What is Dry Eye

Our eyes need tears to nourish, and lubricate our eyes. Dry Eye Disease (DED), is a multi factorial disease of the ocular surface with loss of tear film stability often times from unhealthy or insufficient barrier oil later. As a result, variety of symptoms such as itchy, red, and strained eyes are common. Approximately 16.4 million people in United States have been diagnosed with DED. Prevalence is higher in females and in older adults. 

Many patients suffer from this chronic syndrome without realizing that it can permanently harm their eyes. Because this is a progressive condition, it is critical to get treatment before symptoms exacerbate to the point that it harms the cornea. Without treatment or proper medication, DED often worsens over time.

Intense pulsed light (IPL) therapy is a new treatment for evaporative dry eye and rosacea

How  Does it work?

Using filters and selecting the correct light wavelength, this technology can inhibit inflammation by destroying redundant, small blood vessels (telangiectasia) that carry inflammation mediators within them. All of this happens without negatively affecting skin. In addition, there is a warming sensation that opens meibomian glands for easier and better expression of old and viscous oil, to be replaced with clear and healthy oil. IPL also is used to treat facial skin damage, including wrinkles, coarseness, laxity, and dyspigmentation. It increases the creation of collagen I and III, procollagen, collagenase, and elastin and increased hyaluronate receptor expression which makes skin look healthier, tighter and clearer. 

What to Expect During the Procedure

During the treatment, your eye will be protected with an opaque goggle and ultra sound gel will be applied to cheek, around the eye, and eyelids for protection and spread of conduction of light. Using the hand-piece we apply a few flashes of light to cheek area and around the eye. 

Meibomian gland expression may be performed following the conclusion of IPL. 

Finally, sun protection cream is applied to avoid exposure to the sun for the first 48 hours. Patients may receive four separate treatment sessions, the first day (Day1), at Day14, at Day28, at Day49. The treatment session times might vary depending on the results of the first day of treatment which will be concluded at the end of the first session by Dr. Ardakani.

WHAT CONDITIONS DOES THIS PROCEDURE TREAT? 

1. Meibomian Gland Dysfunction

Meibomian gland dysfunction (MGD) is a common condition associated with Dry eye disease (DED), representing the leading cause of the evaporative dry eye. Meibomian glands are located on the “water line” of the eyelids and produce meibom (oil) to top of the tear film and prevent evaporation of the tear layer. 

The pathogenesis of Meibomian Gland Dysfunction and Dry Eye Disease has been described as a vicious cycle in which inflammation is the essential factor. MGD happens for different reasons such as skin disorders, eyelid inflammation, and microbial infections, resulting in thickening of the glands, reducing their normal function, and increased meibum viscosity. MGD results in instability of the tear film which increases exposure of the corneal nerve plexus, stimulating more inflammation. The result is a vicious DED cycle that feeds back to the MGD cycle.

Different treatments are currently used such as use of preservative-free artificial tears, anti-inflammatories, and cyclosporine, dietary supplements with Omega-3 fatty acids to improve the lipid composition, warm compresses and lid hygiene, radio-frequency to decrease the viscosity of the meibum, mechanical expression of the Meibomian glands, and intraductal probing. 

It is often that no one achieves a fully effective long-term improvement. Intense pulsed light (IPL) can successfully treat DED symptoms and signs by decreasing symptoms due to MGD, tear film abnormality, and tear inflammatory markers. Results might last for months after completion of treatment.

How Does IPL Treat MGD?

The most important proposed mechanisms of actions are:

– Warming the meibomian glands to facilitate the expression and release of the meibum inside.

– Improving the function of the Meibomian glands.

– Inducing intravascular thrombosis of the small blood vessels surrounding the Meibomian glands and telangiectasia of the eyelid margin, reducing the levels of pro inflammatory mediators that contribute to dry eye.

– Reducing tear osmolarity, helping to control the inflammation of the ocular surface, which is one of the key factors in dry eye pathogenesis.

– Reducing the load of Demodex mites that stimulate secondary inflammation.

– Improving cellular functions such as collagen synthesis, fibroblasts regeneration, and motility in immunoregulatory cells.

– Inducing a neurotrophic effect on the cornea and ocular surface and a neuroimmunomodulatory effect on the meibomian glands.

2. Rosacea

Rosacea is a common chronic skin disease on the central face, affecting cheeks, nose, chin, and forehead. It manifests as redness, dryness, and discomfort of skin.

Ocular rosacea (affecting the eyes) is estimated to occur in up to three-quarters of patients with rosacea, and frequently produces a foreign-body sensation, dryness, burning, itching, redness, photophobia, tearing, and blurred vision. The spectrum of presentation varies from mild to severe, affecting any age group, typically most severe in the 30 to 50 years, being women more commonly affected than men. The prevalence ranges from 1% to 22% depending on the definition and population characteristics.

There are many treatment options for rosacea, such as topical metronidazole, azelaic acid cream, and non-irritating benzoyl peroxide; or systemic oral antibiotics, including tetracyclines, doxycycline, and minocycline. Because of antibiotic resistance, irritation after the use of topic treatments, etc, Intense pulsed light (IPL) can be a substitute. Itcan successfully treat the clinical manifestations of rosacea that fail to respond to medical therapies, resolving telangiectasia (spider veins) and redness, though longterm outcomes are less certain. 

Rosacea affects the physical aspect and can have critical psychosocial impacts, with a loss of self-confidence and distress in social or work circumstances. Patients with rosacea have higher rates of depression, anxiety, and decreased self-esteem.

How Does IPL Treat Rosacea Condition?

1. Inflammatory status: patients with DED present high inflammatory molecules in tears and on the ocular surface. IPL has the potential to interfere with this inflammatory cycle.
2. Microcirculation of the skin: IPL affects the circulation of small blood vessels. It induces localized destruction of these small blood vessels around the meibomian glands and telangectasic vessels in lids and eyelid margins.   

READ MORE