Drugs with meibomian gland expression alone versus combined with intense pulsed light in ocular rosacea: a randomised controlled study.

OBJECTIVES: To determine the effects of intense pulsed light (IPL) combined with meibomian gland expression (MGX) and topical medication on ocular rosacea and assess glutathione peroxidases (GPxs) change in the meibum after IPL treatments. METHODS: Ninety-six eyes of 48 participants with ocular rosacea were randomly assigned to either MGX with erythromycin eye ointment alone (control group) or the combination with IPL (treatment group). During the five visits, participants underwent four IPL or sham IPL sessions at intervals of 2 weeks ± 3 days. The best corrected visual acuity, intraocular pressure, ocular surface disease index (OSDI) questionnaire, lid margin telangiectasia grade, tear break-up time (TBUT), corneal fluorescein staining (CFS), marx line (ML) score, Schirmer's test, meibomian gland yield secretion score (MGYSS), meibography, Demodex were evaluated sequentially. The meibum collected from participants and cryosections of mouse meibomian glands were used for the determination of GPxs or GPx-3. RESULTS: The TBUT revealed significant improvement in the treatment group compared to the control group (p < 0.001). The lower lid margin telangiectasia grade (p < 0.001), MGYSS, lower eyelid ML score and CFS exhibited significant improvement in the treatment group compared to the control group. However, the OSDI score, upper lid margin telangiectasia grade, upper eyelid ML score, Schirmer's test, meibography and Demodex showed no statistical difference between the two groups. The GPxs and GPx-3 showed significant increase after IPL treatment. CONCLUSIONS: IPL offered additional benefit in stabilising the tear film, improving the secretion of meibomian gland and reducing abnormal eyelid vascularity. GPxs could be a therapeutic target in IPL treatment.