Comparison between the Effect of Intense Pulsed Light and Lid Hygiene on the Tear Film and Ocular Surface: A Randomized Controlled Study.

Abstract

Purpose: Demodex folliculorum infestation is an important contributor to meibomian gland dysfunction (MGD) and chronic ocular surface disease. This study evaluated and compared the therapeutic efficacy of intense pulsed light (IPL) and eyelid hygiene (ELH) for Demodex-associated MGD.

Methods: In this prospective, randomized comparative trial, 50 patients (100 eyes) with Demodex-associated MGD were allocated to two arms. Group A (n = 25) received three Eyesis IPL sessions at baseline, week 2, and week 4. Group B (n = 25) performed daily eyelid hygiene with OCuSOFT Lid Scrub for 6 weeks. Ocular surface parameters, including ocular surface disease index (OSDI), tear film lipid layer thickness (TFLL), noninvasive tear film break-up time (NITBUT), meibomian gland dropout, meibum quality and expressibility, corneal fluorescein staining (CFS), Schirmer's I, and Demodex count, were assessed from baseline to week 6. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were recorded at each visit.

Results: Both treatments significantly improved OSDI, NITBUT, TFLL, Schirmer's I, and CFS over 6 weeks (all p < 0.001). Compared with ELH, IPL achieved larger and earlier reductions in symptoms, greater increases in TFLL, and superior improvements in meibum quality and expressibility from week 4 onward (between-group p ≤ 0.021). Demodex counts decreased significantly in both groups with no between-group difference at week 6. BCVA, IOP, and adverse events remained stable, indicating a favorable short-term safety profile.

Conclusion: IPL and ELH are effective for Demodex-related MGD, but IPL provides faster and more pronounced improvements in meibomian gland function, tear film stability, and patient-reported symptoms over 6 weeks.