The Effects of Intense Pulsed Light on Tear Osmolarity in Dry Eye Disease

Abstract

Purpose: In this prospective study we show the influence of Intense Pulsed Light Therapy (IPL) on tear osmolarity, an increasingly important metric of dry eye disease. Previous studies have measured the effectiveness IPL has had on other metrics including tear break up time (TBUT), lipid layer grade (LLG), tear evaporation rate (TER), tear meniscus height (TMH), and subjective responses from patients. Methods:Single center prospective study included 16 patients and 32 eyes. Patient ages ranged from 18 to 90 years old with 75% of participants being female. All patients had an at least one eye with a tear osmolarity of 308 mOsm/L or greater, or had an inter-eye difference in tear osmolarity of 11 mOsm/L or greater. Tear osmolarity was measured bilaterally before a single IPL treatment followed by one drop of topical NSAID. Bilateral tear osmolarity was then measured again one month later.Results: Average tear osmolarity pre-treatment OD was 309 mOsm/L and OS was 306.75 mOsm/L. Average tear osmolarity post-treatment was OD 296.75 mOsm/L and OS 296.06 mOsm/L. Paired t tests were performed showing the change in tear osmolarity to be statistically significant in each eye, OD p=0.0029 and OS p=0.0011. Average inter-eye difference in osmolarity went from 11.81 mOsm/L to 6.81 mOsm/L, statistically significant with p=0.0148. Conclusions:A statistically significant decrease in tear osmolarity from abnormal to normal range as well as a reduction in inter-eye difference demonstrates an improvement in tear film quality after one treatment with IPL, thus suggesting IPL's effectiveness at treating dry eye disease.

Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction

“…In agreement with our findings, Craig, Chen and Turnbull did not find any change in tear osmolarity or tear evaporation rate with intense pulsed light treatment. Toyos reported a mean decrease of 7.8 mOsmol/l (p = 0.002) in tear osmolarity one month after intense pulsed light treatment for dry eye in a dry eye participant group characterised by a tear break‐up time of less than 10 seconds; however, as was the case in our study, the mean pre‐treatment osmolarity for the Toyos’ participant cohort fell within the normal range of less than 308 mOsmol/l (303.03 and 301.96 mOsmol/l for right and left eyes, respectively). Hence, it could be argued that the Toyos osmolarity reduction was statistically but not clinically significant.…”