ACTIVA MASK AS ADJUVANT THERAPY TO INTENSE PULSED LIGHT IN PATIENTS WITH MEIBOMIAN GLAND DYSFUNCTION

This study aimed to evaluate the effects on objective and subjective ocular surface analysis of the application of a heating and vibrating eye mask following intense pulsed light (IPL) therapy in the treatment of meibomian gland dysfunction (MGD).

Double-arm, non-randomized, prospective study from the outpatient clinic of a tertiary hospital.

Consecutive adult patients with MGD whose signs and symptoms were not controlled with conventional treatment were eligible for participation. All patients were initially assigned to four sessions of IPL therapy. After this treatment, patients that showed residual symptoms were proposed treatment with recently developed Activa Mask (group 1) – 4 weekly sessions followed by 1 session every 2 months. Asymptomatic patients did not perform additional treatment (group 2). In both arms, subjects were evaluated at baseline, 1 month and 6 months after the last IPL session. The main outcomes were the variation of the validated Dry-Eye Related Questionnaire (OSDI-12) and automated ocular surface analysis (IDRA®) - non-invasive tear break-up time (NIBUT), tear film meniscus height (TFHMH), infrared meibography, blink rate and lipid layer thickness (LLT). Schirmer’s test, biomicroscopic evaluation (Oxford score) and tear film osmolarity (TearLab®) were evaluated separately.

This study enrolled 113 eyes (of 56 subjects): 54 in group 1 and 59 in group 2. Mean age was 58.4 ± 16.5 years, with no significant difference between groups, and ten patients (17.8%) were male. At baseline, there were no differences between groups regarding blink rate (p=0.661), tear film meniscus height (TFMH, p=0.158), corneal fluorescein staining (p=0.223), and OSDI-12 score (p=0.884). After IPL treatment (1 month follow-up), there were no significant differences regarding ocular surface analysis between groups but patients from group 1 showed higher OSDI-12 (32.3 vs. 24.4 points, p=0.032). Differences between 1 and 6-months revealed significant differences in lipid layer thickness (Δ-7.31 in group 1 vs. Δ-19.1 in group 2, p=0.009), meibomian gland atrophic area (Δ-17.8% vs. Δ-9.4%, respectively, p=0.026), and Schirmer’s test (Δ+1.76 vs. Δ -4.65, respectively, p=0.002). Six months after the last IPL treatment session (after treatment with Activa mask) there was persistent improvement in blink rate (Δ+29.1, p<0.001), while group 2 showed lower improvement (Δ+11.6, p<0.001), comparing with baseline. At 6-month follow-up, both groups showed a significant reduction in OSDI-12 score (Δ-15.3, p<0.001 vs. Δ-15.0, p<0.001, respectively), but patients from group 1 reported marked subjective improvement in ocular comfort. 

Adjuvant sessions of a heating and vibrating mask after IPL therapy are a safe and effective treatment modality in MGD. It may enhance ocular surface parameters such as lipid layer thickness, meibomian gland atrophy, and Schirmer’s test, while persistently improving ocular discomfort symptoms in dry eye disease associated with MGD.