Light therapy · Scientific evidence

FOTOAGE: photobiomodulation for dry eye disease

Low-level light therapy (LLLT) applied to the eyelids to reactivate the Meibomian glands, ease inflammation and restore the tear film — non-invasive, painless and suitable for every skin phototype.

View the FOTOAGE deviceSee the evidence
  • 630 nm
  • 590 nm
  • 530 nm
  • 425 nm
FOTOAGE: photobiomodulation for dry eye disease
1 · The pathology

Dry eye: a highly prevalent condition

The TFOS DEWS II report defines dry eye as a multifactorial disease of the ocular surface marked by loss of tear-film homeostasis, in which tear instability and hyperosmolarity, inflammation, ocular-surface damage and neurosensory abnormalities all play a role. Evaporative dry eye — driven mainly by Meibomian gland dysfunction (MGD) — accounts for the majority of cases.

5–50% Prevalence of dry eyeTFOS DEWS II
>1/3 of the world's populationaffected by MGD
+7.0°C eyelid temperatureenough to melt inspissated meibum

The vicious circle of MGD

  1. 1 Gland obstruction Dysfunction of the Meibomian glands.
  2. 2 ↓ Meibum / lipid layer Lower quality and quantity of lipids.
  3. 3 ↑ Evaporation & hyperosmolarity The tear evaporates and irritates the surface.
  4. 4 Inflammation & damage Glandular dysfunction is aggravated further.

Breaking this cycle — reactivating the gland and controlling inflammation — is the therapeutic goal of light therapy.

2 · The principle

What is photobiomodulation (LLLT)?

The use of low-power red and near-infrared light to stimulate tissue repair, reduce inflammation and reactivate Meibomian gland function, without any harmful thermal or ablative effect. Unlike IPL — polychromatic and higher-energy — LLLT uses specific wavelengths at sub-thermal levels.

  • Non-invasive

    External application over the eyelids, with no harmful contact.

  • Painless, well tolerated

    No pain during or after the session; high adherence.

  • Sub-thermal level

    Stimulates the cell without damaging tissue (biphasic response).

3 · Mechanisms

How it works at the cellular level

Red and near-infrared photons are absorbed by cytochrome c oxidase in the mitochondria, boosting ATP synthesis and triggering repair, anti-inflammatory and antioxidant pathways.

  1. 1 Red / NIR light 590–630 nm photons penetrate the tissue.
  2. 2 Cytochrome c oxidase Chromophore in the mitochondria (complex IV).
  3. 3 ↑ ATP · ↓ NO Inhibitory NO dissociates; ATP rises.
  4. 4 Transcription factors Repair, anti-inflammation, antioxidation.

Dose-dependent biphasic response: the right fluence (J/cm²) stimulates; excess inhibits. (Hamblin, 2017)

How it works at the cellular level

  • Thermal

    +7.0°C eyelid temperature (Antwi, 2024)

    Raises eyelid temperature enough to melt inspissated meibum.

  • Metabolic

    +12.9 nm lipid layer thickness

    Reactivates the Meibomian glands and improves meibum secretion and quality.

  • Anti-inflammatory

    −10.2 OSDI (Antwi, 2024)

    Reduces pro-inflammatory cytokines (IL-1β, TNF-α) and oxidative stress.

4 · Evidence

Quantitative synthesis: meta-analysis

A meta-analysis and multiple randomised trials support LLLT — alone or combined with IPL — in dry eye disease and Meibomian gland dysfunction.

−22.8 OSDI (symptoms)95% CI −29.1 to −16.5
+2.2s TBUT (tear stability)95% CI 0.9 to 3.4
+1.5mm Schirmer test (volume)95% CI 0.6 to 2.5

12 pooled studies (Chan, 2024). Statistically significant improvements, sustained at ≥6 months after treatment — the highest level of quantitative evidence available in MGD.

Key studies

Study (year) Design n Key result
Chan, 2024 Meta-analysis 12 st. OSDI −22.8 · TBUT +2.2 s · Schirmer +1.5 mm; sustained ≥6 months.
Chiang, 2025 Paired-eye RCT 24 Meibum expressibility maintained with LLLT; combined adds metabolic change.
Antwi, 2024 Prospective (LLLT) 30 Eyelid temperature +7 °C · lipid layer +12.9 nm · OSDI −10.2.
D'Souza, 2023 Controlled RCT 100 Significant improvement in OSDI (p<0.0001) and TBUT (p<0.005).
Giannaccare, 2022 Comparative RCT 40 SPEED falls more with LLLT than IPL (−9.9 vs −6.75).
Stonecipher, 2019 Multicentre registry 460 ≥1-grade MGD reduction in 70% of eyes; TBUT improved.

Instruments: OSDI/SPEED (symptoms) · TBUT/NIBUT (tear stability) · Schirmer (volume).

International consensus · TFOS DEWS III (2025)
A significant difference between LLLT and IPL is that LLLT can be applied directly to the eyelids. In addition, LLLT is not affected by skin colour and can be safely applied to all phototypes.
Translated from TFOS DEWS III: Management and Therapy (2025) · doi:10.1016/j.ajo.2025.05.039
5 · Safety

Safety and tolerability

  • No serious adverse events

    The reviewed studies agree on a favourable safety profile, with no serious adverse effects attributable to LLLT.

  • Independent of phototype

    Unlike IPL, LLLT does not depend on skin phototype and is applied to all phototypes (confirmed by TFOS DEWS III, 2025).

  • An alternative to IPL

    It may be considered when IPL is contraindicated (very pigmented skin, periorbital tattoos).

6 · The solution

FOTOAGE: photobiomodulation with a scientific basis

FOTOAGE is a High Density Diode (HDD) system that emits pure monochromatic light at higher power than a conventional LED. For dry eye it combines red 630 nm and yellow 590 nm at fluences that sit within the range described in the LLLT literature.

Yellow light
590 nm ± 10 nm · 25.29 J/cm²
Red light
630 nm ± 10 nm · 16.75 J/cm²
Emission
Pulsed at 73 Hz
Technology
High Density Diode (HDD), monochromatic light
Application
External, over the eyelids · non-contact
View the device
FOTOAGE: photobiomodulation with a scientific basis
630 nmRed

Photobiomodulation: reactivates the Meibomian glands (cytochrome c oxidase → ATP) and reduces inflammation.

16.75 J/cm²
590 nmYellow

Improves eyelid microcirculation and drainage; supports nutrition and epithelial regeneration.

25.29 J/cm²
530 nmGreen

Complementary wavelength used in combined protocols.

13.75 J/cm²
425 nmBlue

Antimicrobial action: reduces the eyelid-margin biofilm, relevant in blepharitis (TFOS DEWS III).

22.84 J/cm²
Clinical protocol

FOTOAGE dry-eye protocol

Device parameters aligned with published LLLT protocols (633 nm). Pulsed emission is a technical parameter of the system.

Parameter Yellow light · 590 nm Red light · 630 nm
Eyes closed 5 minutes 5 minutes
Eyes open 1 minute 1 minute
Energy density 25.29 J/cm² 16.75 J/cm²
Emission Pulsed, 73 Hz Pulsed, 73 Hz

Use must follow the device's instructions for use and the ophthalmologist's judgement. Commercial support material; it does not replace the technical data sheet.

Clinical application

Indications in ophthalmology

FOTOAGE is aimed at the management of evaporative dry eye and eyelid-margin conditions related to Meibomian gland dysfunction (MGD).

  • Meibomian gland dysfunction

    The primary cause of evaporative dry eye.

  • Evaporative dry eye

    Lipid deficiency and tear instability.

  • Blepharitis & eyelid margin

    425 nm blue channel: antimicrobial action on the biofilm.

  • Ocular rosacea

    Eyelid inflammation associated with MGD.

  • Lens / screen intolerance

    Symptomatic dry eye from prolonged use.

  • Pre-surgical optimisation

    A healthy ocular surface before cataract or refractive surgery.

Treatment guide

Recommended protocols

Anterior-segment LLLT phototherapy. Guideline schemes by indication — each wavelength is applied for 5 minutes with the eyes closed plus 1 minute with the eyes open, per the FOTOAGE instructions for use.

Indication Wavelength Sessions Interval
MGD / evaporative dry eye 630 nm 2–4 2–7 days
Maintenance (MGD) 630 nm 2–4 6–18 months
Dry eye from other causese.g. contact lenses 630 nm 2–4 2–7 days
Blepharitis & Demodexeyelid margin 425 + 630 nm 3–4 2–7 days
Chalazion & stye 630 nm 2–4 2–7 days
Ocular rosacea & telangiectasia 425 + 630 nm 4–5 2–7 days
Sjögren's syndromesymptomatic 630 nm 4–5 2–7 days

Guideline schemes based on the LLLT / photobiomodulation literature; adapt to the specialist's judgement and the device's instructions for use. They do not replace the technical data sheet. FOTOAGE is an anterior-segment system.

Bring photobiomodulation to your clinic

Discover how FOTOAGE fits into your dry-eye and MGD protocol. Our clinical team will help you get started.

View the FOTOAGE deviceTalk to our team
Selected references (22 with DOI)
  1. Craig JP, et al. TFOS DEWS II Definition and Classification. Ocul Surf. 2017. doi:10.1016/j.jtos.2017.05.008
  2. Stapleton F, et al. TFOS DEWS II Epidemiology. Ocul Surf. 2017. doi:10.1016/j.jtos.2017.05.003
  3. Jones L, et al. TFOS DEWS III: Management and Therapy. Am J Ophthalmol. 2025. doi:10.1016/j.ajo.2025.05.039
  4. Hamblin MR. Anti-inflammatory effects of photobiomodulation. AIMS Biophys. 2017. doi:10.3934/biophy.2017.3.337
  5. Chan KE, et al. LLLT and IPL in MGD: systematic review & meta-analysis. Cont Lens Anterior Eye. 2024. doi:10.1016/j.clae.2024.102344
  6. Chiang JCB, et al. LLLT vs. combination with IPL in DED/MGD (RCT). Cont Lens Anterior Eye. 2025. doi:10.1016/j.clae.2025.102456
  7. Antwi A, et al. Effect of LLLT in dry eye disease. Ophthalmic Physiol Opt. 2024. doi:10.1111/opo.13371
  8. Giannaccare G, et al. LLLT versus IPL for MGD (RCT). Cornea. 2023. doi:10.1097/ICO.0000000000002997
  9. D'Souza S, et al. IPL and LLLT for MGD and evaporative DED (RCT). Indian J Ophthalmol. 2023. doi:10.4103/IJO.IJO_2834_22
  10. Meduri A, et al. IPL + LLLT for refractory MGD. Eur J Ophthalmol. 2022. doi:10.1177/11206721221127206
  11. Pérez-Silguero MA, et al. IPL + LLLT for dry eye, 1-year follow-up. Clin Ophthalmol. 2021. doi:10.2147/OPTH.S307020
  12. Markoulli M, et al. Photobiomodulation (LLLT) and dry eye disease. Clin Exp Optom. 2021. doi:10.1080/08164622.2021.1878866
  13. Stonecipher K, et al. Combined LLLT + IPL for MGD (460 eyes). Clin Ophthalmol. 2019. doi:10.2147/OPTH.S213664

Full list of 22 peer-reviewed references with DOI available in the supporting bibliographic review. Bibliographic data obtained in part via PubMed.