(not so) Secret Weapon of Dry Eye Treatment: Intense Pulsed Light, or IPL

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Secret Weapon of Dry Eye Treatment: Intense Pulsed Light, or IPL

One treatment that can help to both reduce inflammation and improve oil glands is Intense Pulsed Light, or IPL. Originally designed, and subsequently FDA-approved to even-out complexions, remove unwanted hair and stimulate repair of older or sun-damaged skin, it was often used for years “off label” to treat dry eye disease. “Off label” means a technology was never investigated, nor approved, as a treatment for a specific disease (but does not necessarily mean it is ineffective in such treatment – just not approved as it has not been investigated by that agency). IPL for dry eye usually requires four (or more) sequential treatments and is not commonly covered by insurance companies due to the off label nature of this use. Late in 2021, the FDA approved IPL as safe and effective treatment for dry eye disease - so the secret is out! (Even though many dry eye specialists have known this for many years).

IPL appears to benefit dry eyes through several pathways. First, it can close the red, angry blood vessels in the lids that are carrying inflammation to the eyes. This is kind of like stopping the army before it leaves the gate, so it never gets to the eye. This may mean less need for drops to deal with inflammation, since inflammation doesn’t make it to the eye in the first place.

It also heats the oil, so some glands can express their blockages with a squeeze after the treatment. Most often this requires the doctor to express the oils using a squeezing force under direct visualization using a microscope and certain tools. If the oil is truly like wax, then IPL may not heat enough to fully melt it and a stronger heat source may be required. For some, this may require some combination of deeper heat and expression, like on-label use of Lipiflow, ilux, SightScience’s TearCare or the off label use of other heating tools, like radio frequency (something I have researched extensively and have several published studies showing its usefulness in treating problems ranging from clogged glands to ironing loose membranes and loose skin). These treatments can be combined with a series of IPL treatments, but also are not commonly covered by insurance as they view this as more of a “spa treatment,” involving “only ”heat and massage.”

IPL treatments take out a layer of the unwanted blood vessels with every treatment. Staggered every 3 to 6 weeks, the surface vessels have time to clear - and expose the next, deeper layer for the next treatment. I see this like pruning a tree, where the top twigs give way to small branches, then we take out the bigger branches and finally get to the trunk. We stop at the “stump,” as the deeper, root-level is where the good vessels live and we don’t want to take those away.

Eventually some branches sprout from the stump, so IPL requires regular maintenance treatments, but IPL can have many benefits when used regularly, too.

What else can IPL do?  

As mentioned above, Intense Pulsed Light was originally designed to even-out complexions, reduce unwanted hair and stimulate skin into making better, younger looking skin - so it has earned its place in cosmetic skin care. IPL has been shown to help with acne, probably by mechanisms somewhat similar to what helps eyelid oil glands to make better tears.

Not only does it close angry blood vessels, but it also kills germs (as well as a common mite called Demodex) that commonly cause acne and otherwise aggravate oil glands.

IPL also appears to directly stimulate the cells making your tears.  It appears to give a “kick in the pants“ to the cells that make tear products, including water and oil. We call this “bio-stimulation” through “photo-bio-modulation.“ It seems the cellular furnaces making the energy for each cell are revved-up by the heat and light from IPL - so the cells can work better.

Unfortunately IPL is not for everybody, as those with the darkest skin have pigment (called melanin) that gets in the way of the light and prevents it from targeting the deeper blood vessels. As the pigment absorbs the heat from the strong light, too much can cause burning and damage to the surface of the skin. Those with medium pigment, who tan, should avoid tanning so as to help the light penetrate deeper and work better. Feel free to check with your eye care provider to see if you may be a candidate for IPL.