Intense Pulsed Light (IPL) Treatment for Dry Eyes Disease due to MGD

Dry eyes:

Dry eye is a condition in which eyes do not have enough tear production and lubrication of the eyes is also not adequate. The major cause of dry eye syndrome is Meibomian Gland Dysfunction (MGD). There are various symptoms that help in identifying dry eyes such as redness of the eye, eye inflammation, and constant watering of eyes along with irritation.

Meibomian Gland Dysfunction (MGD):

These glands are modified sebaceous glands that help in the secretion of the lipid composition of the tear film. These are located in the upper and lower margins of the eyelid. This also contains some antimicrobial properties that prevent the growth of microorganisms inside the eye.

This abnormal functioning of these glands causes Meibomian Gland Dysfunction (MGD). This is a chronic disease that causes instability information of the tear film. The function of the tear film is to prevent drying of the eye by premature evaporation of tears.

The instability in the tear film affects the eye and causes irritation and redness of the eye. Also, there is a chronic inflammation seen around the Meibomian glands which secrete inflammatory mediators which in turn, aggravates the activities of glands.

Intense pulsed light treatment (IPL):

Intense pulsed light treatment, also called Intense pulsed light (IPL) treatment is a common therapy that is used in dermatology treatments and it is also called photo facial. This treatment is used for treating skin and its disorders. This treatment is useful in treating acne, dark spots, birthmarks, stretch marks, and lessening skin color if one has dark skin and wants to get rid of it.

The Intense pulsed light (IPL) treatment is not recommended for people who are pregnant or using retinoid creams or have light sensitivity or have very dark skin.

Intense pulsed light (IPL) treatment in ophthalmology:

It is introduced recently in the treatment of dry eyes syndrome which is caused by meibomian gland dysfunction. This is an adjuvant therapy used in dry eyes and it is well accepted by patients all over for its non-invasive nature. It is completely safe and has greater efficacy and very few adverse side effects.

Mechanism of action:

Though it is still unclear about the mechanism of action of Intense pulsed light (IPL) treatment. There are various theories to explain this Intense pulsed light (IPL) treatment for dry eyes such as

Superficial blood vessels destruction:

In the patients who suffer from rosacea acne problems, there are inflammatory mediators that trigger the inflammation of meibomian glands which results in dysfunction of the glands.

During Intense pulsed light (IPL) treatment, the chromophores such as melanin or hemoglobin absorb light energy and convert that energy into heat which causes thrombosis (clot formation inside the vessel) and also blood vessel destruction.

This destruction of blood vessels causes the removal of inflammation around the eyelids and meibomian glands. A single pulse produced by Intense pulsed light (IPL) treatment increases the temperature of the vessel to about 80°c-90°c which is enough to cause thrombosis and destruction of blood vessels.

Decrease in viscosity of meibum fluid:

The meibum fluid which is produced by Meibomian glands has increased viscosity than the normal value when the patient is suffering from obstructive MGD which causes an increase in temperature inside the Meibomian glands.

So, the Intense pulsed light (IPL) treatment helps in increasing the temperature of the skin that in turn makes the meibum fluid less viscous.

Due to decreased viscosity of the fluid, it leads to unclogging of glands and in the normal functioning of the meibomian glands.

Procedure Intense Pulsed Light (IPL) Treatment:

The devices which are used in Intense pulsed light (IPL) treatment show regulations in wavelengths, pulse duration, and pulse intervals as well. The intensity of the treatment depends on the type of skin of the patient. These devices have low-intensity energies of about 8.5 to 20J and have dry eye mode previously set.

Protective eye shields are placed over the eye. The area which is to be treated must be free from makeup and ultrasound gel is covered over that area.

• The disposable Intense pulsed light (IPL) treatment pads are placed over the eyes.
• Then, an ultrasound gel is placed over the patient’s face by overlapping flashes so that treatment can take place over the entire area smoothly.
• Then the gel is removed carefully, and the doctor gently presses the gland and the patient is given proparacaine (1%)
• Then after that, the doctor gently presses the gland area for at least 30 seconds by continuous pressure.
• After the upper lid treatment, the same is repeated along the length of the lower lid.
• After the gland is pressed, the patient is given NSAIDs or other anti-inflammatory drugs.
• The upper eyelids are not directly treated because it has a risk of penetration of light inside the eyelids and absorption through eye surfaces.

After the eye treatment is completed, the patients experience a decrease in pain and inflammation, and this treatment is given to the patient once every 30 days.

Safety of Intense Pulsed Light (IPL) Treatment:

This treatment method is well popular among patients as well as ophthalmologists due to its non-invasive nature. If eye protection is neglected, it can cause severe problems such as permanent ocular damage or intraocular inflammation that can cause blockages in a pupil or glaucoma-like conditions. So, the use of eye shields is a must to prevent side effects.

Apart from these, it can also cause pain, formation of blisters, and increase or decrease in pigmentation of the eye.

Efficacy of treatment:

A study was conducted in order to understand the efficacy of the IPL treatment over dry eyes. It showed that young people showed more sensitivity towards light than older people who are aged above 40 years.

There were no severe side effects shown by intense pulsed light treatment and patients who have undergone this treatment showed improvement in tear break-up time (TBUT), an index used to determine the intensity of dry eyes in a person. In this study, the patients had severe dry eyes along with increased meibum viscosity and also ocular discomfort symptoms. Various of the patients showed few adverse effects such as redness, slight eye irritation, and loss of hair from eyebrows.

Risk factors:

Sometimes, the patients can undergo some risk while taking this treatment i.e, the patient’s skin can experience scars, swelling, or bleeding of the skin, change in color is also seen and blisters are also formed on the skin. Skin can also be infected due to this treatment.

• Long term treatment: 

The Intense pulsed light (IPL) treatment shows beneficial effects in long term, but repeated sessions must be performed to maintain the efficiency of the treatment every 30 days once.

Intense pulsed light (IPL) treatment shows improved ocular surface improvements and decreases in symptoms and meibomian gland secretion is also increased and unclogging of meibomian glands is seen for up to six months after the treatment is taken.

Conclusion:

The intense pulsed light treatment method is a safe procedure that shows greater results in treating dry eyes which are primarily caused by meibomian gland dysfunction.

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