Let There Be Light

Eye institute offers innovative treatment for dry eye, facial rejuvenation.

Photo by Jordan Pysz.

Dr. Mathews uses the IPL machine to treat her patients dry eye disease.

Everyone sheds tears, and not just when they’re sad. Healthy eyes produce tears at all times. When a person blinks, tears spread across the front surface of the eye, lubricating it. Tears also clear the eyes of debris and protect them from infection.

There are factors, however, that can interfere with this natural process of tear development that can lead to a condition called dry eye disease.

“Dry eye is a very common disease,” reports Priya M. Mathews, MD, a board-certified, fellowship-trained cornea specialist at Florida Eye Specialists & Cataract Institute based in Brandon. “In the United States, more than forty million people suffer with dry eye, but it is more prevalent in those areas of the country that are very humid, such as Florida.”

“Many people do not even know they have dry eye, but they do experience some of its symptoms,” reports Ana-Maria Oliva, MD, a board-certified, fellowship-trained specialist in cornea and refractive surgery at Florida Eye Specialists & Cataract Institute. “It is not until they come to the office and we examine them that they realize many of their symptoms are actually coming from dry eye.

“The most common of those symptoms are decreased vision or intermittent blurred vision, a dry sensation and a feeling there is something in the eye, which we refer to as foreign body sensation,” continues Dr. Oliva. “Some people experience eye fatigue, redness, itching, double vision and glare, and some actually have excessive tearing.”

To keep the eyes lubricated, there must be a consistent tear film on the surface of the eyes. Dry eye can result when the glands around the eyes that make tears do not make enough. This is a form of dry eye called aqueous-deficient dry eye disease, Dr. Oliva describes.

“On the other hand, some people with dry eye do produce enough tears, but they do not remain on the eye’s surface long enough to maintain a consistent tear film,” she states. “This is evaporative dry eye disease, and it is more common than the aqueous-deficient form.”

To maintain a consistent tear film on the eye’s surface, tears must contain the proper proportions of oil and water. Too much or too little of either can lead to dry eye. Oil is made and released from glands located in the rim of the lower eyelids called meibomian glands.

“Dry eye typically occurs when the meibomian glands become clogged, which can lead to inflammation and bacterial overgrowth,” Dr. Mathews relates. “The presence of these conditions is referred to as meibomian gland disease. It is the main cause of evaporative dry eye disease.”

To treat meibomian gland disease and subsequently dry eye, ophthalmologists first try a regimen of artificial tears, warm compresses and eyelid cleansing. But for some patients, that is not enough to relieve their symptoms. In those cases, the ophthalmologists at Florida Eye Specialists & Cataract Institute use innovative techniques to treat these conditions.

Bursts of Light 

One of the innovative techniques used for dry eye is treatment with intense pulsed light, or IPL, Dr. Mathews notes. IPL has been used in dermatology for many years and was introduced in ophthalmology a few years ago.

“IPL involves delivering powerful bursts of light to generate heat underneath the skin of the eyelids,” Dr. Mathews explains. “IPL treats dry eye in two ways. One, it warms and liquifies the clogged oil in the meibomian glands. Secondly, it eliminates abnormal blood vessels that result in inflammation, which causes gland dysfunction and leads to dry eye.

“IPL treats dry eye in two ways. One, it warms and liquifies the clogged oil in the meibomian glands. Secondly, it eliminates abnormal blood vessels that result in inflammation, which causes gland dysfunction and leads to dry eye.” – Dr. Mathews

“To perform IPL, we use specific wavelengths of light delivered through a filter, so the intense light does not damage the patient’s eyes. We determine which wavelength to use based on the patient’s skin color and tone.”

At Florida Eye Specialists & Cataract Institute, IPL treatments are performed in the surgical suite. The ophthalmologist begins the treatment by placing shields over the patient’s eyes to protect them and applying a thin layer of cooling gel on the areas of skin to be treated.

“We then use the appropriate wavelength of light to penetrate the skin and open up the clogged meibomian glands,” Dr. Mathews explains. “Patients may feel a warm sensation as the IPL is applied, but it is not uncomfortable. An IPL treatment session lasts approximately ten minutes, and several treatments are typically required to achieve the best results.”

While IPL has only been used in ophthalmology for several years, it has become a widely accepted treatment for meibomian gland disease and dry eye. And it’s highly effective.

“IPL has been shown to reduce dry eye symptoms in more than ninety percent of patients who receive the treatment,” Dr. Mathews elaborates. “This was determined subjectively by the patients’ reports of symptom relief and objectively by examining their eyes under a slit lamp. The effectiveness of IPL treatment has been validated both ways.”

It’s Better with BlephEx®

There’s a second eye disorder that commonly coexists with dry eye. It’s called blepharitis, and it’s a bacterial infection of the eyelids.

“Symptoms of blepharitis include itching, burning, tearing, foreign body sensation and a red line along the lid margin, almost as if the person is wearing red mascara,” Dr. Oliva describes. “Blepharitis can be very debilitating, and it can actually lead to dry eye.

“Blepharitis and dry eye are interrelated,” Dr. Mathews concurs. “When people’s eyelid hygiene is compromised, it causes a build-up of bacteria on their eyelashes. The resulting infection can lead to dry eye by causing meibomian gland disease.

The ophthalmologists at Florida Eye Specialists & Cataract Institute often combine IPL with two other techniques when treating dry eye and blepharitis. One is an eyelid cleansing procedure using a machine called BlephEx.

“BlephEx targets the dirt and bacteria that cause blepharitis,” Dr. Oliva informs. “It uses a sponge soaked in a special cleaning solution. The sponge is then placed on a small tool that resembles a drill, but instead of a drill bit, there is the soft sponge. The tool gently spins to scrub and massage the eyelid margins, cleaning and exfoliating the eyelids and lashes and relieving the blepharitis symptoms.”

“I like to use the BlephEx before applying IPL,” Dr. Mathews reports. “That way, the eyelids are completely clean when the IPL is applied. I combine these two steps with a third technique called meibomian gland expression.”

To perform meibomian gland expression, the ophthalmologist uses forceps to gently squeeze the glands. This removes, or expresses, the clogged oil that was warmed and softened by the IPL.

“If it is the patient’s first treatment, it may not be possible to fully express the meibomian glands, especially if the glands have been clogged for a long time,”Dr. Mathews notes. “Typically, we perform the three-step process more than once, and each time, gland expression is easier, and we are able to express more of the clogging material.”

Photo by Jordan Pysz.

Craig E. Munger, MD, PhD

Tremendous Tears

People who experience severe dry eye symptoms that do not respond to artificial tears have another treatment option, serum tears. These tears are eye drops made using the patient’s own serum. Serum is the liquid component of blood left after the blood cells have been removed. Serum tears are shown to more closely mimic a patient’s natural tears.

“Sometimes, I offer serum tears before treatment with IPL, BlephEx and meibomian gland expression,” Dr. Mathews states. “If a patient has autoimmune-related dry eye disease, I believe serum tears can be highly effective before trying these office procedures.

“However, if the patient has significant meibomian gland disease or a condition called ocular rosacea, which is an inflammatory eye condition, I would use IPL first. It all depends on the cause of the dry eye and where I target my therapy.”

While serum tears are generally highly effective against meibomian gland disease and dry eye, their full method of action remains undetermined.

“There are certain growth factors and nutrients in serum that promote healing in ways we do not fully understand yet,” Dr. Mathews confirms. “But we have learned over the years that by making eye drops using the patient’s serum, we can achieve a huge improvement in their symptoms. Serum tears are a revolutionary treatment for dry eye.

“Because serum tears are made from the patient’s own blood, there is typically no adverse or allergic reaction to the eye drops. And patients generally do very well using these drops a few times a day.”

Florida Eye Specialists & Cataract Institute makes getting serum tears very convenient for their patients in Florida. Technicians from the Institute will actually go to patients’ homes to draw their blood. Once the drops are formulated in the lab, they are mailed to the patients to begin using immediately. 

Clarifying Cosmetics

Among its team of physicians, Florida Eye Specialists & Cataract Institute also has two oculoplastic and reconstructive surgeons in Robert J. Applebaum, MD, and Craig E. Munger, MD. Leaning on its other purpose, Dr. Applebaum and Dr. Munger commonly use IPL as a cosmetic treatment to rejuvenate the skin of the face and around the eyes.

“IPL is not a laser resurfacing technique. Instead of a laser, IPL uses high-intensity light at multiple wavelengths. The wavelengths and frequency of the light can be adjusted to address various skin conditions.” – Dr. Munger

“Skin problems typically begin when people are in their thirties,” Dr. Applebaum observes. “That is when production of collagen and elastin, the building blocks of skin, starts to decrease and skin cell turnover begins to decline. These conditions make it more difficult for the skin to recover from the effects of aging and from injury caused by exposure to the sun and elements.

“The result of these conditions is the formation of brown age spots, discoloration of the skin, visible blood vessels on the surface of the skin, uneven skin tone, and fine lines and wrinkles. They also make the small scars on the skin, such as those from acne, more visible. But IPL can improve all of those concerns.”

“IPL is not a laser resurfacing technique,” Dr. Munger stresses. “Instead of a laser, IPL uses high-intensity light at multiple wavelengths. The wavelengths and frequency of the light can be adjusted to address various skin conditions. IPL does not damage the surface of the skin, which can occur with laser techniques.

“IPL is used primarily for the face, but it can be used on the skin of the hands, neck and chest as well. Treatment is tailored to the patient’s specific needs.”

While not a laser, IPL works on the same principles as lasers. Light is absorbed into specific skin cells, where it is converted into heat energy. The heat damages the walls of target blood vessels and breaks up skin’s pigment cells. The affected blood vessels and pigment cells then either rise to the surface of the skin, where they fade, or are carried away by the body’s lymphatic system.

“One of the biggest advantages of IPL over lasers, which generally produce more noticeable results, is its minimal downtime,” Dr. Munger points out. “Because IPL does not affect the surface of the skin, there is little redness following the treatment. Patients can have IPL over their lunch break and return to work immediately afterward.”

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