We excited to present the IPL (Intense Pulse Light), known to help with rosacea, skin discoloration and now dry eye disease.  The IPL helps photo-rejuvenate the skin and help the function of the meibomian glands of the eyelids, helping improve the quality of the meibum produced.  The treatment is not covered by insurance.  We are pleased to offer it for dry eye disease (DED protocol) or full face (rosacea protocol including DED).  Please call for pricing.  You may need multiple treatments (4-6 total) to achieve optimal results and then maintenance treatments once yearly.


What is IPL?

IPL stands for Intense Pulse Light.  It is a treatment that has been around for decades in the world of dermatology to treat rosacea.  Dr. Toyos discovered that his dry eye patients were also improving when they had IPL for their face and over the years, has developed a dry eye disease protocol to help patients with dry eye disease (DED) with a component of meibomian gland dysfunction (MGD).

How does IPL work?

The meibomian glands are located in your eyelids and produce the meibum (or the oily layer) of the tear film that prevent the tears from evaporating.  MGD occurs when the meibomian glands are obstructed or inflamed.  In patients with either facial or ocular rosacea, the eyelids have abnormal dilated blood vessels (telangiectasia) that bring more inflammation to the surface of the eyelid and can cause dysfunction of the meibomian glands.  IPL cause photocoagulation of those abnormal blood vessels and photorejuvenation of the skin cells.  It also causes dilation of the meibomian glands and liquification of the obstructed meibum.  After the IPL treatment, we follow the DED protocol to manually express the meibomian glands or in combination with the Lipiflow treatment.  Patients generally feel some relief even after one session (upto 89% of patients had improvements in symptoms)1.

Tell me more about IPL.

Dr. Pradhan is pleased to offer the Lumenis M22 for IPL given the safety features with contact-cooling which make it safe and comfortable. It also has different filters which allow it to be used for different purposes including the dry eye disease protocol, full-face rosacea as well as skin discoloration.  The dry eye disease protocol involves treatment from one side of the face to the other including the lower lids as well as Meibomian gland expression afterwards.  The upper lids benefit from the treatment although they are not treated directly with the IPL and all four lids are expressed after the treatment.  The treatment generally takes approximately 20-30 minutes. Your eyes are covered the entire time to prevent any damage directly to your eyes.  The IPL also has the ability to kill bacteria and even kill demodex and has been shown to help blepharitis as well.  If you have blepharitis, it will be important to remove the crusting with the BlephEx procedure prior to treatment with the IPL.

How many treatments do I need?

The studied protocol for dry eye disease with the IPL involves treating for 4 initial treatments approximately 3-5 weeks apart and then once annually.

How is the IPL different than the Lipiflow?

Dr. Pradhan is leading the way for dry eye treatment options available by offering IPL for dry eye disease.  Both the IPL and the Lipiflow treat the underlying cause of evaporative dry eye disease with meibomian gland dysfunction.  The IPL works on the inflammatory blood vessels and is only safe for certain skin types and works best in patients with ocular or facial rosacea.  The Lipiflow heats, unclogs and expresses the obstruction of the meibomian glands and can be used in all skin colors/types.  With a dry eye evaluation, Dr. Pradhan can tell you which one is better for you or whether a combination treatment would produce the best results.

Are there any contraindications for treatment?

  • No sun exposure or tanning beds or tanning cream for 3-4 (minimum 2) weeks prior to treatment; no harsh scrubs, acids, benzoyl peroxide, Retin-A
  • No use of isotretinoin (Accutane) within the last year
  • Pregnant, postpartum or nursing
  • History of cancer in the area of treatment
  • Active cold sores or herpes simplex or herpes zoster virus
  • History of keloids
  • History of metal plates, rods or screws in the area
  • Use of any photosensitive medications or herbal supplements
    • Includes use of antibiotics
  • Psoriasis, vitiligo or warts, lupus or connective tissue disorder
  • Avoid Botox and dermal fillers for 1 week prior to treatment and 2 weeks after treatment
  • Fitzgerald skin type four or below (darker skin has risk of depigmentation).

Post-treatment instructions

  • Suncreen SPF 30-50 – apply every 2 hours with incidental sun exposure like walking or driving for the next two weeks
  • May need soothing gel/cream/steroid cream like aloe vera gel
  • Avoid picking or scratching the area of treatment
  • You may have mild swelling, redness or crusting for upto 5 days after treatment
  • No harsh cleansers/scrubs on your face for the next two weeks.
  • You may wear makeup over the treated area if there is no broken skin
  • Warm compresses to eyes for 10 min 2-3x per day for the next 3 days and then every night. (DERM mask for heat available in our office for purchase)
References:
  1. Vegunta S, Patel D, Shen JF. Combination Therapy of Intense Pulse Light Therapy and Meibomian Gland Expession (IPL/MGX) Can Improve Dry Eye Systoms and Meibomian Gland Function in Patients with Refractory Dry Eye: A Retrospective Analysis. Cornea. 2016 Mar;35(5):318-22. doi:10.1097/ICO.0000000000000735.
  2. Craig JP, Chen YH, Turnbull PR. Prospective trial of intense pulsed light for the treatment of Meibomian gland dysfunction.  Invest Ophthalmol Vis Sci. 2015 Feb 12;56(3):1965-70. doi:10.1167/iovs.14-15764.
  3. Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, Lemp MA, Sullivan DA. The international workshop on Meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011 Mar 30;52(4):1922-9. doi:10.1167/iovs.10-6997a.
  4. Toyos R, McGill, W, Briscoe D. Intense Pulsed Light Treatment for Dry Eye Disease Due to Meibomian Gland Dysfunction; A 3-Year Retrospective Study. Photomed Laser Surg. 2015 Jan 1;33(1):41-46. doi:10.1089/pho.2014.3819.
  5. Gupta PK, Vora GK, Matossian C, Kim M, Stinnett S. Outcomes of intense pulsed light therapy for treatment of evaporative dry eye disease.  Can J Ophthalmol 2016 Aug:51(4):249-253. Doi:10.1016;j.jcjo.2016.01.005. Epub 2016 Jun 22
  6. Papageorgiou P, Clayton W, et al. Treatment of rosacea with intense pulsed light: Significant improvement and long-lasting results. Br J Dermatol 2008:159;3;628-632. doi: 10.1111/j.1365-2133.2008.08702.x. Epub 2008 Jun 28.
  7. Mark, KA, Sparacio, RM, Voigt, A, Marenus, K, Sarnoff, DS. Objective and quantitative improvement of rosacea-associated erythema after intense pulsed light treatment. Dermatol Surgery 2003;29:6:600-604.
  8. Clark, SM, Lanigan, SW, Marks, R. Laser treatment of erythema and telangiectasia associated with rosacea. Lasers in Medical Science 2002;17:1:26-33.
  9. Tan SR, Tope WD. Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life. J Am Acad Dermatol 2004;51:4:592-9.
  10. Elmnasser N, et al. Bacterial inactivation using pulsed light. Acta Alimentaria 2007;36:3:401-408.
  11. Byun JY, et al. Expression of IL-10, TGF-beta(1) and TNF-alpha in cultured keratinocytes (HaCaT cells) after IPL treatment or ALA-IPL photodynamic treatment. Ann Dermatol 2009;21:1:12-7.
  12. Prieto VG, Sadick NS, Lloreta J, Nicholson J, Shea CR. Effects of intense pulsed light on sun-damaged human skin, routine, and ultrastructural analysis.  Lasers Surg Med. 2002;30(2):82-5.