An estimated 4.88 million Americans ages 50 and older suffer from dry eye syndrome. Of these, more three million are women and 1.68 million are men.
Dry eye is a condition in which your eyes cannot produce enough tears or produce poor quality tears. Those poor-quality tears cannot properly lubricate the eyes, and over time, can result in damage to the surface of the eye, discomfort, and poor vision.
Although a common condition, dry eye runs the risk of becoming a chronic problem, especially as we age. Those who suffer from seasonal allergies or who wear contact lenses have an even higher risk of experiencing dry eye.
There are several treatments available to provide temporary relief from dry eye, including artificial tears, prescription eye drops, and punctal plugs that conserve tears. At the Dean McGee Eye Institute, we also offer Intense Pulsed Light, an advanced dry eye treatment that provides long-term relief.
What Is IPL Treatment?
Intense Pulsed Light, or IPL, is a dry eye treatment that addresses the root cause of most dry eye issues: meibomian gland dysfunction (MGD). For patients with this condition, the meibomian glands are blocked, damaged, or do not function properly, which results in a decrease in oil production and eventually dry eye symptoms. A 2012 study published in the journal Cornea showed that 86% of study participants with dry eye also had symptoms of MGD.
IPL uses short but powerful bursts of light of a specific wavelength to gently heat the skin around the meibomian glands, which in turn, melts any obstructions present in the glands. With the removal of any obstructions, the glands gain increased oil production that results in healthy tears.
Introduced in 1994, IPL was initially used by dermatologists as a skin treatment for the effects of photoaging.
“Dr. Rolando Toyos, an ophthalmologist in Memphis, Tenn., ‘accidentally’ discovered the use of IPL for dry eye in 2002 after opening an aesthetics clinic in his practice,” says Ralph B. Hester III, MD, an ophthalmologist at DMEI. “Some of his patients that were treated for rosacea reported that their eyes were feeling better and less dry. He was able to obtain a grant in 2003 to investigate further, and IPL as a treatment for dry eye has evolved from his studies.”
Dr. Hester says IPL is so effective because it has multiple mechanisms of action, all of which treat the fundamental root cause of dry eye (inflammation), not just the symptoms. Light energy from IPL warms the meibomian glands internally. This liquifies the solidified meibum (the oily substance that is produced in the glands) and allows the meibum to be expressed easily.
How Does IPL Treatment Work?
IPL treatment for dry eye is very similar to IPL for facial rejuvenation. The treatment causes a warm feeling on the area being treated and a sensation of small rubber bands slapping the skin.
“Treatment involves a series of pulses of light from one temple to the other across the lower eyelids. A second pass is completed across the same area. After the treatment, patients are brought to the slit lamp and the meibomian glands are expressed using a special instrument,” Dr. Hester says.
Recovery is minimal, and patients may feel a slight “wind-burned” sensation on their skin for a day or two. IPL results in decreased inflammation, improvement in meibomian gland function, and increased comfort for patients.
Treatments are initially completed in a series of four, each spaced about three weeks apart, and follow up treatments are performed every six to 12 months.
“The largest benefit of IPL is it treats the root cause of dryness — inflammation,” says Tasha J. Schellenberg, OD, an optometrist at DMEI.
The wavelength of light used in IPL treatments is selectively absorbed by telangiectatic blood vessels, which are often present in patients with MGD and are a sign of inflammation. When the IPL is absorbed by the telangiectatic blood vessels, it coagulates them and destroys them.
“While other treatments may treat inflammation in one part of the inflammatory cascade, IPL treats multiple avenues of inflammation making it a more effective treatment than many others,” states Dr. Schellenberg.
“Patients who have tried conservative treatments for dry eye with limited benefits are excellent candidates for consideration of IPL,” Dr. Schellenberg says. “Patients with meibomian gland dysfunction are the best candidates, but patients with dry eye symptoms are encouraged to make an appointment for evaluation.”
Are There Side Effects to IPL Treatment?
If performed incorrectly, IPL does have a risk of unwanted side effects, which can include blistering, burning, hyperpigmentation, hypopigmentation, or scarring. However, our doctors at DMEI screen patients closely regarding skin type to mitigate these risks.
“We make sure we clean the skin carefully of makeup and/or sunscreens that can cause burning,” says Dr. Schellenberg. “We also make sure patients have not recently tanned in the sun or tanning bed, waxed, or have had a chemical peel in the two weeks prior, or have taken any medication that will increase photosensitivity, such as doxycycline.”
Patients who have heavily pigmented skin (greater than grade 4 by Fitzpatrick skin typing) are not good candidates due to risk of permanent hypopigmentation of the skin.
Uses for IPL Beyond Just Dry Eye
Treating dry eye and MGD is also vital in the success of cataract surgery. For the modern cataract surgeon, the ability to manage meibomian gland atrophy and dysfunction is absolutely crucial.
“This was managed in the past, sometimes successfully and sometimes not, with frequent, daily use of hot compresses and eyelid scrubbing,” says Dr. Hester. “As we all know, anything that requires daily, cumbersome treatment is often neglected by the patient, so little ground is gained in treatment of the problem.”
Fortunately, as cataract surgery technology advanced, so did the technology to treat MGD.
“We learned that IPL could also be used to basically resurface these tiny glands leading to what can be considered a rejuvenation of the architecture of the glands or ‘making them young again,’ just as resurfacing the skin makes someone look young again,” Dr. Hester says.
Dr. Hester says when he and Dr. Schellenberg identify a patient with MGD, they can now offer a short series of treatments with IPL, which will rejuvenate the crucial oil glands, reestablish normal oil production, stabilize the ocular surface, and offer patients a comfortable and successful surgical experience.