Intense Pulsed Light (IPL) for the treatment of Meibomian Gland Dysfunction (MGD)and Dry Eye Disease (DED)
Dr Dirk J. Booysen & Gerrie H. Kruger
The Meibomian glands in the eye lids are responsible for secretion of lipid which protect the lid margins and prevent evaporation of the tear layer. These glands are under neuro-hormonal control(Sullivan et al., 2002) and are often affected by systemic medications such as hormone replacement therapy as well as Isotretinoin (commonly used in the treatment of acne), age and contact lens wear (Gannavarapu et al., 2017).
|Figure 1 Meibomian gland architecture|
|Figure 2 Blocked Meibomian gland openings, thickened lids, and telangiectasia due to MGD|
Studies have shown that IPL therapy led to improved tear break up times and lipid layer grades, as well as self-reported patient satisfaction (Craig et al., 2015, Toyos et al., 2015). Although increased meibum secretions are often seen after a single treatment, multiple treatments are usually recommended over several months (7 to 8 treatments per year) to improve MGD and DED. Treatment can cause mild discomfort and redness that can persist for several days before resolution. Adverse effects include blistering (red spot lasting <1 week), cheek swelling, conjunctival cysts, floaters, hair loss at the brow and forehead, light sensitivity, and redness of the face. In most cases the adverse effects self-resolved within 1 week (Toyos et al., 2015).
Although IPL therapy results in improved meibum secretions and patient symptoms, expression of the Meibomian gland in conjunction with the therapy is recommended to maximize results. In future IPL therapy may evolve into a Botox-like procedure that requires consistent reapplication to maintain effect.
CRAIG, J. P., CHEN, Y. H. & TURNBULL, P. R. 2015. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci, 56, 1965-70.
GANNAVARAPU, R., SWARNA, S. & MAHADEVAN, R. 2017. MEIBOMIAN GLANDS AND DRY EYE SYMPTOMS: A pilot study compared the structural changes in meibomian glands and dry eye symptom scores in daily soft contact lens wearers. Contact lens spectrum, 32, 36,38,39.
RAULIN, C., GREVE, B. & GREMA, H. 2003. IPL technology: a review. Lasers Surg Med, 32, 78-87.
SULLIVAN, B. D., EVANS, J. E., CERMAK, J. M., KRENZER, K. L., DANA, M. R. & SULLIVAN, D. A. 2002. Complete androgen insensitivity syndrome: effect on human meibomian gland secretions. Arch Ophthalmol, 120, 1689-99.
TOYOS, R., MCGILL, W. & BRISCOE, D. 2015. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg, 33, 41-6.