TYPE Original Research

PUBLISHED 10 August 2022

DOI 10.3389/fmed.2022.893940

Skin temperature change in

OPEN ACCESS patients with meibomian gland
dysfunction following intense
EDITED BY
Alejandro Navas,
Instituto de Oftalmología Fundación
de Asistencia Privada Conde de
Valenciana, I.A.P, Mexico pulsed light treatment
REVIEWED BY
Melis Palamar,
Ege University, Turkey Jeongseop Yun and Ji Sang Min*
Yonathan Garfias,
Universidad Nacional Autónoma de Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul,
México, Mexico South Korea

*CORRESPONDENCE
Ji Sang Min
[email protected] Purpose: We investigated the change in skin temperature of treated
SPECIALTY SECTION areas during intense pulsed light (IPL) treatment in patients who have
This article was submitted to meibomian gland dysfunction (MGD) to determine whether there is superficial
Ophthalmology,
a section of the journal
telangiectatic blood vessel ablation.
Frontiers in Medicine Methods: The medical records of 90 patients (90 eyes) with MGD who
RECEIVED 11 March 2022 underwent IPL treatment were reviewed. The patients had undergone IPL
ACCEPTED 21 July 2022
treatment four times every 4 weeks. Ocular Surface Disease Index (OSDI)
PUBLISHED 10 August 2022
scores, dry eye (DE), and MGD parameters were obtained before the first and
CITATION
Yun J and Min JS (2022) Skin after the fourth IPL treatments. The skin temperatures of the upper and lower
temperature change in patients with lids were measured before every IPL treatment.
meibomian gland dysfunction
following intense pulsed light Results: The skin temperatures of the lower lids were 31.89 ± 0.72◦ C at the
treatment. Front. Med. 9:893940. first IPL (IPL#1), 30.89 ± 0.63◦ C at the second IPL (IPL#2), 30.14 ± 0.95◦ C at
doi: 10.3389/fmed.2022.893940
the third IPL (IPL#3), and 29.74 ± 0.87◦ C at the fourth IPL (IPL#4) treatments.
COPYRIGHT
© 2022 Yun and Min. This is an
The skin temperatures of upper lids were 32.01 ± 0.69◦ C at IPL#1, 31.13 ±
open-access article distributed under 0.75◦ C at IPL#2, 30.34 ± 1.07◦ C at IPL#3, and 29.91 ± 0.76◦ C at IPL#4. The
the terms of the Creative Commons skin temperature of the upper and lower lids significantly decreased with every
Attribution License (CC BY). The use,
distribution or reproduction in other IPL treatment. Schirmer 1 test (ST) result was 12.97 ± 10.22 mm before IPL#1
forums is permitted, provided the and 14.45 ± 9.99 mm after IPL#4. Tear break-up time (TBUT) was 3.15 ± 1.38 s
original author(s) and the copyright
before IPL#1 and 5.53 ± 2.34 s after IPL#4. Corneal staining scores (CFS) was
owner(s) are credited and that the
original publication in this journal is 1.61 ± 3.09 before IPL#1 and 0.50 ± 0.78 after IPL#4. Lipid layer thickness
cited, in accordance with accepted (LLT) was 71.88 ± 26.34 nm before IPL#1 and 68.38 ± 24.16 nm after IPL#4.
academic practice. No use, distribution
or reproduction is permitted which Lid margin abnormality score (LAS) was 1.96 ± 0.62 before IPL#1 and 0.86
does not comply with these terms. ± 0.67 after IPL#4. Meibum expressibility (ME) was 1.67 ± 0.87 before IPL#1
and 1.03 ± 1.67 after IPL#4. Meibum quality (MQ) was 18.18 ± 6.34 before
IPL#1 and 10.16 ± 5.48 after IPL#4. OSDI was 35.38 ± 19.97 before IPL#1 and
15.48 ± 34.32 after IPL#4. OSDI scores, DE, and MGD parameters significantly
improved after the fourth IPL treatment but not ST and LLT.
Conclusion: Our study showed that the occurrence of superficial
telangiectatic vessels were indirectly reduced by the decrease in skin
temperature accompanying IPL treatments in patients with MGD.

KEYWORDS

dry eye, intense pulsed light therapy, skin temperature, meibomian gland dysfunction,
vessel ablation

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Introduction treatments. Patients with MGD were diagnosed according to

previous criteria (14, 15): (i) there had to be at least one symptom
Meibomian gland dysfunction (MGD) is a disease occurring from a list including ocular fatigue, discharge, foreign body
in the meibomian glands, characterized by ductal obstruction sensation, dryness, uncomfortable sensation, sticky sensation,
or changes in the quantity and quality of meibomian gland pain, epiphora, itching, redness, heavy sensation, glare, excessive
secretions (1). As a consequence, changes in meibomian gland blinking, burning sensation, and ocular discomfort upon arising;
secretions can lead to an unstable tear film (2). Symptoms (ii) at least one abnormal lid margin finding associated with
such as dryness, eye irritation, foreign body sensations, burning vascular engorgement, anterior or posterior replacement of the
sensations, tearing, and fatigue may be experienced by such mucocutaneous junction, and irregularity; and (iii) plugged
changes (3). Warm compresses, lid massages, use of antibiotic meibomian gland orifices and poor meibum expressibility (ME)
and anti-inflammatory ointments, and artificial tears are known in the target eye. IPL treatment was performed in patients who
conventional treatments for MGD (4). However, despite the were refractory to conventional treatments such as artificial
variety of treatment options currently available, many patients tears, warm compresses, eyelid scrubs, or topical/systemic
with MGD do not respond to treatments. In other words, antibiotics. Inclusion criteria of the enrolled patients were as
symptoms may not disappear completely or for the long-term. follows: (i) age of more than 18 years and (ii) completion of four
This has led to the rise of intense pulsed light treatment (IPL) (5). sessions of IPL treatment at 4-week intervals. Patients meeting
IPL therapy has been applied for the removal of hirsutism, the following criteria were excluded: patients who had (i)
pigmented lesions, and vascular lesions like cavernous missing DE and MGD evaluations before the first IPL treatment
hemangiomas, venous malformations, telangiectasia, and port or after the fourth IPL treatment; (ii) systemic disorders that may
wine stains (6). The first application of IPL therapy in the field have affected DE or MGD disease; (iii) undergone oral or topical
of ophthalmology was performed by Toyos et al. (7), who found retinoid use; (iv) intraocular surgery in the past 6 months; (v)
that patients with facial rosacea had significant improvements receipt of botulinum toxin or filler injections in the past month;
in dry eye (DE) symptoms after IPL treatment. Studies have (vi) uncontrolled ocular disease; or (vii) dark skin type, such
shown that IPL therapy is effective in improving both subjective as Fitzpatrick skin type V or VI (16); (viii) previous diagnosis
symptoms and objective findings in patients with mild to of rosacea.
moderate MGD or DE (8–11).
The mechanisms underlying IPL treatment in MGD
patients have been postulated to involve superficial blood IPL procedure
vessel destruction, meibum fluidification, epithelial turnover
downregulation, photomodulation, and antimicrobial effects Prior to IPL treatment, patients were advised to clean their
(12). Despite these proposed mechanisms, the action mechanism face to remove any makeup. After the ultrasound gel was applied
of IPL in MGD and DE patients remains obscure, and there is to the eyelid skin area, the clinician placed the Jaeger lead plate
no common consensus about the actual action mechanism (12). (Katena Products, Denville, NJ, USA) within the conjunctival sac
Gan et al. (13) used IPL therapy to treat patients with facial to protect the eye. The M22 Optima device (Lumenis, Yokneam,
telangiectasia and reported that superficial blood vessels were Israel) was used, and a duration of 6.0 ms and an interval of
ablated and that the patients’ skin temperatures decreased after 60.0 ms were set. Furthermore, a 590-nm filter and a 6-mm
IPL treatment. In addition, a reduction in facial telangiectasia cylindrical light guide were used on the hand piece (17). The
after IPL treatment has been shown to decrease local blood flow, fluence was set up according to the Fitzpatrick skin type (13–19
thereby lowering skin temperature. J/cm2), as reported in previous studies (17–19). Six IPL pulses
The purpose of this study was to investigate whether were applied to each the upper and lower eyelids (Figure 1) (17,
superficial vascular resection occurs during IPL treatment in 18). At the end of IPL treatment, meibomian gland expression
MGD patients, by measuring their skin temperatures at the was performed using an Arita Meibomian Gland Compressor
treatment site. (Katena Products, Denville, NJ, USA).

Materials and methods Skin temperature measurement before

IPL treatment
Patients
Patients rested for 20 min at 22–24◦ C and 50–60% humidity
This study was performed with the approval of the relevant prior to each IPL session (13). The skin temperatures of
institutional review board (No. KEH 2021-11-015-002). We the upper (Figure 2A) and lower (Figure 2B) eyelids were
reviewed the medical records of patients diagnosed with MGD measured using a thermometer (Testo 925, one-channel
from March 2021 to December 2021 who had received four IPL temperature measuring instrument T/C Type K, Testo AG,

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DE parameters such as the Schirmer 1 test (ST), tear

break-up time (TBUT) test, corneal staining scores (CFSs),
and MGD parameters such as meibomian gland examinations,
their lipid layer thickness (LLT), and lid margin abnormality
score (LAS) were obtained. Standard paper strips (Eagle Vision,
Memphis, TN, USA) were placed on one-third of the mid-
lateral portions of the lower fornix without topical anesthesia
for ST (17). After 5 min, the length of the wet columns were
recorded in millimeters (17). A single fluorescein strip (Haag-
Streit International, Koniz, Switzerland) wetted with a drop
FIGURE 1
IPL treatment zone, including six periocular areas on each of preservative-free normal saline was placed over the inferior
eyelid. IPL, intense pulsed light. tear meniscus, and then the CFSs and TBUT were measured
(17). Three repeated measurements of the TBUT, after several
blinks, were obtained, and the average was calculated (17). The
corneal staining was acquired according to the criteria of the
Oxford Schema (20). LLT was obtained by using the LipiView
interferometer (TearScience, Morrisville, NC, USA) (17). The lid
margins and meibomian glands were examined under slit lamp
microscopy after all the other measurements had been obtained
(17). LAS was assigned as 0 (absent) or 1 (present) for lid margin
irregularity, vessel engorgement, plugged meibomian glands,
and anterior or posterior mucocutaneous junction displacement
(21). The meibum expression level (ME) was determined
by applying digital pressure to the five glands of the lower
eyelid, and classifying them as follows: grade 0, all five glands
expressible; grade 1, three to four glands expressible; grade 2,
one to two glands expressible; and grade 3, none of the glands
expressible (21). Meibum quality (MQ) was also examined and
designated one of the following scores: grade 0, clear; grade
1, cloudy; grade 2, cloudy with granular debris; and grade 3,
toothpaste-like. A total score was obtained by summing the
scores for the eight glands (maximum score: 24) (21).
FIGURE 2
A picture of skin temperature measurement of lower lid (A) and DE and MGD parameters of the right eye, as well as OSDI
upper lid (B) and a picture of a thermometer (Testo 925, scores before IPL#1 and after IPL#4 were compared using paired
one-channel temperature measuring instrument T/C Type K,
t-tests. Additionally, the skin temperatures of the upper and
Testo AG, Germany) (C). Skin temperature measurement site
including three periocular areas of the upper and lower lids (D). lower eyelids at IPL#1, IPL#2, IPL#3, and IPL#4 were compared
using repeated-measure analyses of variance.
The amount of the change of the upper and lower
eyelids temperature at IPL#1 and at IPL#4 was obtained,
Germany)(Figure 2C) before each IPL session at the first, and the amount of the changes of each DE and MGD
second, third, and fourth IPL treatments (IPL#1 to IPL#4) parameters between before IPL#1 and after IPL#4 were
(13). The temperatures of each eyelid were measured in obtained. Additionally, multivariate linear regression analysis
the temporal, middle, and nasal areas (Figure 2D), and the was performed to reveal the relation between skin temperature
average temperature of each eyelid was calculated from the change and improvements of DE and MGD parameters.
three measurements.

Results
Clinical assessment Patient demographics

DE and MGD parameters, as well as Ocular Surface Disease A total of 90 patients were included in this study (90 eyes, 24
Index (OSDI) scores were measured before IPL#1 and after men, and 66 women). The average age of the patients was 54.67
IPL#4 in all patients (Figure 3). ± 13.62 years.

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FIGURE 3
The schedule of IPL treatment and clinical measurements. DE and MGD parameters and the OSDI were measured before the first IPL treatment
and after the fourth IPL treatment. The skin temperatures were measured before every IPL treatment. IPL, intense pulsed light; DE, dry eye; MGD,
meibomian gland dysfunction; OSDI, Ocular Surface Disease Index. IPL, intense pulsed light; DE, dry eye; IPL#1, first intense pulsed light
treatment; IPL#2, second intense pulsed light treatment; IPL#3, third intense pulsed light treatment; IPL#4, fourth intense pulsed light
treatment; MGD, meibomian gland dysfunction; OSDI, Ocular Surface Disease Index; LL, lower eyelid; UL, upper eyelid.

TABLE 1 Changes in the skin temperature (◦ C) of eyelids after each intense pulsed light treatment.

IPL#1 IPL#2 IPL#3 IPL#4 Difference Difference Difference Difference Difference

IPL#1– IPL#2 IPL#1–IPL#3 IPL#1–IPL#4 IPL#2–IPL#3 IPL#3–IPL#4

LL 31.89 ± 0.72 30.89 ± 0.63 30.14 ± 0.95 29.74 ± 0.87 <0.001 <0.001 <0.001 <0.001 0.001
UL 32.01 ± 0.69 31.13 ± 0.75 30.34 ± 1.07 29.91 ± 0.76 <0.001 <0.001 <0.001 <0.001 <0.001
Average of 31.95 ± 0.70 31.01 ± 0.70 30.24 ± 1.01 29.83 ± 0.82 <0.001 <0.001 <0.001 <0.001 <0.001
LL and UL

IPL, intense pulsed light; IPL#1, first intense pulsed light treatment; IPL#2, second intense pulsed light treatment; IPL#3, third intense pulsed light treatment; IPL#4, fourth intense pulsed
light treatment; LL, Lower Eyelid; UL, Upper Eyelid.

Skin temperature of each IPL session TABLE 2 Summary of the findings obtained before and after intense
pulsed light treatments.

Table 1 shows the skin temperature changes and average skin Before IPL#1 After IPL#4 P-value
temperature of the lower and upper eyelids of the patients at
IPL#1, IPL#2, IPL#3, and IPL#4. The skin temperatures of lower ST 12.97 ± 10.22 14.45 ± 9.99 0.211
eyelids were 31.89 ± 0.72◦ C at IPL#1, 30.89 ± 0.63◦ C at IPL#2, TBUT 3.15 ± 1.38 5.53 ± 2.34 <0.001
30.14 ± 0.95◦ C at IPL#3, and 29.74 ± 0.87◦ C at IPL#4. The skin CFS 1.61 ± 3.09 0.50 ± 0.78 0.001
temperatures of upper eyelids were 32.01 ± 0.69◦ C at IPL#1, LLT 71.88 ± 26.34 68.38 ± 24.16 0.209
31.13 ± 0.75◦ C at IPL#2, 30.34 ± 1.07◦ C at IPL#3, and 29.91 LAS 1.96 ± 0.62 0.86 ± 0.67 <0.001
± 0.76◦ C at IPL#4. The average temperatures of the upper and ME 1.67 ± 0.87 1.03 ± 1.67 <0.001
lower eyelids were 31.95 ± 0.70◦ C at IPL#1, 31.01 ± 0.70◦ C at MQ 18.18 ± 6.34 10.16 ± 5.48 <0.001
IPL#2, 30.24 ± 1.01◦ C at IPL#3, and 29.83 ± 0.82◦ C at IPL#4. OSDI 35.38 ± 19.97 15.48 ± 34.32 <0.001
The temperatures of the upper and lower eyelids, including the
IPL#1, first intense pulsed light treatment; IPL#4, fourth intense pulsed light treatment;
average temperature, were significantly lower after all sessions
ST, Schirmer 1 Test; TBUT, Tear Break-Up Time; CFS, Corneal and Conjunctival Staining
than before the first IPL session. Scores; LLT, Lipid Layer Thickness; LAS, lid margin abnormality score; ME, Meibum
Expressibility; MQ, Meibum Quality, OSDI, Ocular Surface Disease Index.

Comparison of DE and MGD parameters IPL#4. ST was 12.97 ± 10.22 mm before IPL#1 and 14.45 ±
and OSDI scores before IPL#1 and after 9.99 mm after IPL#4. TBUT was 3.15 ± 1.38 s before IPL#1 and
IPL#4 5.53 ± 2.34 s after IPL#4. CFS was 1.61 ± 3.09 before IPL#1 and
0.50 ± 0.78 after IPL#4. LLT was 71.88 ± 26.34 nm before IPL#1
Table 2 shows the changes in the DE and MGD parameters, and 68.38 ± 24.16 nm after IPL#4. LAS was 1.96 ± 0.62 before
and in the OSDI scores of the patients before IPL#1 and after IPL#1 and 0.86 ± 0.67 after IPL#4. ME was 1.67 ± 0.87 before

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TABLE 3 Multivariate linear regression analysis between skin temperature (◦ C) change and DE and MGD parameter improvement.

LL temperature change UL temperature change Average of LL and UL temperature change

B p-value B p-value B p-value

LAS 0.099 0.287 LAS 0.009 0.939 LAS 0.084 0.476

ME −0.090 0.250 ME −0.0743 0.483 ME −0.107 0.284
MQ −0.132 0.871 MQ 0.567 0.596 MQ 0.158 0.878
CFS 0.912 0.009 CFS 0.408 0.040 CFS 0.928 0.040
TBUT −0.028 0.919 TBUT −0.042 0.908 TBUT −0.043 0.904
OSDI −0.577 0.696 OSDI 0.071 0.975 OSDI −0.514 0.816

LL, lower eyelid; UL, upper eyelid; TBUT, Tear Break-Up Time; LAS, Lid Margin Abnormality Score; ME, Meibum Expressibility; MQ, Meibum Quality; CFS, Corneal and Conjunctival
Staining Scores; OSDI, Ocular Surface Disease Index.

IPL#1 and 1.03 ± 1.67 after IPL#4. MQ was 18.18 ± 6.34 before was introduced in 1983, and a flash lamp for treating vascular
IPL#1 and 10.16 ± 5.48 after IPL#4. OSDI was 35.38 ± 19.97 lesions of the skin was developed in 1990 (12). In 1994, the
before IPL#1 and 15.48 ± 34.32 after IPL#4. The TBUT, CFS, first commercialized IPL machine was released by Lumenis
LAS, ME, and MQ measurements obtained before IPL#1 were (12), and was applied for the removal of hirsutism, pigmented
significantly higher than those measured after IPL#4. There were lesions, and vascular lesions like cavernous hemangiomas,
no significant differences between the ST and LLT scores before venous malformations, telangiectasia, and port wine stains in
IPL#1 and after IPL#4. The OSDI scores before IPL#1 decreased dermatology fields (6). In 2002, Toyos et al. discovered that
significantly when compared with those after IPL#4. dry eyes improved after IPL treatment in facial rosacea patients
and introduced IPL into the ophthalmology field. Many studies
have been conducted on the use of IPL treatments in patients
Multivariate linear regression analysis with MGD (7, 8, 19, 21–25). These studies have shown that
between skin temperature change and ocular discomfort, DE, and MGD parameters improved after
DE and MGD parameter changes IPL treatment (7, 8, 19, 21–25). Similar to previous studies, the
current study also found that DE and MGD parameters, as well
There was no significant difference between LLT and as OSDI scores, improved after IPL treatment. In addition, IPL
ST before and after 4 sessions of IPL treatments, therefore treatment is effective in reducing eyelid ecchymosis after eye
multivariate linear regression analysis was not performed. lid surgery (26), treatment for blepharokeratoconjunctivitis (27),
Table 3 shows the result of multivariate linear regression analysis and ocular demodex infestation (28).
result between amount of skin temperature decrease and DE Several studies have tried to prove the occurrence of
and MGD parameters except ST and LLT. Multivariate linear superficial ablation in the field of dermatology (13, 29, 30).
regression analysis showed that there was significant relation Bäumler et al. (29) presented a mathematical model for
between the amount of skin temperature decrease of upper, calculating the photon distribution and thermal effects of IPL
lower, and average of upper and lower lid after 4 sessions of emissions within cutaneous blood vessels. They demonstrated
IPL treatments and CFS improvement. However, there were no the occurrence of superficial vessel ablation resulting from
significant relationship between the skin temp decrease and DE IPL treatment. Furthermore, studies have reported that IPL
and MGD parameters except CFS. treatment was effective in patients with MGD; superficial blood
vessel destruction, meibum fluidification, epithelial turnover
downregulation, photomodulation, antimicrobial effects,
Discussion modulation of the secretion of pro- and anti-inflammatory
molecules, and suppression of matrix metalloproteinases
We investigated whether there were changes in skin (MMPs) were proposed as possible mechanisms of IPL
temperature associated with each IPL session. We found that treatments of MGD patients in previous studies (12, 31).
patients with MGD who were treated with IPL experienced However, no study has demonstrated the mechanism of action
improvements in ocular discomfort as well as in their DE and of IPL treatment clearly. Therefore, there is a need for research
MGD parameters. In addition, there was a gradual decrease and to directly or indirectly prove the mechanism of action of IPL
downward trend in skin temperature after each IPL session. treatment in patients with MGD. To the best knowledge, the
IPL was first introduced for the treatment of vascular current study is the first attempt to prove vessel ablation on the
diseases of the skin in 1976. The concept of photothermolysis treatment area in MGD patients indirectly.

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Recently, Mejía et al. (31) demonstrated the concept that of inflammatory molecules on the ocular surface of patients
the main mechanism of action of IPL on the eyelids is with MGD might increase their skin temperature. In the
secondary to its effects on the mitochondria of the tarsal plate. current study, the skin temperature of patients with MGD
The light absorbed into the mitochondria in the tarsal plate gradually decreased, and the signs and symptoms of MGD
activates the mitochondria, and exerts its initial effect, resulting improved after serial IPL treatments. In addition, there was
in increased ATP production, modulation of reactive oxygen significant relation between the skin temperature decrease and
species, and induction of transcription factors. Together, these CFS. Therefore, there is a possibility that the degree of change
effects produce proliferation and increased cell migration in the in skin temperature due to IPL treatment is related to the
acini of the meibomian glands, in addition to the modulation degree of improvement in MGD. Changes in skin temperature
of cytokines, growth factors, and the levels of inflammatory following IPL treatment could also be a predictor of the response
mediators, and finally an increase in cell oxygenation. Therefore, to MGD treatment. Additional studies should be conducted to
research on the relationship between mitochondria activation further explore the changes in skin temperature due to IPL
mechanism and reduction in skin temperature at the IPL therapy and the degree of MGD treatment. Furthermore, studies
treatment site is considered necessary in the future. are required to investigate the relationship between changes
Gan et al. (13) reported that IPL treatment was effective in skin temperature following IPL treatment and changes in
in patients with facial telangiectasia, and they confirmed a inflammatory substances on the ocular surface.
decrease in superficial vessel ablation and a reduction in skin In this study, it was confirmed that the eyelid temperature
temperature at the affected site after IPL treatment. In addition, of patients gradually decreased after IPL treatment. However,
it has been reported that the reduction of facial telangiectasia it was not clear whether the eyelid temperature change was a
after IPL treatment reduced the local blood flow, and thus result of vessel ablation or a result of decreased inflammation
the skin temperature (13). Additionally, Su et al. (32) reported of the eyelids and ocular surface. However, Su et al. (32)
that local inflammation in MGD patients may increase local confirmed that the eyelid skin temperature was high in MGD
blood flow on the eyelid and result in increases in the eyelid patients, and Gan et al. (13) reported that the skin temperature
skin temperature. In the current study, a gradual decrease in at the treatment site dropped after IPL treatment. All these
skin temperature was observed after successive IPL treatments, previous studies support the notion that vessel ablation at
thus indirectly confirming the occurrence of superficial vessel the IPL treatment site in MGD patients resulted in decreased
ablation. Further studies are required to confirm the occurrence skin temperature at the treatment area in this current study.
of superficial vessel ablation after IPL treatment in patients with However, this study was a retrospective study and could not
MGD by applying mathematical models (29) or by evaluating directly confirm vessel ablation or decrease of inflammation
the presence of direct superficial ablation. on the eyelid or ocular surface. Therefore, additional studies
Several studies have reported the relationship between skin are needed in the future to directly ascertain the relationship
temperature and MGD. Most of them have demonstrated that between eyelid skin temperature change and vessel ablation or
the use of eyelid warming devices was effective in patients with eyelid and/or ocular surface inflammation in MGD patients in
MGD (33–35). These studies showed that the skin temperatures response to IPL treatment.
of patients with MGD were approximately 33.2◦ C (33) and This study has certain limitations which should be
32.7◦ C (35), which are higher than the eyelid temperature at considered. First, it is retrospective. Second, it was difficult to
IPL#1 in the current study. In previous studies, skin temperature directly confirm the occurrence of superficial vessel ablation on
was measured using an infrared thermometer (33, 35). However, the eyelids of patients with MGD in an ophthalmology clinic.
in the current study, the skin temperature was measured using a Additional studies that directly confirm the occurrence
contact thermometer. The differences in the skin temperatures of superficial vessel ablation on eyelids or that apply
between the current study and the previous studies may be mathematical models are required. Third, the follow-up
attributed to the use of different measuring devices. Gan et al. period was limited to 4 weeks after the final treatment.
(13) measured skin temperature with the same thermometer as Longer follow-up periods are needed to evaluate long-term
was used in the current study and obtained temperature values changes in a patient’s eyelid skin temperature. Furthermore,
that are almost identical to those obtained in the current study. randomized controlled clinical trials or well-designed cohort
Many studies have measured the skin temperature of patients studies are required to confirm the occurrence of superficial
with MGD, but the current study is the first to investigate the vessel ablation on the eyelids of patients with MGD after
changes in skin temperature after IPL treatment in patients IPL treatment.
with MGD. In conclusion, the reduction of superficial telangiectatic
One study measured eyelid temperature using an infrared vessels was confirmed indirectly through a decrease in skin
thermometer and found that the eyelid temperature of patients temperature after IPL treatments in patients with MGD.
with MGD was higher than the temperature of the controls Therefore, further evaluations of the relationship between skin
(32). In addition, this study concluded that the accumulation temperature changes and MGD improvement are required.

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Data availability statement interpretation and supervision were performed by JM. Both
authors approved the final version of the manuscript.
The raw data supporting the conclusions of this article will
be made available by the authors, without undue reservation.
Conflict of interest
Ethics statement The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could
The studies involving human participants were reviewed
be construed as a potential conflict of interest.
and approved by Kim Eye Hospital Institutional Review Board.
Written informed consent for participation was not required for
this study in accordance with the national legislation and the
institutional requirements.
Publisher’s note
All claims expressed in this article are solely those of the
Author contributions authors and do not necessarily represent those of their affiliated
organizations, or those of the publisher, the editors and the
Conceptualization, design, and critical revisions were reviewers. Any product that may be evaluated in this article, or
performed by JY and JM. Data acquisition and drafting of the claim that may be made by its manufacturer, is not guaranteed
manuscript were performed by JY. Data/statistical analyses and or endorsed by the publisher.

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