Short-term efficacy of intense pulsed light in the treatment of hordeolum: A prospective cohort study

Abstract

The study aims to evaluate the efficacy of conservative treatment of hordeolum with intense pulsed light (IPL), compared with the medication treatment of hordeolum. Eighty patients with hordeolum who received treatment at the ophthalmology clinic of Quzhou People’s Hospital from June 2023 to December 2024 were selected. Patients were randomly assigned to the control group and the experimental group using the principle of random allocation. The control group received external drug application combined with local hot compress treatment, while the experimental group received 1 session of IPL treatment for the ocular skin, followed by local hot compress treatment. Ocular surface disease index (OSDI) scores and noninvasive tear meniscus height information were collected from all patients with ocular discomfort symptoms before and after treatment. Furthermore, anterior segment photographs and images depicting meibomian gland morphology were obtained from patients both prior to and following treatment. The duration of recovery and surgical rates for the 2 groups were documented. A comparative analysis was conducted to evaluate the efficacy before and after treatment and to assess the differences between the 2 groups posttreatment. The results indicated no statistically significant difference in OSDI scores within the medication group before and after treatment (P > .05). Conversely, the IPL group exhibited a statistically significant reduction in OSDI scores following treatment (P < .05). Posttreatment, the medication group demonstrated higher OSDI scores, longer recovery times (in days) and increased surgical rates compared to the IPL group with these differences reaching statistical significance (P < .05). Intense pulsed light is a more efficient and convenient method for treating hordeolum, compared with the medication treatment of hordeolum.

1. Introduction

Hordeolum is a very common acute infectious disease in ophthalmology. It is caused by acute suppurative inflammation of the eyelid gland. It is usually manifested as redness, pain, fever and induration or abscess formation^[1] in the eyelid. According to the part of the gland, infection can be divided into internal hordeolum and outer eyelid inflammation.^[2] So far, the clinical treatment of hordeolum preferred conservative hot compresses and combined local drugs^[3] that inhibit gland bacteria growth and reproduction, alleviate symptoms of infection and promote inflammation subsidence. But local drugs can produce local irritation to the eye and eyelid skin resulting in effects such as eye pain and a burning sensation. Severe cases may even produce the allergic reaction^[4] which presents redness, itching and skin rash. For severe pain and swelling of the blepharitis, simple conservative treatment using drugs combined with local hot compresses has limited effect.^[5] In severe cases, abscess incision and surgical drainage^[6] are even required. Although surgery can quickly reduce the degree of swelling, patients have obvious pain during the operation, and the incision is traumatic after the operation which is easy to leave scars. At the same time, there are certain surgical risks^[7] including infection and bleeding. With the rapid development of photovoltaic technology, intense pulsed light (IPL)^[8] as a noninvasive physical therapy method is widely applied in the field of ophthalmology in recent years. With unique physical characteristics and biological effects, IPL provides a new train of thought for the treatment of the acute eyelid inflammation. The study aims to systematically observe and analyze the clinical efficacy of IPL treatment for hordeolum with the objectives of assessing the effectiveness in alleviating symptoms and promoting the resolution of inflammation. The findings are intended to provide a scientific basis and reference for clinical treatment.

2. Materials and methods

2.1. Subjects and ethical approval

This study was a prospective controlled clinical trial. Subjects were selected from June 2023 to December 2024 at the Quzhou City People’s Hospital of Ophthalmology including eighty patients with a clinical diagnosis of hordeolum. There were eighty eyes of the patients with hordeolum who participated in the study. This study was approved by the Medical Ethics Review Committee of the Quzhou People’s Hospital, which is affiliated with Wenzhou Medical University (Approval number: Quzhou People’s Hospital Ethical Review 2023 study No. 058). All checking and operating procedures (Fig. 1) were conducted in accordance with the moral regulations of the Declaration of Helsinki. All study subjects signed an informed consent form before the start of the study.

Figure 1.

Flow chart of the experiment. IPL = intense pulsed light, OSDI = ocular surface disease index.

2.2. Inclusion and exclusion criteria

Inclusion criteria for hordeolum are shown below: the clinical diagnosis of hordeolum was made and it was the first episode of hordeolum. The patients aged 8 to 60 years who were able to cooperate with the treatment presented with a painful eyelid mass as the typical clinical symptom. The exclusion criteria for blepharitis are as follows: patients with solar dermatitis, systemic lupus erythematosus, simple recurrent herpes, skin cancer and epilepsy. Patients with mental disorders, epilepsy or taking photosensitive drugs including isotretinoin and tetracycline. Individuals with serious diabetes, heart disease or those taking anticoagulant drugs and those who have a bleeding disorder should consult their healthcare provider for guidance. Patients who have undergone radiation and chemotherapy within 6 months. People who have recently been exposed to or are not suitable for IPL treatment after exposure.

2.3. Treatment methods

2.3.1. Control group

Medication treatment group is as follows: Tobramycin and dexamethasone eye ointment was applied to the affected eye twice a day and a local hot compress was applied twice a day for 5 minutes each time.

2.3.2. Experimental group

The treatment process was administered by a team of experienced ocular specialists utilizing the M22 optimum pulse technology system. Technical parameters were programmed with triple-pulse sequences at 590 nm wavelength, featuring 5 ms pulse width and inter-pulse intervals of 50 ms. Before application, clinicians thoroughly coated the dermal surface with medical-grade ultrasound transmission gel. Safety protocols mandated operators to wear specialized ocular protection prior to parameter adjustment, with energy density parameters being calibrated between 11 and 14 J/cm². Preliminary cutaneous evaluations were conducted on temporal regions to determine individualized energy settings based on Fitzpatrick scale assessments. The therapeutic zone covered bilateral periocular regions (including upper and lower eyelid margins and partial malar areas), with continuous application across nasal bridge connectivity (Fig. 2). Operational methodology emphasized precise margin alignment during device application, with subjects maintaining ocular occlusion throughout the process. Treatment adequacy criteria required repetition when light coverage fell below 90% threshold, typically involving 22 to 24 discrete applications per therapeutic session. Post-procedural care included meticulous removal of residual coupling medium from treatment zones and thorough palpebral margin cleansing. Adjuvant therapy comprised bilateral thermal management through twice-daily 5-minute warm compresses applied topically to intervention sites.

Figure 2.

IPL treatment area. IPL = intense pulsed light.

2.4. Eye safety measures

After ocular surface preparation, topical anesthesia was achieved using 0.5% proparacaine hydrochloride ophthalmic solution instilled into the inferior conjunctival fornix. Aseptic protocol required placement of disposable polymer-based corneal shielding apparatus through transpalpebral fixation, ensuring complete isolation of anterior chamber structures from photothermal exposure. All clinical personnel utilized wavelength-specific optical filtration goggles during energy delivery phases.

2.5. Safety assessment

Binocular visual acuity was measured using standardized charts alongside continuous intraocular pressure monitoring with noncontact tonometry. Ocular parameters were recorded digitally for treatment efficacy assessment. Anterior/posterior segment evaluations included slit-lamp examinations and fundus observations.

2.6. Evaluation of efficacy

2.6.1. Ocular surface disease index scale

To assess the severity of ocular surface pathology, the study used a standardized assessment tool based on patient-reported symptoms. This validated instrument evaluates 3 clinical domains: sensory irritation, functional vision limitations, and sensitivity to external stimuli. A composite numerical score is generated through the systematic scoring of 12 clinically relevant parameters, allowing for the quantitative stratification of disease progression. The assessment framework utilizes a 4-tier response metric across twelve clinically validated items, with individual scores ranging from 0 to 4 based on symptom frequency. The response anchors are defined as follows: 0 (asymptomatic), 1 (intermittent presentation with <25% temporal occurrence), 2 (periodic manifestation for up to 50% of the observation period), 3 (persistent symptoms for more than 50% of the duration), and 4 (continuous discomfort). The evaluation matrix comprises 3 components: sensory ocular parameters (3 items), vision-related functional capacity (6 items), and exogenous aggravation factors (3 items).

2.6.2. Tear meniscus height (TMH)

TMH parameters were objectively evaluated using the K5M dry eye measurement analyzer. Triplicate measurements obtained during baseline and follow-up assessments underwent computational averaging to determine mean TMH values. Dimensional analyses adhered to SI unit conventions (millimeter scale), with rigorous quality control maintained through standardized imaging protocols.

2.6.3. Healing time

The cure time for hordeolum was defined as the duration, measured in days, from the initial presentation of characteristic symptoms (including eyelid redness, swelling, pain, and induration) and the commencement of immediate treatment at the Department of Ophthalmology, Quzhou People’s Hospital, utilizing either pharmacological conservative therapy or IPL treatment, until the complete resolution of these symptoms, subsidence of inflammation, and total absorption or disappearance of local lesions (such as abscesses and induration).

2.6.4. Surgery rate

Following a period of conservative management with pharmacological agents or IPL therapy, the patient exhibited the subsequent symptoms: a marked exacerbation of ocular pain, accompanied by pronounced foreign body sensation, burning, stinging, and fluctuating discomfort upon palpation. The extent of eyelid erythema and edema associated with blepharoadenitis progressively increased, resulting in diffuse swelling of the entire eyelid, with the coloration intensifying to a bright or dark red hue. The eyelid abscess progressively enlarges, resulting in a noticeable bulge on the eyelid surface, with a potential risk of spontaneous rupture. The patient exhibited symptoms of systemic infection, including fever and chills, alongside lymphadenopathy in the preauricular, submandibular, and other regions, accompanied by tenderness. Additionally, the patient experienced reduced vision, exophthalmos, severe ocular pain, photophobia, lacrimation, exacerbated conjunctival hyperemia, and increased ocular discharge. The patients who met the above conditions were immediately treated with surgical incision and drainage (Fig. 3) and the number of surgical drainages was recorded.

Figure 3.

Patient’s ocular surface image: (A) depicts the slit lamp examination of the anterior segment of the patient's right eye prior to incision and drainage. (B) Illustrates the slit lamp examination of the anterior segment of the patient's right eye following incision and drainage. (C) Presents the slit lamp examination of the anterior segment of the patient's left eye in the IPL group before treatment. (D) Presents the slit lamp examination of the anterior segment of the patient's left eye in the IPL group after treatment. IPL = intense pulsed light.

2.7. Statistical analysis

Statistical analyses were conducted using SPSS version 26.0 (IBM Corporation, Armonk). Measurement data that conformed to a normal distribution were expressed as mean ± standard deviation, while data that did not conform to a normal distribution were represented as median (interquartile range). For data conforming to a normal distribution, comparisons between 2 groups were performed using the independent samples t-test. For data not conforming to a normal distribution, the Mann–Whitney U test was employed for comparisons between 2 groups. Categorical data were summarized using frequencies and percentages, and differences between groups were assessed using either the chi-square test or Fisher’s exact test, as appropriate. Intragroup comparisons before and after treatment were conducted using a paired t-test, with statistical significance defined as P < .05.

3. Results

3.1. Comparison of the baseline charateristics of medication group and IPL group before treatment

There were no significant differences in age, ocular surface disease index (OSDI) score, TMH, gender, and eye condition before treatment between the medication group and the IPL group (P > .05; Table 1).

Table 1.

The baseline charateristics of medication group and IPL group before treatment.

Variables	Medication (n = 40)	IPL (n = 40)	t/χ2	P
Age (yr)	25.23 ± 9.65	23.23 ± 8.61	0.97	.337
Gender, n (%)			0.20	.654
Male	20 (50.00)	22 (55.00)
Female	20 (50.00)	18 (45.00)
Eyes apart, n (%)			1.80	.179
Right eye	22 (55.00)	16 (40.00)
Left eye	18 (45.00)	24 (60.00)
OSDI score before treatment	16.55 ± 8.66	15.43 ± 7.84	0.61	.544
Tear meniscus height before treatment (mm)	0.33 ± 0.14	0.34 ± 0.14	−0.20	.842
Size (mm)	1.97 ± 0.5639	1.99 ± 0.56	−0.10	.921

IPL = intense pulsed light.

3.2. Comparison of OSDI scores before and after treatment in medication group and IPL group

In the comparison of OSDI scores before and after medication treatment, there was no statistically significant difference (t = −0.19, P > .05; Table 2). The comparison of IPL group OSDI scores before and after the treatment showed a statistically significant difference (t = 7.64, P < .05; Table 2).

Table 2.

Comparison of OSDI scores before and after treatment in medication group and IPL group.

Variables	OSDI score before treatment	OSDI score after treatment	t	P
Medication	16.55 ± 8.66	16.58 ± 8.81	−0.19	.850
IPL	15.43 ± 7.84	11.08 ± 4.55	7.64	<.001

IPL = intense pulsed light, OSDI = ocular surface disease index.

3.3. Comparison of tears river height before and after treatment in medication group and IPL group

In the IPL group, the tears river height showed statistically significant difference before and after treatment (t = −10.791, P < .05; Table 3). The TMH in the medication treatment group did not exhibit a significant difference pre and posttreatment (t = −0.190, P > .05; Table 3).

Table 3.

Comparison of tears river height before and after treatment in medication group and IPL group.

Variables	Tears river height before treatment (mm)	Tear meniscus height (mm) after treatment	t	P
Medication	0.336 ± 0.141	0.336 ± 0.141	−0.190	.85
IPL	0.342 ± 0.139	0.451 ± 0.082	−10.791	<.05

IPL = intense pulsed light.

3.4. Comparison of efficacy between medication group and IPL group after treatment

There were significant differences in the OSDI score (16.58 ± 8.81 vs 11.08 ± 4.55, t = 3.51, P < .05), recovery time (days; 6.39 ± 1.60 vs 3.79 ± 0.89, t = 8.95, P < .05) and operation rate (X² = 22.92, P < .05) between the medication group and the IPL group after treatment (Table 4).

Table 4.

Comparison of efficacy between medication group and IPL group after treatment.

Variables	Medication (n = 40)	IPL (n = 40)	t	P
OSDI score before treatment	16.55 ± 8.66	15.43 ± 7.84	0.61	.544
OSDI score after treatment	16.58 ± 8.81	11.08 ± 4.55	3.51	.001
Tear meniscus height before treatment (mm)	0.33 ± 0.14	0.34 ± 0.14	−0.20	.842
Post treatment tear meniscus height (mm)	0.34 ± 0.14	0.45 ± 0.08	−4.4599	<.001
Recovery time (d)	6.39 ± 1.60	3.79 ± 0.89	8.95	<.001
Surgery or not, n (%)			24.92	<.050
Deny	21 (51.43)	40 (100.00)
Correct	19 (48.57)	0 (0.00)

IPL = intense pulsed light, OSDI = ocular surface disease index.

4. Discussion

Hordeolum is a very common eyelid disease. Hordeolum is usually characterized by swelling and congestion at the edge of the eyelid. As the condition gradually worsens, there is marked pain and a palpable induration in the affected area, as well as potential swelling and tenderness in the ipsilateral preauricular lymph nodes. According to the site of onse, it can be clinically divided into external hordeolum and internal hordeolum. External hordeolums are the Zeis or Moll glands at the root of the eyelash hair follicle and internal hordeolums are the meibomian glands^[3] of the eyelid. The meibomian glands are located in the meibomian glands of the upper and lower eyelids which are arranged vertically with the eyelid margin and open at the eyelid margin. Their function is to secrete oil which is the outermost component of tear and plays an important role in stabilizing the tear film and lubrizing the eyelid margin. Hordeolum can not only cause pain and eye appearance damage, but also may further damage the structure and function of the meibomian gland. Especially in patients who have been surgically removed, it eventually forms conjunctival scars and dry eyes.^[2] So there is of important clinical significance for the timely diagnosis and correct treatment of patients with hordeolum.

IPL is recognized to be a new and noninvasive treatment that can improve the meibomian gland dysfunction (MGD). Many studies have found that IPL is effective^[9-13] in the treatment of blepharitis and MGD, which is considered to be safety.^{[10,12,14,15]} The symptoms of MGD patients can be obviously improved after accepting first IPL treatment. Compared with the condition before IPL treatment, the eyelid edge morphology, meibomian gland secretion, and discharge capacity of patients treated with IPL show significant increases^[14,16] and the study found that the earlier patients with MGD receive IPL treatment, the better the treatment effect will be.^[10] Studies^[9] have shown that the IPL can reduce ocular surface and eyelid margin of inflammation and promote the meibomian gland secretion. The thermal effects of IPL and bactericidal action^[17] along with the ability to clear glandular obstructions and promote lipid secretion,^[18] inhibit inflammatory factors^[19] and enhance the microenvironment and tissue repair^[20] are features potentially associated with the etiology of hordeolum. Compared with the traditional treatment, IPL treatment has the advantages of being noninvasive, safe and more suitable for people of all ages. Only a handful of studies^[8] reported on the IPL sty with obvious therapeutic effects, but these studies relied on before and after comparisons and lacked a control group. Therefore, this study collected the data of eighty patients with hordeolum before and after treatment including forty patients treated with conservative medicine as the control group and forty patients treated with IPL as the experimental group to observe the short-term efficacy of IPL in the treatment of hordeolum.

The results of this study showed that the OSDI score of the IPL group which decreased after treatment was significantly lower than that of the medication treatment group and the difference was statistically significant. The decrease in OSDI scores after IPL treatment may be related to anti-inflammatory effects,^[19] sterilization and mite removal^[17] as well as improvements in the eyelid margin microenvironment and tissue repair.^[21] A study^[19] reported that 6 patients with MGD and dry eye disease (DED) were treated with IPL. The OSDI questionnaire was used to evaluate the effect after DED treatment and found that OSDI scores decreased significantly after treatment. The OSDI questionnaire was used to evaluate the effect after DED treatment and found that OSDI scores decreased significantly after treatment. The study suggested that the photothermal and photobiomodulation effects of IPL could reduce the expression of inflammatory mediators in the eyelid margin and meibomian glands as well as decrease the secretion of inflammatory chemokines, which relieved the patients’ eye discomfort symptoms. Another study^[22] found that nineteen DED patients who underwent 3 IPL treatments had lower OSDI scores after treatment. The study demonstrated that IPL effectively reduced the dilation of ocular surface capillaries, inhibited aberrant angiogenesis, alleviated tissue edema and congestion, regulated cellular metabolism and further mitigated inflammatory effects. They both show that reduction of inflammation is one of the important factors to improve OSDI score. Studies have shown that the photothermal effect of IPL^[18] can effectively kill bacteria and mites in the eyelid margin and meibomian gland. IPL also has a destructive effect on the biofilm attached to the eyelid margin and meibomian gland. IPL can improve the ocular surface discomfort after removing mites, which may be another reason for the decrease of OSDI score. Some studies have shown that IPL^[3,5,7] can also promote nerve repair and regeneration, which may help improve ocular nerve damage caused by high OSDI scores.

The results indicated that the tears river height showed statistically significant difference before and after treatment in the IPL group. Many previous studies^[23-25] have found that IPL treatment can improve TMH in patients with MGD disorders. The increase of TMH is associated with the improvement^[26] of meibomian gland function. IPL can unclog the meibomian ducts through photothermal effect, reduce blockage and allow meibomian fat to be secreted and discharged^[27] smoothly. The study^[10] demonstrates that IPL light plays a biological regulatory role in stimulating the differentiation and maturation of meibomian gland epithelial cells. Mature meibomian gland epithelial cells utilize organelles such as the endoplasmic reticulum and Golgi apparatus for lipid synthesis. These synthesized lipids are encapsulated in vacuoles and released into the gland duct via cell membrane fusion. Ultimately, the lipids are secreted through the eyelid margin onto the ocular surface. As the function of recovery occurs, eyelid fat secretion will increase accordingly. Eyelid fat is an important component, as it can reduce tear evaporation and maintain the stability^[28] of the tear film. The increase in meibum secretion can directly improve the thickness and stability of the tear film, which in turn leads to an increase in TMH.^[29,30] The high temperature of IPL will continue to promote the secretion and discharge of the eyelid margin sebaceous glands, further cleaning the eyelid edge area and reducing residual dirt and bacteria.^[31]

In this study, patients with hordeolum exhibited local abnormalities in the meibomian gland structure. Following IPL treatment, there was an observed improvement in eyelid inflammation and OSDI scores at the 3-month follow-up. However, no significant improvement was noted in the abnormal meibomian gland structure (Fig. 4). Studies have demonstrated that IPL treatment primarily exerts its effects through thermal radiation.^[18] These effects include sterilization^[32] and anti-inflammatory actions,^[33] which contribute to the improvement of meibomian gland function and the ocular surface microenvironment. Additionally, IPL treatment has been shown to reduce the levels of inflammatory cytokines in ocular surface tissues, thereby enhancing homeostasis and decreasing inflammation at the eyelid margin. The meibomian glands are composed of intricate tissues including glands and ducts. Morphological and structural alterations in the meibomian glands typically necessitate extended periods and intricate intervention methods.^[34] IPL therapy primarily targets the functional modifications of the meibomian glands. A single IPL treatment is insufficient to induce significant structural changes in the meibomian glands. Thus, multiple treatment courses are required to observe gradual structural improvements.^[35] Some patients experience ocular complications or other systemic diseases; these factors^[36-39] will affect the recovery rate and degree of meibomian gland function, which is consistent with the results of this study.

Figure 4.

Meibomian gland diagram of the patient after 1 IPL treatment: (A) illustrates the morphology of the meibomian glands in the patient's left upper eyelid prior to IPL treatment. (B) Depicts the meibomian gland morphology after three months of IPL treatment. IPL = intense pulsed light.

The recovery time for patients with hordeolum in the IPL treatment group was significantly shorter than that in the drug therapy group with the difference being statistically significant. IPL therapy can directly target the meibomian gland, enhancing blood circulation around the eyes, improving the fluidity of lipids within the meibomian gland secretions and promoting normal glandular secretion.^[40] Furthermore, the intense thermal radiation generated by IPL can rapidly eradicate bacteria and alleviate inflammatory responses, thereby providing swift relief from inflammatory symptoms, pain, and discomfort for patients. Additionally, IPL reduces the bacterial load around the eyelid and enhances the ocular surface microenvironment, thereby expediting the recovery process.^[41] This straightforward, direct, and efficient treatment modality has demonstrated significant efficacy in the management of hordeolum. Medical treatment predominantly employs topical medications to manage infection and inflammation. However, the scope of action and drug absorption are relatively constrained rendering it insufficient to comprehensively address all affected meibomian glands.^[42] Pharmacological intervention necessitates an extended treatment duration to attain the desired therapeutic outcomes. Prolonged use of these medications may lead to adverse effects including drug resistance and allergic reactions, which can compromise the overall efficacy of the treatment.^[43]

The operation rate of the IPL group was significantly lower than that of the drug group. IPL can intervene in the early stage of the disease by improving the meibomian gland function and ocular surface microenvironment to prevent the further development of the disease and reduce the number of patients who need surgical treatment.^[44] Furthermore, IPL treatment can reduce the need for surgery by alleviating inflammation and decreasing the number of bacteria around the eyelid.^[45]

This study introduces IPL technology as a new method for the treatment of hordeolum. Traditionally, the treatment of hordeolum mostly relies on hot compresses and topical application of antibiotics but the effect is often not satisfactory and may even lead to suppuration and increase the pain of patients. IPL technology can drese meibomian glands, liquify lipid secretion and inhibit the expression of inflammatory factors through its unique photothermal effect and biological regulation thereby effectively relieving the symptoms of stye and improving the therapeutic effect. The results of this study showed that IPL was effective in the treatment of hordeolum. After IPL treatment, the symptoms of redness, swelling, pain, and other discomfort were quickly relieved. Serious adverse reactions have not been observed in the procedure of IPL which is considered simple, effective, and safe. This feature makes the IPL treatment highly acceptable to patients. Especially for children, IPL treatment provides a more ideal treatment option.

The limitations of this study are that the study time and sample size are relatively small and the studies mainly focus on the short-term efficacy of IPL treatment when there is a lack of long-term follow-up data. In addition, the conditions and constitutions of different patients vary and the specific parameters of IPL treatment need to be adjusted according to the actual condition of each patient. Future studies need to further expand the sample size, optimize the IPL treatment parameters and enhance the long-term follow-up of patients to more comprehensively evaluate the long-term efficacy and safety of IPL in the treatment of hordeolum.

5. Conclusions

IPL can reduce ocular discomfort and shorten the healing time for patients with hordeolum through multiple mechanisms including high temperature, light regulation, and antibacterial and anti-inflammatory effects. Besides, IPL can effectively cure hordeolum by avoiding skin scar and pain caused by surgical incision.

Author contributions

Conceptualization: Youlv Lu.

Data curation: Youlv Lu.

Funding acquisition: Chunyun Feng.

Supervision: Chunyun Feng.

Writing – original draft: Youlv Lu.

Writing – review & editing: Chunyun Feng.