5 minutes of treatment, TFLLT was 63.8 +/- 14.3 nm; after 15 minutes of treatment, 62.3 +/- 13.9 nm; after 30 minutes of treatment, 64.5 +/- 14.4 nm; and after 5 minutes following the 30-minute treatment period, 58.5 +/- 13.1 nm. Using a paired-data t-test, the results demonstrated a significant increase in mean TFLLT in the experimental eye after 5 minutes (P < 0.001), 15 minutes (P < 0.001), and 30 minutes (P < 0.001) of treatment, and after 5 minutes following the 30-minute treatment period (P < 0.001) when compared to baseline TFLLT. In comparison, there was no significant increase in TFLLT of the control eye after 5 minutes (P = 0.79), 15 minutes (P = 0.77), and 30 minutes (P = 0.81) of treatment, and after 5 minutes following the 30-minute treatment period (P = 0.20) when compared to baseline TFLLT. Warm, moist compress therapy applied to the skin of the closed eyelids increases TFLLT for subjects with MGD by more than 80%, 5 minutes after initiating treatment and an additional 20% after 15 minutes of treatment. This study supports clinical experience and previous reports on warm, moist compress therapy as an effective treatment for meibomian gland dysfunction.
Article
Rosacea is a common skin condition but the treatments currently available are not satisfactory. To assess the efficacy of intense pulsed light (IPL) for treatment of stage I rosacea (flushing, erythema and telangiectasia). Thirty-four patients were treated, 25 women and nine men, mean age 47 years. The treatment employed was IPL 515-1200 nm, with a 560 nm cut-off filter. The fluence range was 24-32 J cm(-2). Four treatments were administered on the face at 3-week intervals. Erythema values were measured at baseline and at the end of the treatment period on the cheeks and chin. Digital photographs were assessed by a consultant dermatologist on a 10-point visual analogue scale (VAS). Patients' assessments were also made using a 10-point VAS. Outcome measures were repeated 6 months after treatment. After four treatments the mean reduction of the erythema values was 39% on the cheeks (P < 0.001) and 22% on the chin (P < 0.001). This was confirmed by photographic assessment where erythema improved by 46% and telangiectasia by 55% (P < 0.001). The severity of rosacea was reduced on average by 3.5 points on the 10-point VAS. Patients' and physicians' assessments of the overall improvement of rosacea were similar: more than 50% improvement was noticed in 73% and 83% of patients, respectively (P < 0.001). The results were sustained at 6 months. Side-effects were minimal and self-limiting. IPL significantly reduces erythema and telangiectasia of rosacea and this is sustained for at least 6 months.
  • E Tu
  • Dry Eye
Tu E. Dry Eye. Ophthalmology 2008. Available at: http:// www.mdconsult.com/das/book/body/1994000895/0/1869/ 0.html (Last accessed May 10, 2010).
Ocular surface treating dry eye
  • V Caceres
Caceres V. Ocular surface treating dry eye. Eye World, 2011. Available at: http://www.eyeworld.org/printarticle .php?id = 5835 (Last accessed June 5, 2012).
Topical steroids and the treatment of dry eye. Review of Cornea and Contact Lenses
  • E Bowling
  • G Russell
Bowling E, Russell G. Topical steroids and the treatment of dry eye. Review of Cornea and Contact Lenses, 2011. Available at: http://www.reviewofcontactlenses.com/content/ d/dry_eye/c/27245/ (Last accessed July 22, 2014).
Intense pulsed broadband light: a novel treatment for dry eye disease
  • R Toyos
Toyos R. Intense pulsed broadband light: a novel treatment for dry eye disease. ASCRS 2005 Research Grant Winner, 2005. Available at http://www.eyeworld.org/article.php?sid = 2638&strict = &morphologic = &query = ophthalmology (Last accessed December 18, 2014).
Management of meibomian gland disease and ocular surface inflammation
  • E Holland
Holland E. Management of meibomian gland disease and ocular surface inflammation. Healio Ophthalmology, 2009. Available at: http://www.osnsupersite.com/view.aspx?rid = 41658 (Last accessed July 22, 2014).
Intense pulsed light: for treating dry eye
  • C Kent
Kent C. Intense pulsed light: for treating dry eye. Review of Ophthalmology Ò, 2010. Available at: http://www.revophth .com/content/d/technology_update/c/25857/ (Last accessed July 22, 2014).
Case report: Dry-eye symptoms improve with intense pulsed light treatment
  • R Toyos
  • C Buffa
  • S Youngerman
Toyos R, Buffa C, Youngerman S. Case report: Dry-eye symptoms improve with intense pulsed light treatment. EyeWorld News Magazine, 2005. Availablea t: http://www .eyeworld.org/article.php?sid = 2698 (Last accessed July 22, 2014).
IPL therapy aids in dry eye
  • R Toyos
Toyos R. IPL therapy aids in dry eye. Ophthalmology Times Europe, 2010. Available at: http://www.oteurope .com/ophthalmologytimeseurope/Cornea/IPL-therapy-aidsin-dry-eye/ArticleStandard/Article/detail/695640 (Last accessed July 22, 2014).