Which treatment works better for Meibomian Gland Dysfunction: LipiFlow or intense pulsed light? A systematic review...

Meibomian Gland Dysfunction (MGD) is a common cause of evaporative dry eye disease. Intense Pulsed Light (IPL) and LipiFlow thermal pulsation are two device-based treatment modalities currently used for managing MGD. This systematic review and meta-analysis aimed to assess and compare the efficacy of these interventions. It is important to underscore that none of the 12 studies included in this review directly compare LipiFlow with IPL, making indirect comparisons necessary.

We systematically searched PubMed, Google Scholar, and ScienceDirect for randomized controlled trials (RCTs) assessing either IPL or LipiFlow for MGD, published up to February 2025. Study quality was appraised using the Cochrane Risk of Bias (RoB 2) tool. A random-effects meta-analysis was conducted for primary outcomes including TBUT (tear breakup time), SPEED (Standard Patient Evaluation of Eye Dryness) score, and OSDI (Ocular Surface Disease Index). A Bayesian network meta-analysis (NMA) was performed to enable indirect comparison between IPL and LipiFlow.

Twelve RCTs involving 969 patients (1938 eyes) were included. Six studies assessed LipiFlow and six assessed IPL, but none provided a head-to-head comparison. LipiFlow significantly improved TBUT (MD: +0.67s; 95% CI: [0.08, 1.26], p=0.03) and reduced OSDI scores (MD: -6.07; 95% CI: [-10.85, -1.29], p=0.01), though changes in SPEED score were not statistically significant (p=0.15). IPL demonstrated superior efficacy in increasing TBUT (MD: +2.08s; 95% CI: [0.39, 3.71], p=0.02) and reducing SPEED scores (MD: -2.9; 95% CI: [-5.18, -0.64], p=0.01), while OSDI results were not significant. Control groups across studies varied greatly, ranging from untreated controls to warm compresses, eyelid hygiene, or mechanical expression, further complicating cross-study comparisons. However, these conclusions are based solely on indirect comparisons, which should be interpreted cautiously given the absence of head-to-head studies and the heterogeneity of control interventions.

While both IPL and LipiFlow showed improvements over controls in treating MGD, there is currently no direct comparative evidence between these modalities. As a result, any comparative conclusions must be interpreted with caution. The variability in control group interventions across studies (e.g., untreated vs. warm compresses or eyelid hygiene) introduces significant heterogeneity, reducing the certainty of indirect comparisons. Direct head-to-head RCTs are urgently needed to establish the relative efficacy of these interventions.

PROSPERO registration number: CRD42024543448.