Intense pulsed light as a multi-target intervention paradigm for refractory ocular surface diseases: a review

Ocular surface diseases (OSDs) are a heterogeneous group of disorders characterized by overlapping inflammatory, vascular, microbial, neuroimmune, and meibomian gland abnormalities that contribute to the onset and persistence of ocular surface symptoms and signs. Conventional symptom-directed therapies do not adequately alleviate refractory meibomian gland dysfunction, Demodex-associated blepharitis, ocular rosacea, recurrent chalazion, and allergic conjunctivitis. Recent evidence suggests that these conditions may share convergent pathological features, including chronic inflammation, abnormal lid-margin vascularity, and microbial or parasitic imbalance. Intense pulsed light (IPL), which was initially used for vascular and inflammatory disorders in dermatology, has emerged as a potential physical therapy that acts through several proposed mechanisms in patients with selected refractory OSDs, including photothermal liquefaction of inspissated meibum, coagulation of abnormal vessels, reduction of Demodex and microbial burden, modulation of inflammatory responses, and possible effects on neuroimmune signaling; however, these mechanisms remain incompletely established. Case series and clinical studies have reported improvements in ocular symptoms, tear film stability, meibomian gland function and drainage, lid-margin inflammation, and chalazion or lesion resolution, particularly when IPL is combined with meibomian gland expression or other adjunctive therapies. However, treatment responses vary across disease phenotypes and standardized treatment parameters, long-term safety data, and high-quality randomized controlled trials remain limited. Anatomical factors, disease severity, glandular structure, and inflammatory status may also influence therapeutic outcomes. Overall, IPL therapy represents a promising but evolving treatment strategy for refractory OSDs. This review summarizes the current knowledge regarding the proposed mechanisms, clinical applications, treatment protocols, limitations, and future directions and provides updated perspectives for the rational use of IPL in OSD management.