EFFICACY AND SAFETY OF INTENSE PULSED LIGHTTHERAPY IN MEIBOMIAN GLAND DYSFUNCTIONASSOCIATEDDRY EYE DISEASE: A SYSTEMATIC REVIEW

Abstract

Background: Meibomian gland dysfunction (MGD) is the leading cause of evaporative dry eye disease (DED), characterised by terminal duct obstruction, altered meibum quality, and chronic ocular surface inflammation. Intense pulsed light (IPL) therapy has emerged as a non-pharmacological treatment modality for MGD-associated DED, yet its clinical evidence base requires systematic evaluation.

Objective: To systematically evaluate the efficacy and safety of IPL therapy in human clinical studies of MGD-associated DED, reporting outcomes including tear break-up time (TBUT), ocular surface symptoms, meibomian gland function, and inflammatory biomarkers.

Methods: A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Embase from January 2020 to December 2024. Only peer-reviewed original research articles reporting human clinical outcomes of IPL for MGD-associated DED were included. Animal studies, systematic reviews, meta-analyses, conference abstracts, preprints, and grey literature were explicitly excluded.

Results: Nine studies met all inclusion criteria, comprising six randomised controlled trials, one prospective randomised paired-eye study, and two prospective cohort studies. All nine studies reported statistically significant improvements in TBUT following IPL treatment. Ocular Surface Disease Index (OSDI) scores improved significantly in eight of nine studies. The addition of meibomian gland expression (MGX) to IPL was evaluated in four studies; results were inconsistent regarding incremental benefit over IPL alone. Adjunctive Diquafosol significantly enhanced goblet cell density and tear stability compared to IPL monotherapy. IPL demonstrated efficacy in specialist populations including chronic ocular graft-versus-host disease. No serious ocular adverse events were reported across any included study.

Conclusion: IPL therapy produces consistent, clinically significant improvements in tear film stability, meibomian gland function, and ocular surface symptoms in MGD-associated DED with an acceptable safety profile. Standardisation of treatment protocols, patient selection criteria, and long-term follow-up data are required before definitive clinical guidelines can be established.