IPL (Intense Pulsed Light) Treatment for Dry Eye Disease

Is IPL Treatment good for dry eyes?

The best treatment by far for patients suffering from Evaporative Dry Eye Disease is Intense Pulsed Light treatment, or IPL. IPL treats the root cause of the disease, not just the symptoms.

IPL treatment has been used by Dermatologists and Aestheticians for the past 30 years. The goal of this treatment has been to remove skin blemishes such as sunspots, small blood vessels commonly called “spider vessels”, and unwanted hair follicles. When the treatment zone neared the eyelids, their patients reported a substantial improvement in their dry eye symptoms. In 2015, the first study on IPL specifically for Dry Eye Disease was conducted, and the researchers found substantial improvement in both the signs and symptoms of Dry Eye Disease in the treatment group. Since then, many more studies have been done, and it is quickly proving to be the most effective treatment we have for combating Evaporative Dry Eye Disease.

During your Dry Eye Evaluation, we will take a series of high definition and infrared photos to determine what type of dryness you are suffering from, and to what extent. Excessive amounts of spider vessels, or telangiectasia, on your eyelids (see Figure 1) suggest that you have excess inflammation around your meibomian glands in your eyelids.  This inflammation limits the production of free-flowing, healthy oil that is released from your meibomian glands, and causes the glands to permanently die off. Further, bacteria and mites on the eyelid margin create a biofilm that also clogs the meibomian glands. When the meibomian glands become clogged, no oil is produced on the tear film, so your tears evaporate way too fast, causing signs and symptoms of Evaporative Dry Eye Disease.

Telangiectasia photo

Figure 1

IPL Rendition

Figure 2

      Ready for some tear film science? Good, me too! To simplify, there are 2 main layers in your tear film, an oil layer and a water layer. The oil layer forms a protective outer barrier for the water layer, much like looking at an oil slick on a puddle on a rainy day. This protective oil layers keeps the tears from evaporating too fast. We have oil glands called Meibomian glands that are located in our upper and lower eyelids, and their openings are right on your water line, the 1-2mm area on your eyelid between your eyelashes and your eyeball. During our routine Dry Eye Exam at Peak Eyecare, we image these glands using an infrared camera. We then compare your glands to a normative database, where we look for early signs of gland atrophy and adjust our treatment recommendations accordingly. In a healthy eye, these meibomian glands produce an olive oil-like substance called Meibum during every blink, and this meibum forms the protective oil layer on your tear film. In Dry Eye Disease, these oil glands are surrounded by inflammation, which is seen as small little blood vessels called telangiectasia that we can image in our office (see figure 2 of one of our patient’s lids). This inflammation can lead to clogging of the meibomian glands, which changes the meibum from an olive oil consistency to a toothpaste-like consistency. This thick clog prevents the meibomian glands from releasing the protective, essential oil that the tear film needs for stability. Further, if these meibomian glands remain clogged for a long period of time, they can start to atrophy (die off), and once they atrophy, there is no way to regenerate them. Our goal is to never let these glands die off, because if they do, your dry eye symptoms will get drastically worse, and there is little that we can do at that point.

      IPL attacks Evaporative Dry Eye Disease multiple ways. During each treatment session, a high energy light is used to flash the treatment area on each lower eyelid (see Figure 2). This high energy burst of light ablates the small spider vessels, thus reducing the pro-inflammatory mediators from being released. Also, this flash of light kills the bacteria and mites that make up the biofilm, further allowing the meibum to flow more freely. In addition, each pulse of light also has a simultaneous pulse of Radio Frequency energy, which helps the treatment penetrate deeper, and also heats up the oil in the glands, allowing it to flow more freely. 

     Finally, IPL has the helpful side effect of making your skin look healthier, younger, and tighter by getting rid of unwanted skin blemishes. After all, aestheticians have been using IPL solely for this purpose for years!

 

What to Expect During Your IPL Treatment for Dry Eye Disease

IPL treatment for Dry Eye Disease is very simple, taking about 20 minutes per session. Before your first treatment, we will send you our IPL Packet, which will include a Dry Eye questionnaire, a consent form, and pre and post-treatment instructions. Starting 2 weeks before, you must avoid prolonged, unprotected sun exposure. This means it is ok being outside, but make sure you are wearing a hat and good quality sun screen. The goal is to avoid any sun burn or suntan prior to treatment. 

When you arrive for your first treatment, we will collect the IPL Packet, answer any of your questions, and prep you for the treatment. This entails removing any and all make-up or face lotion before applying protective stickers over your eyelids. We will then apply ultrasound gel to the treatment zone, which consists of the lateral side of your brow, your upper cheek area and your nose. We do not need to directly pulse the eyelids, as the skin is too thin here and the energy radiates upwards from the light pulse to treat your meibomian glands. 

At Peak Eyecare, we perform 4 treatment sessions, each separated by 2-3 weeks. During your third treatment session, we perform a few additional treatments at no charge. The first is an in-office exfoliation of your lid margins using a NuLids device. This helps break up the biofilm that contributes to clogging your meibomian glands. Next we place an electronic pair of goggles over your eyes, which allows up to heat up your meibomian glands much hotter than your can with a warm compress mask at home. Finally, I express your meibomian glands with the aid of a microscope to clear any obstructions. Our goal in IPL therapy is to reduce your symptoms of irritated, scratchy, red, or dry eyes, and to decrease your dependence on artificial tears. From my personal experience, I expect you to notice improvement around the 3rd or 4th treatment, depending on how inflamed your eyelids are at the start. 

What is the feeling during IPL treatment?

As we begin treatment, you may feel slight discomfort with each pulse, similar to a mild rubber band snap at worst or a tingle of your skin at best. We perform 12-15 light pulses per each side of the face. Once completed, we will remove the gel and the eye stickers, and apply high quality sunscreen to your face. It is important that you avoid any sun burn or sun tan for the 2 weeks following each treatment.

 

Equipment and Protocol Upgrades

Medicine is an ever expanding and improving field, and Dry Eye Disease treatment is no exception. At Peak Eyecare, we are committed to providing the newest and best treatment options in the Dry Eye space to our patients in the Four Corners region. 

Radio Frequency combined with IPL

In early 2023, we upgraded our IPL machine to one that combines standard IPL with Radio Frequency (RF). The addition of RF enables the energy from IPL to penetrate deeper into the skin, allowing further reduction of inflammation around the meibomian glands. RF also adds heat to the glands, which helps melt the oil that is clogging diseased meibomian glands. Third, RF stimulates collagen production, which tightens skin tissue. We love this benefit, as it keeps your eyelids tight against your eyes, enabling an even distribution of tear. Patients love this benefit, as it smooths out your skin and helps reduce crows’ feet. Currently, every patient undergoing IPL at Peak is also getting RF treatment simultaneously. Click here for one of the studies that supported our decision to invest in this new combination device.

Low Level Light Therapy after IPL/RF

In summer of 2024, we added an additional piece Dry Eye Disease treatment technology called Low Level Light Therapy (LLLT). Historically, LLLT is red and infrared light therapy used for skin rejuvenation in the aesthetic space. More recently, studies have been done that show LLLT improves meibomian gland function through a process called photobiomodulation. The same process also decreased inflammation in your lacrimal glands, which increases tear production. LLLT has been used as a stand alone therapy for years, but recently has been combined with IPL/RF therapy with additive results. At Peak, we combine IPL/RF with LLLT at each session, but do offer LLLT stand alone therapy if the necessary. 

If you have any questions about Intense Pulsed Light, Radio Frequency, or Low Level Light Therapy treatment, please don’t hesitate to contact our office for more information. Nothing gives our team more satisfaction than finding solutions for our patients struggling with Dry Eye Disease!