Management of Glaucoma-Related Dry Eye Disease with Intense Pulsed Light: A Randomized Control Study

Purpose: The objective of this study was to assess the effectiveness of intense pulsed light (IPL) therapy in individuals diagnosed with glaucoma and dry eye disease (DED).<br /> Methods: This randomized control study recruited 22 individuals diagnosed with glaucoma, ranging in age from 33 to 82 years. These participants were undergoing treatment with hypotensive eyedrops and had clinical indications and subjective complaints associated with dry eye. Each patient underwent three sessions of IPL therapy in one eye, while the contralateral eye served as the control eye (CT). The following parameters were assessed at three time points: baseline, week-2, and week-4. These parameters include non-invasive breakup time (NITBUT), tear meniscus height (TMH), conjunctivocorneal epithelial staining score (CS), tear film lipid layer (TFLL), meibomian gland expressibility score (MGEx), Schirmer I test, ocular bulbar redness score (OBRS), and ocular surface disease index (OSDI). Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and corneal endothelial cell count (ECC) were assessed for safety. The clinical trial was registered on 25/12/2023 at ClinicalTrials.gov website (NCT06158984).<br /> Results: Comparing baseline and 4-week measurements revealed that the IPL group found significant improvements in NITBUT (IPL: 8.74 +/- 2.60 sec. vs CT: 5.76 +/- 1.75 sec. p< 0.01), TMH (IPL: 0.23 +/- 0.05mm vs CT: 0.19 +/- 0.06mm, p=0.011), C.S. (IPL: 1.14 +/- 0.56 vs CT: 1.95 +/- 1.17, p=0.005), TFLL (IPL: 2.91 +/- 2.91 vs CT:3.36 +/- 0.58, p=0.047), MGEx score (IPL: 1.14 +/- 0.35 vs CT: 1.45 +/- 0.51, p=0.020) and OSDI scores (IPL: 31.77 +/- 15.59 vs 50.59 +/- 21.55, p=0.002) significantly improved. Conversely, other parameters showed no significant improvements (p> 0.05).<br /> Conclusion: The progression of ocular surface disease in individuals using topical anti-glaucoma medication may worsen if the condition is not addressed. Nevertheless, IPL therapy has the potential to result in significant improvements in both objective and subjective measures of dry eye. Best-corrected visual acuity, endothelial cell count, and intraocular pressure were determined to be within the permitted limits. No adverse events were reported during the course of the study.