Intense pulsed light, known as IPL received FDA approval for use for the treatment of dry eye symptoms in the spring of 2021. Intense pulsed light has been used for photorejuvenation treatments to remove unwanted hair, sun damage, broken vessels, and to treat rosacea for over 20 years. It was discovered while treating patients with IPL for rosacea that their dry eye symptoms improved.
What is Dry Eye?
Dry eye is a common condition that occurs when the body is unable to provide adequate lubrication or tear production to the eyes. Dry eye can occur when the body does not produce enough tears or is producing poor quality tears leading to inflammation and damage to the surface of the eye.
Symptoms of Dry Eye:
- A stinging, burning or foreign body sensation in the eyes
- Mucous around the eyes
- Sensitivity to light
- Eye redness
- Difficulty wearing contact lenses
- Difficulty with nighttime driving
- Watery eyes, which is the body’s response of over compensation to dry eye disease
- Blurred vision or eye fatigue
How does dry eye disease occur?
Healthy tears are composed of three layers: a fatty oil layer, aqueous fluid and mucus. Dysfunction of any of these layers can lead to eye dryness.
Decreased tear production
Decreased tear production can occur when you are unable to produce enough aqueous fluid known as keratoconjunctivitis sicca.
Medical conditions commonly associated with decreased tear production include:
- Aging
- Autoimmune issues such as Sjogren’s syndrome, rheumatoid arthritis, lupus,
- scleroderma, sarcoidosis and thyroid disorders.
- Vitamin A deficiency
- Medications such as antihistamines, decongestants, hormone replacement therapy,
- antidepressants as well as medications for hypertension, acne, birth control and
- Parkinson’s disease.
- Corneal nerve damage from contact lens use, laser eye surgeries, or from symptoms of dry eye.
Increased tear evaporation
Meibomian glands are small glands that are located on the eyelid margin and produce a film of oil to coat the eyes. When they become blocked less oil is produced which allows the tears or aqueous fluid to evaporate more easily leading to dry eye symptoms. Meibomian gland dysfunction, MGD, is more common in people with rosacea and can lead to chalazion formation. Chalazion are painless, generally non-infectious bumps that form at the base of the eyelids as a result of chronically blocked meibomian glands.
Common causes of increased tear evaporation:
- Meibomian gland dysfunction also known as MGD
- Decreased blinking, which occurs when focusing on certain activities such as prolonged
- computer use, reading or driving or with conditions such as Parkinson’s disease.
- Eversion or inversion of the eyelids
- Eye allergies
- Preservatives in eye drop medications
- Windy conditions such air conditioning, fans or dry air
- Vitamin A deficiency
How does IPL work for treating symptoms of dry eye and meibomian gland dysfunction?
Intense pulsed light has been used for for over 20 years for photorejuvenation treatments to remove unwanted hair, sun damage, broken vessels, and to treat rosacea. It was discovered that patients with dry eye commonly will have rosacea and that while having their rosacea treated with IPL their dry eye symptoms improved.
Intense pulsed light uses multiple wavelengths of visible and infrared light to target inflamed vessels along the upper and/or lower lid margins. By warming the dermis IPL helps to soften the thick oil that blocks the meibomian glands while simultaneously killing bacterial overgrowth and Demodex on the lid margins leading to a decrease in irritative eye symptoms and reducing the incidence of styes and chalazion.
How many treatments do I need and how often?
Mild to moderate dry eye symptoms: 4 treatments recommended (one treatment every 3-4 weeks)
Moderate to severe dry eye symptoms: 4-6 treatments recommended (one treatment every 2-4 weeks)
Maintenance Treatments: One treatment every 6 months or as symptoms begin to return.
Stye Treatment: 1-2 treatments recommended.
Demodex Treatment: Typically one treatment needed, some patients may require additional treatments depending on symptoms.
Do I have to wear protective eyewear for the treatment?
Yes, protective eyewear must be warn by everyone in the treatment room. If the patient is only having their lower lids treated they can wear occlusive eyewear that looks like a swim goggle but is laser and IPL safe. If the upper lids are being treated then intra-ocular eye shields must be warn by the patient. They are inserted onto the eyes like a contact lens and are laser and IPL safe. An anesthetic eye drop is instilled prior to placement of the intra-ocular eye shields.
How soon after will I see results?
Most patients report gradual improvement in symptoms with each treatment and report longer symptom relief with the more treatments they have had.
We have also had patients report symptom relief within minutes of having a treatment and report feeling 90% better within 24 hours of treatment depending on the severity of the condition being treated. Often times patients who don’t even know they have dry eye will feel better as their eyelids feel cleaner and less irritated after treatment.
What other options exist for dry eye treatment?
First line methods for treating dry eye typically include eyelid scrubs, artificial tears, and warm compresses. It is also important to treat any underlying medical condition that may be contributing to symptoms as well as limiting contributing environmental factors. When compared to other treatments for dry eye such those named above IPL has been show to provide longer symptom relief.
What is Demodex?
Demodex is a mite that is considered to be a normal part of the skin flora typically seen at the base of hair follicles of the head and neck, especially the eyelids. Demodex infestation can lead to blepharitis and inflammation of the eyelid margins. Symptoms typically occur first thing in the morning upon waking, as the patient begins to wake up so do the Demodex leading to morning eye irritation and itching. Demodex can be treated with a single IPL treatment to eradicate them. Some patients may require a
series of treatments.
Can IPL be used to treat styes or chalazion?
Yes, intense pulsed light can be used to treat styes with 1-2 treatments and chalazion with a series of treatments. Proactively treating symptoms of dry eye will actually reduce the risk of stye and chalazion from forming as IPL helps to reduce bacteria at the eyelid margin and soften the oil that blocks the meibomian glands.
Disclaimer
It is important to note that we are not an ophthalmology office and therefore we do not diagnose or prescribe medications for dry eye treatments. Eye exams are an important part of your health and should be performed on an annual basis. With that being said, our physician assistant Holly Pelletier PA-C has worked as as a PA for over 20 years in Emergency Medicine and Family Medicine and as a clinical educator in the aesthetic field for over 18 years and has trained many ophthalmology practices in New England how to safely and effectively treat dry eye, rosacea, demodex, chalazion and styes with
intense pulsed light.