Intense Pulsed Light For Dry Eye
WHAT IS INTENSE PULSED LIGHT THERAPY? COULD IT HELP MY DRY EYE?
This page is designed to help you understand. It is best to begin with another question:
MY EYES WATER IN THE WIND, AIR CONDITIONING OR WHEN READING A COMPUTER SCREEN OR BOOK. WHY?
The answer is complicated. But at the bottom of the problem is oil. Not enough of it. In order to be comfortable at all times your eye needs water (tears, obtained from the lacrimal gland) and oil, obtained from small glands in the eyelid- the Meibomian glands.
In early life the Meibomian glands produce a clear product not unlike olive oil in consistency. In almost all of us, this oil thickens over time and in most cases clogs up inside the gland. When things are healthy, the oil coats the water layer of your tear film, allowing you to keep the eyes open for a long time without blinking. As you get less and less oil with age, your watery layer of the tear film becomes unprotected most of the time.
Figure 1 healthy Meibomian glands
Figure 2 healthy Meibomian glands with oil
Figure 3 unhealthy Meibomian glands with thick secretions
Figure 4 unhealthy Meibomian glands with “dropout”
Without oil coating it, conditions which produce more evaporation will cause the tears to simply melt away. These conditions fall into two categories: situations of increased air flow (wind, dry air conditioned environments) or activities which cause you to hold the eyes open for longer (reading, using a computer, driving, or any visual task requiring concentration). Sometimes these factors combine, for instance when concentrating on the road while driving with air conditioning on, or focussing on the golf ball on a windy day.
OK SO IF MY TEARS ARE EVAPORATING, WHY DO MY EYES WATER?
Because of something called the “lacrimation reflex”. Your eyes hate being dry, even for a few seconds. As soon as the tear film is lost, the very sensitive ocular surface sends a message to the brain that things are dry. This is the first half of a reflex. Like all reflexes in the body, this response is rapid and involuntary. The second half is a message to the lacrimal gland to produce more tears. Very quickly the “hose” is turned on and you overproduce tears, often overwhelming your drainage systems and causing the eyes to water.
OK SO IS THERE ANYTHING I CAN DO?
If there are blockages to the tear drainage pathway causing overflow they need to be unblocked. But often this is not the case and the situation will not improve unless we get the Meibomian glands working again. No one can make them like they were when you were a child, but there are strategies that can help. Depending on how much the problem is bothering you, these can range from very simple measures, to more advanced therapy, or the “kitchen sink” approach.
OPTIONS FOR MANAGEMENT
What is stuck in the Meibomian glands used to be oil, and now has turned into something more like fat. Just like in the kitchen, heat can melt fat back into oil again. There are many ways to apply heat properly to the glands, Dr. Moloney can give you several options. Note that using hot water and a towel usually isn’t enough as the heat is lost too quickly.
- MASSAGE OR SQUEEZING
To help express the melted oil out onto the ocular surface. This can be done at home or by Dr. Moloney in a simple manoeuvre known as “Meibomian Gland expression”
Lubricating eye drops can often help the situation. Some are even available with an oil component.
- MEDICATION / DIET
Certain medications are felt to impact the quality of your Meibomian gland product, particularly if you have associated skin disorders such as rosacea. The tetracycline class of antibiotics is an example of a medication you may be placed on to maximise your eyelid health. Dietary supplements may also be of benefit and many patients find intake of omega-3 fatty acids to be helpful in reducing symptoms.
- TREATMENT OF ASSOCIATED BLEPHARITIS
Blepharitis is inflammation of the eye lid margin. This may be from several causes including infection, toxicity or inflammation in the body. These conditions need to be diagnosed and treated selectively as well.
Figure 5 Blepharitis due to Demodex infestation
Figure 6 Same patient 3 weeks after treatment with tea tree oil scrubs
- INTENSE PULSED LIGHT THERAPY
The above measures used to be all we could offer. In the last few years however evidence is mounting behind the value of intense pulsed light (IPL) therapy for dry eye patients. Particularly those who suffer from symptoms mainly due to the Meibomian glands not working, as discussed above.
Intense pulsed light therapy has existed in dermatology practices for 20 years. It is primarily used as a cosmetic laser to treat hyperpigmentation and prominent blood vessels. In 2002 a patient in the US described an improvement in dry eye symptoms after treatment of the face near the eyelids.
This has led to a series of studies into the value of IPL for dry eye patients with Meibomian gland dysfunction. FDA studies into this therapy are completed with results listed below. At Mosman Eye Centre an internal study into this therapy also yielded promising results. How it works is still being studied, but it is likely through a direct effect of heat or energy on the eyelid oil glands or the blood vessels surrounding them.
We are now confident to offer this to patients with dry eye and Meibomian gland dysfunction. Before proceeding Dr. Moloney will have to ensure the procedure is safe for you.
Treatment involves three sessions 1 month apart and are brief, taking only about 15 minutes each. The laser can feel like a “pinch” and sometimes sting. Anaesthetic gel can be applied if you wish prior to treatment.
Best results are usually seen after the second or third treatment. Some patients may not notice a huge improvement in their situation if their eyelid disease is advanced. But for the first time in many years there is something new to offer for this common and frustrating problem.