My IPL Demo and “Pearls” for optimal treatment.
The following IPL video (at the bottom of this post) shows me performing a most basic IPL treatment for dry eye disease. Many patients might be better served with a fuller face treatment than shown here, but for a quick maintenance treatment - especially in the time of a pandemic, this can suffice. What makes an IPL treatment most effective depends on what the goals for that IPL treatment might be and each patient’s care should be customized to best achieve those goals.
One of the most common reasons for dry eyes today, is obstructive Meibomian Gland Dysfunction - or “o-MGD” - the clogging of the oil-producing glands of the eyelids. Oil is a key ingredient of a healthy tear - as I’ve blogged before. If this is the primary problem being addressed with IPL, I find IPL relatively inefficient and often ineffective, as the brief heating achieved by the light is quickly dissipated. This allows the oil to go from solid (cold) to liquid (hot) and then rapidly back to cold (solid) as the skin cools - so the ability to effectively express the oil from these glands becomes harder as the oil itself gets harder (in consistency). For the few patients where clogging is the single significant issue, a simpler heated expression can offer a better alternative.
One of the other common reasons for dry eye is inflammation (from the many causes I’ve covered in past posts). Inflammation is the body’s reaction to irritation and comes via dilated blood vessels - delivering “hot blooded fighters” - our body’s defense - including what I refer to as our “Napalm, bullets and handgrenades” - ammo that we use to fight the most significant, long-term enemies of human life —- germs. The problem with this warfare is that all this ammo spews onto the surface of our eyes and inadvertently “beats up” on the tiny tear glands trying to make healthy tears. IPL is a great solution to this problem. The light can reduce and even close the red, angry blood vessels, so less ammo is delivered. The light also can kill off many of the germs that often contribute to the calling of the defenses - while also stimulating the cells of the glands that make the tears. Yes - it can also heat the oils - so when the oils are not particularly solid - so the glands are not especially clogged - it can help with some of the oil’s flow. When the blood vessels dilate, they can creep up from deeper levels and “bloom” into the lids and then into the tears. IPL can “prune back” this “tree of inflammation.”
When the blood vessels flare, this qualifies as what we dry eye doctors call ocular rosacea. IPL is like a “silver bullet” if used properly to treat this.
So what are the key things one needs to know to get the best out of IPL for this indication?
Remember that the darker the color of skin, the more “pigment” (or color) will get in the way of treating the blood vessels that largely lie below. The primary driver of color comes from your genes and exposure to sun (or any UV) light. Being careful to sun “block” (proper clothing, sunscreen) will help reduce production and if skin is darker than ideal, consideration can be made for skin lighteners (Kojic Acid, Hydroquinone and others) - so that the IPL can do its best against the inflammation-bearing vessels.
The biology of how IPL works on causing blood vessels to “retreat” is to slightly (on purpose) damage them and then allow the body to heal (reabsorbing the damaged ends of the vessels - which causes them to effectively “retreat”). The time course for this regression starts on the day of the IPL (the red blood color is the “target” of the light and causes the vessels to contract, the blood to clot the roughened inner lining to “stick” together with this clotted “glue.” Typically, the damage begins to heal over the first 3 to 5 days and continues over another 3 to 4 weeks. To best take advantage of this healing process, it helps to follow a few basic steps -
Prior to your treatment, avoiding tanning (including tanning lotions) helps the IPL do its best work (as noted above). Avoiding blood thinners that are not required for your medical health may help (consult with your doctor(s) before stopping any blood thinners). Controlling blood pressure can help, too.
Immediately following your treatment, cool compresses (off and on until the skin effectively cools down) can help in shrinking the damaged vessels and help sooth the intentionally injured skin. Extra care to avoid sunburning/sun tanning is important as IPL - while not containing UV - is still light - and your skin is now damaged. Adding UV from any source (like sun or tanning beds) can add to that damage (and also promote tanning).
For the following 3-5 days, avoidance of anything that will dilate blood vessels (causing skin “flushing”) will also work towards closing those blood vessels (flushing pushes blood through the damaged, blood-clotted vessels and keeps blood flowing in ways that can promote the regrowth and extension of these unwanted vessels). This includes excess physical activity (exercising), hot showers, saunas, alcohol and spicy foods among others. If you’ve noticed anything you do that causes flushing, I’d advise against it during this key time where blood is clotting and closing off these vessels from light-related injury.
The ideal “window” for the next treatment appears to be in the range of 3-5 weeks. for most patients attempting to reduce their ocular rosacea. Less than 2 weeks means the “bad” blood vessels have yet to fully heal and “regress” - so treating too early can mean there isn’t enough time to get the full benefit of the earlier treatment session. Waiting beyond 6 weeks appears to give the “bad” blood vessels enough time to regenerate - or grow back - so this is a bit like a dog chasing its tail (and not getting anywhere from all that effort). Catching the vessels at the ideal moment when the healing has fully occurred - but before they begin to come back - is the ideal, but sometimes difficult goal. Age, medications, medical problems and genetics all play a role in how quickly we heal - so sometimes your IPL provider may have to use apparent progress as a means to determine the best spacing of treatments.
The number of treatments required will vary depending on the size and distribution of the “bad” blood vessels, the energy and dynamics of how the light is applied, the degree to which these prescribed recommendations are followed, the extent of the problems caused by the ocular rosacea to the glands and tissues of the lids and eyes, genetics, environment, age and probably countless other issues. The average number of consecutive treatment sessions in my practice averages around 4 before we re-evaluate and for most, there will be “maintenance” treatment sessions of 1 or 2 per year (also depending on all the above).
Ancillary treatments (LID HYGIENE, heated expressions, and the “usual homework” I prescribe can greatly affect the effectiveness of IPL treatments. Other co-contributors to dry eye disease can include deeper levels of obstruction (including harder degrees of clogging from keratin and scar tissue) may require Maskin Probing while co-contributors like allergies, lid problems like inturning, out-turning, poor closing and general laxity - and my favorite - conjunctival chalasis - have generally been covered in my earlier posts (though I expect to continue refining and updating these posts to help keep them current and relevant).
MY IPL DEMO IS LINKED HERE:
https://heycool.wistia.com/medias/pwj9sns0wj