Dry eye

IPL treatment and manual meibum expression

21 February 2023

Saint-Étienne, France

Dr Marie-Caroline Trone

Hospital-based Ophthalmologist Saint-Étienne University Hospital – France

Diagnosis and treatment of a male patient with evaporative dry eye syndrome (DES) and moderate meibomian gland dysfunction (MGD) aggravated by long periods of computer use. A full diagnosis was performed by means of clinical examination and LacryDiag® examinations. This patient received IPL treatment one year ago and was retreated with C.STIM® IPL. After three months, the patient's daily discomfort had disappeared and his MGD was improved, with better meibum quality and expression.

Anamnesis :

Mr P., aged 29, a notary clerk, was undergoing long-term symptomatic treatment, including eyelid care and artificial tears. He had received IPL treatment one year previously with good functional results. He returned to see his doctor due to a relapse in symptoms, despite the symptomatic treatment in place. His eyes were red and stinging in the morning upon waking and at the end of the day. His vision was fluctuating, especially when working on a computer for a long time.

CLINICAL EXAMINATION

The interview did not reveal any risk factors for recent dry eye syndrome. The OSDI questionnaire was used, giving a score of 25.

The results of the eye examination were as follows:

The slit lamp examination showed moderate meibomian gland dysfunction (MGD) with a few blocked glands. The meibum was thick with a few deposits and the tears were foamy.

Meibography was performed, which showed that the meibomian glands were slightly dilated and a few glands were atrophied.

The examination indicated a relapse and worsening of moderate meibomian gland dysfunction (MGD), responsible for evaporative dry eye syndrome (DES).

INITIAL TREATMENT

Symptomatic treatment was to be continued:

Instillation of preservative-free artificial tears multiple times daily
Eyelid care (heating and massaging of the eyelids)
Blinking exercises

The patient was reminded to pay attention to environmental factors that may aggravate dry eye: avoid air conditioning, excessive heating in the room, humidifiers, avoid passive smoking, etc.

Three sessions of IPL retreatment were prescribed.

C.STIM® IPL TREATMENT PROTOCOL

The treatment protocol comprised three sessions on D0, D15 and D45.

Four shots were performed per side per session at a fluence of 8 J/cm2. Both the patient and the doctor wore protective goggles during the treatment.

At the end of each session, the doctor performed meibum expression using forceps, for optimal results. The heat generated by C.STIM® IPL treatment makes it easier to express the meibum by hand.

RESULTS AT THREE MONTHS

The patient presented an improvement in functional signs: he no longer felt any discomfort on a daily basis.

The clinical examination also showed an improvement in meibomian gland dysfunction (MGD), with better meibum expression and quality.

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Focus on manual expression of meibomian glands with forceps

Manual expression of the meibomian glands with forceps should be performed at the end of each IPL session.

It is carried out with a slit lamp under local anaesthetic (a drop of oxybuprocaine or tetracaine), by gently pressing the free margin of the lower eyelids with specialist forceps.

The heat from the IPL treatment makes it easier to express the meibum from each meibomian gland.

The goal of meibum expression is to optimise the results of IPL treatment.

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