Intense Pulsed Light Therapy Eases Sjögren’s Dry Eyes, Study Reports
Intense pulsed light therapy along with meibomian gland expression (IPL-MGX) significantly eased dry eye symptoms and improved eye health in people with Sjögren’s syndrome, according to a recent study.
“Our results indicated that three IPL-MGX sessions could significantly improve the subjective and objective characteristics of [Sjögren’s dry eyes], representing a promising treatment strategy,” the research team wrote.
The study, “Therapeutic Effect of Intense Pulsed Light in Patients with Sjögren’s Syndrome Related Dry Eye,” was published in the Journal of Clinical Medicine.
Sjögren’s is an autoimmune disease in which the immune system mistakenly attacks the body’s own moisture-producing glands. Tear-producing lacrimal glands are affected, leading to chronically dry eyes accompanied by symptoms of itching, blurred vision, eye infections, and eye damage.
Some patients also experience dysfunction of the meibomian glands, which produce oils, called meibum, that prevent tear evaporation on the surface of the eyes.
Sjögren’s-related dry eyes are usually treated with artificial lubricants, with the addition of topical corticosteroids or cyclosporine to reduce inflammation in more severe cases. Some patients, however, remain unresponsive to these treatments.
Intense pulsed light (IPL), which involves flashes of bright light around the eyes and face, has emerged as a promising therapy for other dry eye diseases, but has not been widely evaluated for Sjögren’s. IPL may, in part, work by warming the meibomian glands, encouraging them to secrete meibum.
In this study, researchers evaluated the combined therapeutic potential of manual meibomian gland expression (MGX) — a form of treatment that involves putting pressure on the meibomian glands to squeeze out oils — and IPL in 27 adults with Sjögren’s.
The participants underwent three rounds of IPL-MGX three weeks apart, and were clinically assessed at treatment initiation (baseline), and again at nine, 12, and 15 weeks thereafter. A control group of 28 Sjögren’s patients who did not receive the treatment were assessed on the same time course.
Although both groups showed improvement on several clinical tests of eye health, those who received IPL-MGX showed more significant improvements.
Specifically, corneal fluorescence staining, which can be used to detect eye damage, showed greater reductions at 12 and 15 weeks in the IPL-MGX group than in the control group, indicating less eye damage.
Ocular surface disease index scores (OSDI), acquired with a patient questionnaire that assesses the subjective severity and frequency of symptoms, were also more significantly improved in patients who received treatment.
Meibomian gland function was increased in both groups, with greater gains observed in those who received IPL-MGX. Specifically, the amount and quality of meibum released by the glands were increased to a greater degree in patients who received treatment.
Other clinical evaluations, including non-invasive tear breakup time — a measure of how quickly the eye dries out after blinking — and eyelid margin abnormalities, indicating eyelid inflammation, were also improved more significantly in the IPL-MGX group.
To evaluate whether the treatment was safe, the researchers monitored visual acuity. They found that IPL-MGX was safe, and in fact significantly improved visual acuity from baseline measurements.
The team hypothesized this improvement might be due to decreased inflammation and an overall improvement in ocular surface after treatment.
In general, the findings suggest that IPL-MGX can successfully ease dry eye symptoms in Sjögren’s patients, although the mechanisms remain unclear.
“Although the mechanism of the IPL treatment remains unclear, we believe that the main reason for the improved vision in the patients with [Sjögren’s] is that IPL reduced the ocular surface inflammation considerably, lowering apoptosis [cell death] … and improving the [meibomian gland dysfunction] symptoms and signs,” the researchers wrote.
While findings were promising, the team suggested that Sjögren’s patients may benefit from more than three IPL-MGX sessions, and that the most severe cases may also require corticosteroids or cyclosporine to further reduce inflammation.
“In conclusion, our study showed IPL-MGX to be a promising treatment regimen for patients with [Sjögren’s dry eyes], especially those refractory to the standard therapies,” the team wrote. “Further studies might promote other therapeutic possibilities; however, our findings indicate that IPL-MGX significantly improves the objective and subjective disease characteristics in patients with [Sjögren’s dry eyes].”