Combined Treatments Improve Dry Eye Symptomatology Resulting From Glaucoma Drops

Acne Treatment
Intense pulsed light acne treatment. Photographed in a clinic in France.
Clinicians prescribing hypotensive drops for glaucoma should be careful to monitor ocular surface parameters.

The combined use of intense pulsed light (IPL) therapy and meibomian gland expression (MGX) appears to improve symptomatology in patients with glaucoma who use hypotensive drops to treat ocular surface disease, according to a study published in Eye and Vision.

Researchers conducted a study to investigate the therapeutic effect of using IPL and MGX on patients with glaucoma who used hypotensive eye-drop treatment for more than 2 years and had dry eye symptomatology. They enrolled 30 participants (mean age 74.6±9.0 years, 73.3% women) and performed a series of objective and subjective analyses. Subjective analysis consisted of questionnaires to evaluate patient-reported outcomes (ocular surface disease index [OSDI], standard patient evaluation of eye dryness [SPEED], and symptom assessment questionnaire in dry eye [SANDE]). Researchers also objectively measured corneal staining score, tear meniscus height (TMH), non-invasive break-up time (NIBUT), meiboscore, and meibomian gland expressibility. They administered four IPL and upper and lower eyelid MGX treatments at two-week intervals, and reevaluated patient responses.

Among the cohort, 70.0% used 1 type of hypotensive drop, 23.3% used 2 types, and 6.7% used 3 types. 

The investigators noted significant decreases in OSDI (37.6 vs 22.6; P <.001), SPEED score (13.0 vs 7.3; P <.001), SANDE frequency score (63.8 vs 37.8; P <.001), SANDE severity score (58.6 vs 35.3; P <.001), Oxford staining score (8.9 vs 6.9; P <.001), tear film osmolarity (330.1 vs 313.8 mOsm/l; P =.001), meibomian gland expressibility (2.4 vs 2.1; P =.003), and TMH(288.5 vs 229.9 μm; P =.012) after 4 IPL sessions with MGX treatment.

The team also noted decreases in grade 2 and 3 meiboscores (55.6 vs 51.7% and 37.0 vs 31.0 %, respectively) and an increase in type 1 meiboscore (3.7 vs 13.8%) following treatment. Eyes with grade 1 (0.0% vs 3.4%) and 2 (51.9% vs 79.3%) meibomian gland expressibility increased while those with grade 3 decreased (37.0% vs 17.2%).

“IPL therapy combined with MGX seems to be an effective option to improve symptomatology in glaucomatous patients with pharmacologically-induced moderate to severe ocular surface disease due to prolonged hypotensive eyedrop treatments, with an additional improvement in clinical signs, such as tear osmolarity and corneal staining,” according to the investigators.

Study limitations include a small sample population and single center design. 


Martinez-de-la-Casa JM, Oribio-Quinto C, Milans-del-Bosch A, et al. Intense pulsed light‑based treatment for the improvement of symptoms in glaucoma patients treated with hypotensive eye drops. Eye Vis. 2022;9(1):12. doi:10.1186/s40662-022-00284-4