IPL treatment for dry eyes and the meibomian glands

On this page

1. What IPL treatment is
2. Who the treatment may suit, and who it may not
3. How to prepare for the treatment
4. How the treatment is done at the clinic, step by step
5. What it feels like, and what happens after the treatment
6. Possible side effects and risks
7. What IPL does not do
8. How you know whether the treatment is helping
9. How IPL fits with other treatments
10. Cost

This page is for people with dry eye caused by blocked meibomian glands, who feel that compresses and drops are no longer enough. Here you will find what IPL is, who it may suit, how the treatment is done and what is important to know about side effects.

What IPL treatment is

IPL (intense pulsed light) is a treatment in which short pulses of light across a broad range of wavelengths are passed through a filter onto the skin of the cheeks and below the lower eyelids. It is important to know that IPL is not a laser, but filtered broad-spectrum light. The exact mechanism is still being studied. The accepted explanations are closing off tiny dilated blood vessels near the eyelid margins that feed the inflammation, gentle warming of the glands and softening of their secretion, and a reduction in bacteria and Demodex (a tiny mite) in the area.

Who the treatment may suit, and who it may not

IPL may suit people who have:

• Meibomian gland dysfunction (MGD), in which the oily secretion is thick and the glands become blocked.
• Ocular rosacea or rosacea of the facial skin, with redness and visible blood vessels.
• Recurring eyelid inflammation or styes related to the glands.
• Symptoms that persist despite regular home care.

There are situations in which the treatment is not suitable, or requires careful assessment beforehand:

• Naturally darker skin or recently tanned skin: the light is absorbed more by the pigment, and the risk of burns and changes in skin colour increases. That is why the skin tone must be assessed before any decision.
• Tattoos or permanent make-up in the treatment area: the light is not applied over them.
• Medicines that increase sensitivity to light (for example some antibiotics and certain acne medicines). Tell us about all the medicines you take.
• An open wound, a skin infection or a suspicious skin lesion in the treatment area.
• Pregnancy, or a condition that worsens with exposure to light: the decision is made individually for each patient.

How to prepare for the treatment

• In the weeks before the treatment, avoid prolonged sun exposure on your face and self-tanning cream. Tanned skin is more sensitive to light.
• Tell us about all the medicines you take, including skin medicines, antibiotics and supplements, and also about medicines you have recently stopped.
• Tell us if you have previously had burns, unusual scarring or changes in skin colour after cosmetic treatments.
• Come without make-up in the treatment area, or be ready to remove it at the clinic.

How the treatment is done at the clinic, step by step

1. Examination and suitability. Before the first treatment, dry eye tests are done, your skin tone is assessed and your medicines are reviewed.
2. Preparation. The skin is cleaned of make-up and cream. The eyes are covered with light-proof eye shields, so that the light does not reach the eye itself.
3. Gel. A layer of cool gel is applied to the treated area.
4. Light pulses. The head of the device is placed on the skin and a series of flashes is delivered along the cheeks and below the lower eyelids.
5. Gland expression. Usually, straight after the IPL, meibomian gland expression is done to empty the softened secretion.
6. A series of treatments. Usually several treatments are given a few weeks apart, followed by top-up treatments as needed.

What it feels like, and what happens after the treatment

With each pulse you feel a flash of warmth or a slight pinch, like the snap of a rubber band. Most patients describe it as bearable. After the treatment the skin may be slightly red and warm, similar to mild sunburn, and this usually passes within hours to a day.

After the treatment it is advisable to protect your skin from the sun, use sunscreen and continue the home care you were given, such as warm compresses and eyelid cleaning. Improvement, if it comes, is usually felt gradually and not immediately after the first treatment.

Possible side effects and risks

• Redness, warmth and slight swelling of the skin: common and temporary.
• Changes in skin colour (darker or lighter): uncommon; the risk is higher in dark or tanned skin, and they sometimes last a long time.
• Blisters or a burn: rare.
• Thinning of hair in the treated area, for example in a beard.
• Injury to the eye: this is the reason for the eye shields. Do not remove them during the treatment.

Not all patients respond to the treatment. In the studies listed in the sources at the bottom of the page (Toyos 2015, Dell 2017), improvement in symptoms and gland function was found in some patients, but many studies in this field are small, and research is still ongoing.

What IPL does not do

IPL targets the meibomian glands and the inflammation around them. It does not increase the production of tear fluid, so when the main problem is a shortage of tears, it is not expected to solve it on its own. It also does not replace home care, and glands that have already shrunk over years do not always start working again. It is important to know this in advance, so that expectations are realistic.

How you know whether the treatment is helping

Before the first treatment and during the series, your symptoms and the examination findings, such as the quality of the gland secretion and the stability of the tear film, are recorded. At follow-up visits they are compared. If there is no change after several treatments, that is a reason to stop and think together about a different direction, rather than carrying on "just in case".

How IPL fits with other treatments

IPL does not stand alone. It is almost always combined with meibomian gland expression and with regular home care. If there is also inflammation of the eyelid margins or Demodex, eyelid margin cleaning with BlephEx can be added. The eye doctor may also prescribe anti-inflammatory drops or other treatment as needed.

Cost

The cost is set and discussed at the consultation, according to the treatment that suits you.

Want a basic explanation first?For basic information on IPL treatment: the guide on the Mitzmutz site

Frequently asked questions

Is IPL a laser?

No. IPL is not a laser. It is pulsed light across a broad range of wavelengths that passes through a filter, whereas a laser is light of a single wavelength.

How many treatments are needed?

Usually a series of several treatments is given a few weeks apart, followed by top-up treatments as needed. The number of treatments is decided according to your examination and your response.

Does IPL hurt?

Most patients describe a flash of warmth or a slight pinch with each pulse. The gland expression that follows may be more unpleasant.

Can I have IPL if I have a tattoo or permanent make-up?

The light is not applied directly over tattoos or permanent make-up in the area, because the pigment absorbs the light and may be damaged or cause a burn. Tell us about them before the treatment.

Sources

1. Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg. 2015;33(1):41-46.
2. Dell SJ, Gaster RN, Barbarino SC, Cunningham DN. Prospective evaluation of intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction. Clin Ophthalmol. 2017;11:817-827.
3. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628.
4. Vieira AC, Mannis MJ. Ocular rosacea: common and commonly missed. J Am Acad Dermatol. 2013;69(6 Suppl 1):S36-S41.

The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.