***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim was to evaluate the efficacy of periocular intense pulsed light therapy combined with meibomian gl and expression for chronic dry eye due to moderate to advanced meibomian gl and dysfunction Purpose : The aim of this study was to assess the efficacy of using a combination treatment approach consisting of lipid emulsion eye drops , eyelid cleansing wipes , and omega-3 vitamin supplements compared with warm compresses in improving meibomian gl and functionality in patients with lipid-deficient/evaporative dry eye disease ( LDDE ) . Methods : This single-center , open-label , investigator-masked , r and omized study enrolled patients aged ≥18 years , clinical ly diagnosed with LDDE defined as having ⩽6 functional meibomian gl and s [ meibomian gl and yielding liquid secretion ( MGYLS ) ] and positive for dry eye symptoms at screening . Patients were r and omized to receive either the combination treatment ( lipid emulsion eye drops , omega-3 supplements , and lid hygiene with eyelid wipes ) or to apply warm , wet compresses once daily , 8 minutes per day , for 3 months . Meibomian gl and functionality ( number of MGYLS ; primary outcome ) and patient-reported subjective assessment s ( SPEED and OSDI question naires ; secondary outcomes ) were evaluated . Adverse events ( AEs ) and visual acuity were assessed as safety endpoints . Results : Mean patient age was 41.7 years ( n = 26 ; n = 13 per group ) . Mean ± SD number of MGYLS was not statistically significantly different between groups at baseline ( combination treatment , 3.5 ± 1.5 ; warm compresses , 4.2 ± 1.4 , P > 0.5 ) , and was significantly greater with combination treatment versus warm compresses after 3 months of treatment ( 9.3 ± 2.7 vs. 4.7 ± 2.3 ; P = 0.006 ) . Dry eye symptoms were significantly improved in both groups at all follow-up visits . Two AEs unrelated to treatment were reported ; the BCVA was unchanged from baseline in both groups . Conclusions : The combination treatment regimen result ed in significant improvement in meibomian gl and functionality and dry eye symptoms . No safety issues were observed Objective : To explore short-term effect of intense pulsed light ( IPL ) combined with meibomian gl and expression in treating meibomian gl and dysfunction ( MGD ) . Methods : This study was a prospect i ve , r and omized , double-masked , controlled study . Forty-four MGD patients were enrolled in the study and received three consecutive IPL treatments with an interval of 4 weeks . One eye of each patient was r and omly assigned as the study eye receiving the IPL therapy with an energy of 14 - 16 J/cm(2 ) , and the fellow eye was as the control eye receiving a placebo therapy with 0 J/cm(2 ) . Meibomian gl and expression was immediately performed after the IPL treatment in both eyes . Efficacy was evaluated through assessment of the meibomian gl and yielding secretion score ( MGYSS ) , SPEED question naire , tear film break-up time ( TBUT ) , cornea fluorescein staining and infrared meibography . Safety was evaluated through best spectacle corrected visual acuity , intraocular pressure , slit lamp examination and fundus examination . These examinations were performed before and after each treatment . Results : Significant improvements were observed in the MGYSS and TBUT after IPL treatments ( P<0.05 ) . The improvements compared to the baseline of MGYSS at the upper eyelid in the treatment eyes were significantly higher than those in the control eyes after the first treatment ( Z=-2.036 , P=0.003 ) . The improvements compared to baseline of MGYSS at the lower eyelid and the TBUT in the treatment eyes were significantly higher than those in the control eyes after the second treatment ( Z=-2.999 and -2.036 , respectively P=0.007 and 0.042 , respectively ) . SPEED and cornea fluorescein staining were decreased in both eyes after IPL treatments , but there was no statistical difference between the two eyes . No obvious complication was observed in the study . Conclusions : IPL treatment combined with meibomian gl and expression is an efficient and safe therapy , and can increase meibomian gl and yielding secretion , increase the TBUT , relieve the symptoms and repair the corneal epithelium defects for MGD eyes . ( Chin J Ophthalmol , 2017 , 53 : 675 - 681 ) OBJECTIVE To determine the efficacy and safety of intense pulsed light ( IPL ) applied directly on the eyelids and meibomian gl and expression ( MGX ) in treating meibomian gl and dysfunction ( MGD ) . BACKGROUND IPL application on the periocular skin effectively improves meibomian gl and secretion and tear film break-up time ( TBUT ) in patients with MGD/dry eye . METHODS This prospect i ve , r and omized , double-masked , controlled study involved 44 patients . One eye was r and omly selected for IPL treatment ; the other served as a control . Study eyes received three IPL treatments at 4-week intervals ; IPL was applied directly on the eyelids , and the eye was protected with a Jaeger lid plate . Control eyes received sham IPL treatments . Both eyes received MGX and artificial tears . Meibomian gl and yielding secretion score ( MGYSS ) , TBUT , St and ard Patient Evaluation of Eye Dryness ( SPEED ) , cornea fluorescein staining ( CFS ) , meibography , best corrected visual acuity ( BCVA ) , intraocular pressure ( IOP ) , and fundus examination were performed . RESULTS Compared to the baseline , MGYSS , TBUT , and SPEED and CFS scores improved in the study eyes , while only SPEED and CFS scores improved in the control eyes ( p < 0.001 for all ) . Changes in MGYSS and TBUT were higher in the study eyes than in the control eyes ( p < 0.05 ) , but changes in SPEED and CFS scores were similar ( p > 0.05 ) . BCVA and IOP improved in both the study and control eyes ( p < 0.05 ) . Five patients experienced mild pain and burning during IPL treatment . One patient suffered partial eyelash loss . CONCLUSIONS IPL combined with MGX safely and effectively treated MGD Purpose . This study aims to explore the safety and efficacy of a novel treatment-intense pulsed light ( IPL ) in MGD eyes . Methods . This study is a prospect i ve and open label study . Forty eyes of 40 MGD patients were recruited in the study and received 4 consecutive IPL treatments on day 1 , day 15 , day 45 , and day 75 . Ten ocular surface symptoms were evaluated with a subjective face score at every visit . Best spectacle corrected visual acuity , intraocular pressure ( IOP ) , conjunctival injection , upper and lower tear meniscus height ( TMH ) , tear break-up time ( TBUT ) , corneal staining , lid margin and meibomian gl and assessment s , and meibography were also recorded at every visit , as well as the adverse effects on the eye and ocular surface . Results . Significant improvements were observed in single and total ocular surface symptom scores , TBUT , and conjunctival injection at all the visits after the initial IPL treatment ( P < 0.05 ) . Compared to baseline , the signs of eyelid margin , meibomian gl and secretion quality , and expressibility were significantly improved at every visit after treatments . There was no regional and systemic threat observed in any patient . Conclusion . Intense pulsed light ( IPL ) therapy is a safe and efficient treatment in relieving symptoms and signs of MGD eyes PURPOSE To evaluate the effect of intense pulsed light ( IPL ) applied to the periocular area for meibomian gl and dysfunction ( MGD ) in a prospect i ve , double-masked , placebo-controlled , paired-eye study . METHODS Twenty-eight participants underwent IPL treatment  , with homogeneously sequenced light pulses delivered to one eye and placebo treatment to the partner control eye at 1 , 15 , and 45 days following baseline ( BL ) evaluation . Lipid layer grade ( LLG ) , noninvasive tear break-up time ( NIBUT ) , tear evaporation rate ( TER ) , tear meniscus height ( TMH ) , and subjective symptom score using visual analogue scales ( VAS ) were compared with BL and control values at each visit . RESULTS Lipid layer grade improved significantly from BL to Day ( D ) 45 in the treated eye ( P < 0.001 ) , but not the control eye ( P = 0.714 ) , with 82 % of treated eyes improving by at least one LLG . Noninvasive tear break-up time also improved significantly from BL to D45 in the treated ( P < 0.001 ) but not in the control eye ( P = 0.056 ) and was significantly longer than in the treated eye at D45 ( 14.1 ± 9.8 seconds versus 8.6 ± 8.2 seconds , P < 0.001 ) . The tear evaporation rate was not different in the treated eye compared with the control eye at any visit . Tear meniscus height did not change from BL in either eye ( P > 0.05 ) . Visual analog scale symptom scores improved from BL in the treated ( P = 0.015 ) , but not the control eye ( P = 0.245 ) , with 86 % of participants noting reduced symptoms in the treated eye by D45 . CONCLUSIONS Intense pulsed light with multiple sculpted pulses shows therapeutic potential for MGD , improving tear film quality and reducing symptoms of dry eye . ( https://www.anzctr.org.au number , ACTRN12614000162617 . ) Purpose : To assess the effect of oral re-esterified omega-3 fatty acids on tear osmolarity , matrix metalloproteinase-9 ( MMP-9 ) , tear break-up time ( TBUT ) , Ocular Surface Disease Index ( OSDI ) , fluorescein corneal staining , Schirmer score , meibomian gl and dysfunction ( MGD ) stage and omega-3 index in subjects with dry eyes and confirmed MGD . Methods : This was a multicenter , prospect i ve , interventional , placebo-controlled , double-masked study . Subjects were r and omized to receive 4 softgels containing a total of 1680 mg of eicosapentaenoic acid/560 mg of docosahexaenoic acid or a control of 3136 mg of linoleic acid , daily for 12 weeks . Subjects were measured at baseline , week 6 , and week 12 for tear osmolarity , TBUT , OSDI , fluorescein corneal staining , and Schirmer test with anesthesia . MMP-9 testing and omega-3 index were done at baseline and at 12 weeks . Results : One hundred five subjects completed the study . They were r and omized to omega-3 ( n = 54 ) and control group ( n = 51 ) . Statistically significant reduction in tear osmolarity was observed in the omega-3 group versus control group at week 6 ( −16.8 ± 2.6 vs. −9.0 ± 2.7 mOsm/L , P = 0.042 ) and week 12 ( −19.4 ± 2.7 vs. −8.3 ± 2.8 mOsm/L , P = 0.004 ) . At 12 weeks , a statistically significant increase in omega-3 index levels ( P < 0.001 ) and TBUT ( 3.5 ± 0.5 s vs. 1.2 ± 0.5 s , P = 0.002 ) was also observed . Omega-3 group experienced a significant reduction in MMP-9 positivity versus control group ( 67.9 % vs. 35.0 % , P = 0.024 ) and OSDI scores decreased significantly in omega-3 ( −17.0 ± 2.6 ) versus control group ( −5.0 ± 2.7 , P = 0.002 ) . Conclusions : Oral consumption of re-esterified omega-3 fatty acids is associated with statistically significant improvement in tear osmolarity , omega-3 index levels , TBUT , MMP-9 , and OSDI symptom scores Purpose To assess whether tear hyperosmolarity , being diagnostic of dry eye disease ( DED ) , is associated with specific alterations to the cytokine content of human tears that may provide a biomarker for DED . Methods In this prospect i ve , cross-sectional , clinical study , participants ( n = 77 ) were recruited from a single clinical site and categorized into groups based upon tear osmolarity status ( n = 62 hyperosmolar , n = 15 normo-osmolar ) . Comprehensive anterior eye clinical assessment s were undertaken . Concentrations of seven cytokines ( IL-2 , IL-4 , IL-6 , IL-10 , IL-17A , IFN-γ , and TNF-α ) in basal tears were assayed using multiplex cytometric bead array . The main outcome measure was difference in cytokine concentration between groups . Group comparisons were undertaken using 2-tailed t-tests . Cohen 's effect size was calculated for each finding . Spearman correlations between cytokine concentrations , clinical symptoms , and clinical parameters of DED were calculated . Results Tear hyperosmolarity 
    Output:
    
The body of evidence for this outcome was of very low certainty , so we are uncertain about the effect of IPL on dry eye symptoms .
There were no relevant combinable data for any of the other secondary outcomes , thus the effect of IPL on clinical parameters relevant to dry eye disease are currently unclear .
Due to a lack of comprehensive reporting of adverse events , the safety profile of IPL in this patient population is also unclear .