Intense Pulsed Light for Meibomian Gland Disease OTA

A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel

Edward J. Wladis, MD,¹ Vinay K. Aakalu, MD,² MPH, Jill A. Foster, MD,³ Suzanne K. Freitag, MD,⁴ Rachel K. Sobel, MD,⁵ Jeremiah P. Tao, MD,⁶ Michael T. Yen, MD⁷ 

Ophthalmology, September 2020, Vol 127, 1227-1233 © 2020 by the American Academy of Ophthalmology. Click here for free access to the OTA.

Purpose: To review the literature on the efficacy of intense pulsed light (IPL) on the eyelids in the management of meibomian gland disease (MGD) and meibomian gland-related ocular surface disease.

Methods: A literature search was last conducted on May 15, 2019, in the PubMed and Cochrane Library databases for English-language original research that assessed the effect of IPL on MGD in adult patients. Thirty-three articles were identified, and 12 studies were determined to be relevant to the criteria outlined for assessment. The panel methodologist (V.K.A) assigned a level of evidence rating to each study; 4 studies were rated level II, and 8 studies were rated level III. Five studies had potential conflicts of interest and design limitations that affected interpretation of results.

Results: All studies documented improvement in clinically meaningful metrics, including tear breakup time (TBUT), corneal staining and eyelid margin measurements, meibum quality, meibomian gland expressability, ocular surface disease index (OSDI), and standard patient evaluation of eye dryness (SPEED) questionnaire scores. Side effects were relatively uncommon but included discomfort, cutaneous erythema, blistering, eyelash loss, and floaters; these were uniformly self-limited.

Conclusions: Although methodological limitations and potential conflicts of interest in some studies raised concern, the existing body of literature demonstrates improvements in the signs and symptoms of MGD after IPL therapy.

¹Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York

²Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois

³Ophthalmic Surgeons and Consultants of Ohio, Ohio State University, Columbus, Ohio

⁴Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

⁵Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee

⁶Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California

⁷Cullen Eye Institute, Baylor College of Medicine, Houston, Texas