Tear film and meibomian gland parameters associated with the effectiveness of intense pulsed light therapy for meibomian gland dysfunction

Intense Pulsed Light (IPL) is an effective treatment option for meibomian gland dysfunction (MGD). This study retrospectively examined the differences in tear film and MG-related parameters before IPL therapy between responsive and nonresponsive patients. Overall, 73 patients with MGD who received at least three IPL treatments at 4-week-intervals between January 2022 and December 2023 were included. The patients were followed up for over 3 months. IPL was considered effective if both the symptom score and meibum grade improved by ≥ 4 and ≥ 1, respectively. Of the 73 patients, 58 were in the responsive group and 15 in the nonresponsive group. No significant differences were observed regarding age, sex, number of treatments, or SPEED-based symptoms between responsive and nonresponsive groups. However, the nonresponsive group had significantly lower plugging and vascularity grades (P = 0.008, < 0.001, respectively) and significantly higher upper meibum grade and meiboscore (P = 0.001, 0.011, respectively). Meibography revealed significant upper and lower gland dropout (P = 0.025, 0.007) and extreme thinning (P = 0.002, 0.001) in the nonresponsive group. No significant differences were observed in FBUT, CFS, or Schirmer values. Patients with gland dropout, extreme thinning, and poor upper meibum quality showed resistance to IPL despite fewer eyelid margin findings. Meibography is essential for predicting IPL prognosis.