Abstract

Importance: This study highlights the adjunctive value of low-level light therapy (LLLT) in the management of meibomian gland dysfunction (MGD).

Background: To evaluate the effects of LLLT treatment on clinical measures of dry eye related to MGD in patients unresponsive to previous therapies.

Design: A retrospective chart review of patients treated at one site.

Participants: Fifty eyes of 25 treated patients who were documented treatment failures with previous pharmaceuticals and/or devices were evaluated.

Methods: LLLT treatment consisted of 3 treatments in one week, with adjunct use of a topical steroid/antibiotic combination. The post-treatment diagnostic measures had to have been made 3 to 5 weeks after the last LLLT treatment.

Main Outcome Measures: Results included changes in the graded MGD score (grading scale 0 - 4), tear breakup time (TBUT), an Ocular Surface Disease Index (OSDI) questionnaire score and lissamine green (LG) staining.

Results: Significant improvements in the mean OSDI score (p = 0.002), MGD grading (p < 0.001), TBUT (p < 0.001) and both nasal and temporal LG staining (p < 0.02) were observed after treatment. An MGD grade reduction of 1 or more was observed in 72% of eyes (36/50), and 2 or more in 32% of eyes (16/50). There were no ocular or facial adverse events or side effects related to the treatment.

Conclusion: The application of LLLT over a short series of sessions for the treatment of MGD appeared to be beneficial in the majority of patients who had failed to improve with alternative pharmaceutical and device interventions.

Keywords: LLLT; Low Level Light Therapy; Meibomian Gland Dysfunction; Ocular Surface Disease Index (OSDI); Dry Eye Disease (DED)

References

1. Craig JP., et al. “TFOS DEWS II Report Executive Summary”. The Ocular Surface 4 (2017): 802-812.
2. Nichols KK., et al. “The international workshop on meibomian gland dysfunction: executive summary”. Investigative Ophthalmology and Visual Science 4 (2011): 1922-1929.
3. Baudouin C., et al. “Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction”. British Journal of Ophthalmology 3 (2016): 300-306.
4. Mathers WD. “Ocular evaporation in meibomian gland dysfunction and dry eye”. Ophthalmology3 (1993): 347-351.
5. Nichols JJ., et al. “TFOS DEWS II Definition and Classification Report”. The Ocular Surface 3 (2017): 276-283.
6. Rong B., et al. “Long-Term Effects of Intense Pulsed Light Combined with Meibomian Gland Expression in the Treatment of Meibomian Gland Dysfunction”. Photobiomodulation, Photomedicine, and Laser Surgery 10 (2018): 562-567.
7. Mandal P., et al. “Drugs - Do we need them? Applications of non-pharmaceutical therapy in anterior eye disease: A review”. Eye6 (2018): 547.
8. Tauber J., et al. “Comparison of the iLUX and the LipiFlow for the Treatment of Meibomian Gland Dysfunction and Symptoms: A Randomized Clinical Trial”. Clinical Ophthalmology 14 (2020): 405-418.
9. Kim WS and Calderhead RG. “Is light-emitting diode phototherapy (LED-LLLT) really effective?” Laser Therapy 3 (2011): 205-215.
10. Farivar S., et al. “Biological effects of low-level laser therapy”. Journal of Lasers in Medical Sciences 5 (2014): 58-62.
11. Ablon G. “Phototherapy with Light Emitting Diodes: Treating a Broad Range of Medical and Aesthetic Conditions in Dermatology”. The Journal of Clinical and Aesthetic Dermatology 2 (2018): 21-27.
12. Huang A., et al. “Light Emitting Diode Phototherapy for Skin Aging”. Journal of Drugs in Dermatology 4 (2020): 359-364.
13. Sun Q., et al. “Red light-emitting diode irradiation regulates oxidative stress and inflammation through SPHK1/NF-κB activation in human keratinocytes”. The Journal of Photochemistry and Photobiology B: Biology 186 (2018): 31-40.
14. Toyos R., et al. “The Effects of Red Light Technology on Dry Eye Disease Due to Meibomian Gland Dysfunction”. JOJ Ophthalmology 5 (2017): 555624.
15. Stonecipher K and Potvin R. “Low level light therapy for the treatment of recalcitrant chalazia: a sample case summary”. Clinical Ophthalmology 13 (2019): 1727-1733.
16. Pult H. “Low-Level Light Therapy in the Treatment of Meibomian Gland Dysfunction”. Investigative Ophthalmology and Visual Science 7 (2020): 99.
17. Schiffman RM., et al. “Reliability and validity of the Ocular Surface Disease Index”. Archives of Ophthalmology 5 (2000): 615-621.
18. Stonecipher K., et al. “Combined low level light therapy and intense pulsed light therapy for the treatment of meibomian gland dysfunction”. Clinical Ophthalmology 13 (2019): 993-999.
19. Bron AJ., et al. “Grading of corneal and conjunctival staining in the context of other dry eye tests”. Cornea7 (2003): 640-650.
20. Thaysen-Petersen D., et al. “Side effects from intense pulsed light: Importance of skin pigmentation, fluence level and ultraviolet radiation-A randomized controlled trial”. Lasers in Surgery and Medicine 1 (2017): 88-96.
21. Alam M. “What devices to use or not use in skin of color”. Seminars in Cutaneous Medicine and Surgery 4 (2016): 218-222.
22. Crabb M., et al. “Intense pulsed light therapy (IPL) induced iritis following treatment for a medial canthal capillary malformation”. Australasian Journal of Dermatology 4 (2014): 289-291.
23. Pang AL and Wells K. “Bilateral anterior uveitis after intense pulsed light therapy for pigmented eyelid lesions”. Dermatologic Surgery 9 (2008): 1276-1279.
24. Jewsbury H and Morgan F. “Uveitis and iris photoablation secondary to intense pulsed light therapy”. The Canadian Journal of Ophthalmology 4 (2012): e13-e14.
25. Maganti N., et al. “Macular Hole Formation Associated With Intense Pulsed Light Therapy (2019).
26. Cote S., et al. “Intense pulsed light (IPL) Therapy for the treatment of Meibomian gland dysfuction”. Cochrane Systematic Review- Intervention (2020).
27. Walski T., et al. “The effect of Red-to-Near-Infrared (R/NIR) irradiation on inflammatory processes”. International Journal of Radiation Biology 6 (2019): 1-37.
28. Dompe C., et al. “Photobiomodulation-Underlying Mechanism and Clinical Applications”. Journal of Clinical Medicine 6 (2020): E1724.
29. Avci P., et al. “Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring”. Seminars in Cutaneous Medicine and Surgery 1 (2013): 41-52.

Citation

Citation: Karl Stonecipher., et al. “Low Level Light Therapy as an Adjunct Treatment for Meibomian Gland Dysfunction". Acta Scientific Ophthalmology 3.11 (2020): 13-18.

Copyright

Copyright: © 2020 Karl Stonecipher., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.