M22 IPL with OPT - Treatment for Meibomian Gland Dysfunction

Intense Pulsed Light (IPL) a laser-like device is now being used by Ophthalmologists to reduce your dependence on artificial tears, Restasis™, flax-seed oil, Omega-3 supplements, permanent punctal plugs, warm compresses, and oral Doxycycline.

This 5 minute, painless, non-invasive outpatient procedure requires no anesthesia, sedation, or pre-operative testing. Patients can drive and return to full activities immediately, including unlimited exercise, swimming, and reading. There is no post-operative discomfort, no redness, and no decrease in vision.

 

Patient suffering from dry eye can require a number of modalities for relief. These are often expensive, inconvenient and disruptive, and are only moderately successful. Some remedies have dangerous side-effects including susceptibility to infection, skin photosensitivity, alteration of serum levels of many common medications, inactivation of oral contraceptives and yeast infections.

 

IPL is the answer for many patients who are still uncomfortable despite their use of multiple modalities to treat dry eye as well as those patients fed-up with expensive and lifetime commitment to drops, pills, ocular appliances, warm compresses and supplements for relief.

 

Dry eye is not simply an inadequate volume of natural tears, but also an inadequacy of the surfactant that allows those tears to wet the eye, resist evaporation, and retain stability. An improved surfactant lowers tear film surface tension and enhances the eye-tear interface. The lipid glands at the base of our eyelids (Meibomian glands) are the source of the surfactants needed to optimize our tear film.

 

The IPL is applied to the lower lids of both eyes once a month for 3 months to permanently improve the function of the Meibomian glands. The enhanced lipids are a much more effective surfactant and enhance tear function and reduce or eliminate dry eye symptoms.

Patients frequently recognize an improvement in symptoms after a single treatment. A permanent change in Meibomian gland function requires three monthly treatments the first year and a maintenance treatment once a year thereafter.

Skin and Ocular Rosacea

Eyelid inflammation (blepharitis) is a major cause of meibomian gland dysfunction (MGD) and evaporative dry eye disease. 

There is a clear association between eyelid inflammation and skin inflammation around the periorbital region. In particular, skin rosacea leads to eyelid inflammation in 80% of the cases (subjects with skin rosacea are 3-4 times more likely to suffer from eyelid inflammation and MGD).


This skin condition is characterized by: 

 

  • Facial flushing

  • Erythema (superficial reddening of the skin)

  • Telangiectasia (dilation of the capillaries, which causes them to appear as small red or purple clusters, often spidery in appearance) often accompanied by papules and pustules

Another very common ocular finding in patients with skin rosacea is ocular rosacea. This later condition is characterized by watery of bloodshot appearance, telangiectasia of the conjunctiva and lid margin or lid and periocular erythema.

 

Skin rosacea usually precedes ocular rosacea. Due to the close proximity of regions affected by rosacea (the cheeks, nose and central part of the face) and the periorbital region, these pro-inflammatory agents reach the eyelids via the orbital vasculature. The exposure of the eyelids to these inflammatory agents can trigger blepharitis and subsequently, meibomian gland dysfunction and ocular rosacea.

 

The notable relationship between eyelid inflammation and skin inflammation around the periorbital region has prompted investigators to find ways to reduce eyelid inflammation and associated ocular complications by treating the skin around and close to the periorbital region. One of the most effective tools to do so is by applying intense pulsed light (IPL) on the skin below the lower eyelids: IPL destroys abnormal blood vessels and, thus, removes a major source of inflammation to the eyelids.

 

Treatment:

  • 30 Minutes prior to treatment, a topical anesthetic will be applied.

  • Just before treatment a thin layer (1-2 mm) of coupling gel will be applied from ear to ear to include the nose.

  • Patient must wear eye shields at all times during the procedure.

  • A pulse consisting of 3 sub-pulses will be applied every 1-2 seconds.  Usually 10-15 pulses are sufficient to cover the entire area to be treated.

  • The entire IPL procedure should take no more than 10 minutes.

 

Recovery:

  • Immediately following the IPL treatment, the physician should apply a cold wash cloth to the treated area (cold, not frozen-packs) for 5-10 minutes. Ice or chemical cold packs should not be used.

  • Patients should use a high factor (30-50 SPF) sun block and to protect the treated area from exposure to sunlight, for at least one month following treatment, especially during the first 48 hours of treatment. Note: tanning after treatment sessions may enhance melanin regeneration, which may result in unwanted hyperpigmentation.

  • It is recommended to avoid make-up for the first 48-72 hours following treatment. Removing make-up, especially if it is difficult to remove, may damage the skin and predispose the treated area to infection.

  • In case of broken or damaged skin, it is recommended to keep the treated area covered with a dressing, to reduce the risk of trauma and infection during the first 4-5 days following treatment

A full IPL treatment includes 3 sessions (3-6 weeks apart). After completion of the full IPL treatment, patients will need a maintenance session, usually 6-12 months after the last IPL treatment. We recommend scheduling an examination 3 months after the last IPL session. At that examination, the ophthalmologist will determine when to schedule the maintenance session.

 

Full Face Treatment (Optional):

You many notice that IPL in the previous sessions rejuvenated the skin in the area that was treated and you may wish to treat your entire face. For more information visit: The Lumenis® Photofractional™ solution