We all shed tears. Our eyes produce tears continually, and when we blink, those tears spread across the front surface of our eyes to lubricate them. Tears also clear our eyes of debris and protect them from infection. But in some people, tears don’t work the way they’re supposed to and dry eye disease is the result.
If you’re one of those people, you’re not alone.
In the United States, more than 16 million people suffer from dry eyes. That’s nearly seven percent of the population. And that figure is likely much higher because not all people with dry eye symptoms see a doctor for treatment. But about 33 percent of patients who visit eye doctors complain of dry eye symptoms.
Symptoms of dry eye can be very uncomfortable and include decreased vision or occasional blurry vision, dryness, redness, itching, burning, eye fatigue and the feeling there’s something in your eye. And believe it or not, some people with dry eye experience excessive tearing.
There are two types of dry eye disease. There’s the aqueous-deficient type, which is when your eyes don’t make enough tears. Then there’s the evaporative type, which is when your tears don’t stay on your eyeball long enough to keep it properly lubricated. Evaporative dry eye disease is the more common of the two.
Most of the time, evaporative dry eye occurs when the eye’s oil glands, the Meibomian glands, become clogged and can’t release the oils necessary for healthy tears. The oil component of tears helps keep them from evaporating off the surface of your eyes.
When the Meibomian glands are clogged, inflammation and an overgrowth of bacteria on the eyelids can also occur, which makes dry eye symptoms even worse. These conditions make it difficult for the Meibomian glands to work properly, which is referred to as Meibomian gland dysfunction, or MGD.
Treatment for MGD typically begins with artificial tears, warm compresses and eyelid cleansing. When these steps fall to improve MGD, and subsequently your dry eye symptoms, there’s a newer treatment available called intense pulsed light, or IPL.
IPL was originally designed for use in dermatology to treat conditions such as rosacea and acne but was introduced into ophthalmology a few years ago. IPL is the use of short bursts of powerful light in various wavelengths to treat MGD. The wavelengths chosen for your treatment depends on your skin color and tone.
The IPL light generates heat below the skin of the eyelids, warming and thinning the thickened oil, or meibum, blocking the glands. Once the meibum is thinned, it can more easily be removed through Meibomian gland expression or MGX. During MGX, the doctor uses a cotton-tipped applicator and manual pressure to squeeze out the meibum from the glands.
In addition to thinning the meibum, IPL also closes the small blood vessels on the surface of the skin that contributes to inflammation. The heat IPL generates also kills the problematic bacteria flourishing on the eyelids. All of these functions have beneficial effects on MGD and, as a result, dry eye symptoms.
During an IPL treatment, the doctor will first place shields on your eyes to protect them from the light. The doctor will also place a thin layer of cooling gel on the areas of skin to be treated. The pulses of light are delivered from the outer area of the right eye, across the cheeks and nose to the outer area of the left eye.
You may feel a warm sensation during treatment, but that’s all. IPL treatment is not painful. A typical treatment consists of about 30 pulses and takes 15 to 20 minutes to complete. Afterward, you may be instructed to use low-dose anti-inflammatory eye drops for a few days.
Many people experience improvement in their symptoms after one IPL treatment, but for best results, a series of four treatments over four months is typically recommended. Maintenance treatments are also recommended every six months to a year.
A number of studies confirmed that IPL reduces both signs and symptoms of MGD and dry eye. In one study, more than 90 percent of patients improved in the three areas used to assess MGD. Results are validated subjectively through your report of symptom improvement and objectively when your doctor examines the surface of your eyes under a light.