Intense pulsed light in ocular surface disease: a translational medicine perspective on mechanisms, evidence, and clinical integration

Abstract

Intense pulsed light (IPL) is a non-laser xenon-flash technology used in dermatology since the 1990s; it gained use in ophthalmology in 2015 with the observation that periocular IPL improved tear film parameters in patients with meibomian gland dysfunction (MGD). The technology has since been utilized as a multi-indication ocular surface intervention, with the most robust evidence base in MGD and a much smaller but rapidly growing body of work in chronic ocular graft-versus-host disease and primary Sjögren’s syndrome-related dry eye. The objectives of this review were to synthesize the optical physics and biological mechanisms of IPL relevant to ocular surface disease; map the evidence base across the major indications by study design and certainty, separating what is established from what is investigational; and propose a clinical translation pathway integrating IPL into existing ocular surface disease management. Across the indications reviewed, three constants emerged: IPL is used for chronic inflammatory or obstructive ocular surface disease rather than acute inflammation; the degree of benefit depends more on patient selection and completing a full induction course than the device used; and response weakens without scheduled maintenance. This review places particular emphasis on immune-mediated ocular surface disorders where IPL fills a gap that topical anti-inflammatory pharmacotherapy only partially addresses, and on IPL as an adjuvant, which the available data support more robustly than monotherapy claims.