Intense pulsed light (IPL) refers to a procedure that uses a non-laser high-intensity light source in treating meibomian gland dysfunction (MGD). MGD is a condition that results from oils that harden and clog the eyelids’ meibomian glands. In IPL, light pulses are used to warm and liquefy the hardened oils. Meibomian gland oils help prevent tears from evaporating too quickly. MGD is a root cause of dry eye syndrome. IPL can reduce eyelid inflammation, redness, and stimulate healthy gland function as well as affect vascularization.
Many people who undergo IPL tend to show improvement in dry eye symptoms after one or two sessions. However, some may require more than this. Depending on the severity of dry eye disease, IPL may be performed monthly over a four-month course. Young people usually require fewer sessions. The physician may also recommend a combination of IPL and other dry eye disease treatments such as punctal plugs, medications, or LipiFlow to enhance the relief of symptoms and maximize effectiveness.
The main advantage of IPL is that other than relieving the symptoms of dry eye disease like other methods (artificial tears, warm compresses, and eyelid scrubs), the treatment focuses on treating MGD and slows the progression of chronic dry eye disease. However, IPL is not for everyone, especially those with skin cancer, very dark-skin, sensitive to light, have recently tanned themselves, have used a retinoid cream, or have severe scarring.
Before the Procedure
The patient should discuss with the physician the procedure, benefits, and risks of IPL. This session will also determine whether IPL is the correct procedure for the patient or whether another treatment option will work best.
The patient should avoid tanning, whether in the sun, bed, or using tanning creams at least a month to the procedure. These tanning mechanisms should also be avoided in between the IPL treatment sessions. Waxing, chemical peeling, or collagen shots should not be used two weeks to the treatment session. Aspirin and related drugs should be avoided too. On the day of the procedure, the patient should not use deodorants, perfumes, or skin irritants. Swimming in a chlorinated pool is not recommended before treatment.
A slit lamp is performed before treatment.
During the procedure, the doctor:
- Cleans the area that is to be treated
- Sets the IPL machine to appropriate settings depending on the patient’s Fitzgerald skin type test results and severity of MGD. The ideal candidate will have skin type four or below
- Places disposable shields over the eye for protection against the light pulses. These shields help close and seal the eyelids
- Generously applies cooling ultrasonic gel (a thin layer) to the treatment site
- Uses the IPL device to administer light pulses to the eyelid area. The patient may receive about 30 pulses from the right ear all the way to the left ear. These pulses provide heat which helps to liquefy and loosen the clogged oils in the glands
- Expresses oil from the glands in the lower and upper eyelids manually or using a cotton tip applicator and digital pressure. This action restores the normal flow of oil in the tear film
Risks & Complications
- Tingling sensation
- Redness on the site
- Mild mucus discharge
- Patients with a Fitzgerald skin type above four risk having lightened skin after the procedure
- A little inflammation which may result from the expression of the glands rather than from the procedure itself
- Treatment may fail in some patients necessitating a repeat procedure. Besides, some patients require repeat sessions every 3-6 months
Aftercare & Recovery
Following IPL treatment, preservative-free ketorolac drops are prescribed to be used two times a day over two days. Other anti-pain and anti-inflammatory drugs include Durezol, and Xibrom taken for three days and once a day respectively. Patients who were previously on systemic and topical medications for dry eye can discontinue them after IPL. Omega-3 fatty acids (1,200 mg) are prescribed to be taken daily following the procedure. It is believed the acids help to restore the tear film and ocular surface.
Patients are followed up monthly for four months or until the symptoms are resolved. More monitoring also takes place for patients who find the treatment intolerable or cannot continue with treatment. Once the glands are functioning properly, maintenance treatments can be performed annually or biannually.
The patient is advised to avoid too much exposure to the sun because light and dark spots can develop in the treated area. S/he can apply sunscreen on the treated site and avoid hot sauna, shower, or bath.
IPL treatment is often successful with most reporting significant improvement after having four sessions. One study reported symptom improvement in 58% of the patients after IPL treatment. These patients had a refractory dry eye that had failed to respond to conventional treatment. Yet another study reported that 77% of patients recorded an improvement in at least one eye. It was concluded that IPL therapy can significantly alleviate dry eye symptoms in patients who have not been assisted by other treatments. The procedure can reduce the skin's bacterial load and help with acne. It can also decrease inflammatory cytokines responsible for MGD. IPL reduces parasites found on the lash's margin (the parasites can lead to MGD). Long-term treatment is successful in treating MGD and chronic dry eye syndrome.