Intense Pulsed Light Combined with Low Level Blue and Red Light Therapy for Demodex-Associated Blepharitis

Sarah Farrant,1 Giuseppe Giannaccare,2 Chris Hong Long Lim,3– 5 Giulia Coco6 1Earlam and Christopher Optometrists Ltd, Taunton, UK; 2Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy; 3Department of Ophthalmology, National University Hospital, Singapore; 4Ocular Surface Research Group, Singapore Eye Research Institute, Singapore; 5Centre for Sustainable Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 6Ophthalmology Unit, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, ItalyCorrespondence: Giuseppe Giannaccare, Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy, Tel +39 3317186201, Email [email protected]: Demodex-associated blepharitis is a chronic disease of the lid accounting for over 60% of all blepharitis. Although several therapies have been employed to address Demodex mites’ infestation, there is no universal consensus about the most effective strategy. Purpose of this study was to evaluate the efficacy of combined intense pulsed light (IPL) and low-level light therapy (LLLT) in the treatment of Demodex-associated blepharitis and associated ocular surface disease (OSD).Patients and Methods: Medical records of patients with Demodex-associated blepharitis resistant to first-line therapy who underwent IPL and LLLT (12 minutes of blue light followed by 12 minutes of red light) were retrospectively examined. The following data collected before treatment (T0) and at last follow-up (T1) were reviewed: collarettes (0– 4 grade); saponification (presence/absence); lid margin telangiectasia (0– 3 grade); conjunctival hyperemia (0– 4 grade); corneal fluorescein staining (CFS) (0– 5 grade); noninvasive tear break-up time (NITBUT), tear meniscus height (TMH), inter-blink interval (IBI), meibomian gland dropout (0– 3 grade) and symptoms (5-item Dry Eye Questionnaire [DEQ-5]). Treatment-related adverse effects (TrAEs) were recorded.Results: Data from 34 eyes of 17 patients (3 males, 14 females; mean age 64.6± 10.0 years) were included. A mean of 7.6 ± 3.6 treatment sessions of IPL and LLLT was performed. Mean score of collarettes decreases significantly from 1.44 ± 0.83 at T0 to 1.00 ± 0.97 at T1 (p = 0.007). The rate of eyes with saponification decreases significantly (from 41.18% to 11.76%; p = 0.002). Conjunctival hyperemia significantly decreased from 2.00 ± 0.78 to 1.47 ± 0.61 (p = 0.005). Mean CFS score decreased significantly from 0.56 ± 1.16 to 0.24 ± 0.96 (p = 0.031). Symptoms’ mean score improved significantly after treatment (from 12.00 ± 5.34 to 7.76 ± 4.92; p = 0.003). No patient reported TrAEs.Conclusion: Combined light therapy with IPL and LLLT employing blue and red lights is an effective treatment strategy for patients with recalcitrant Demodex-associated blepharitis to reduce mites count and improve main ocular surface parameters along with patients’ symptoms.Keywords: Demodex, dry eye, IPL, LLLT, meibomian gland dysfunction, MGD