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  • Writer's pictureDr. Zimski

Not All IPL is the Same

Not All IPL is the Same

IPL being performed on a patient

I am often asked if IPL is effective for treating dry eye caused by meibomian gland dysfunction, and the short answer is yes.  The reality is, we have very few effective treatments for treating the underlying cause of meibomian gland dysfunction.  I always take a holistic approach and think of treating dry eye as a puzzle, and each piece matters. This involves looking for eyelid position abnormalities, inflammation, signs of rosacea and demodex and treating each of these when appropriate.  But the reality is, if the meibomian glands are plugged, the only way to unplug them is mechanically.  

In my hands, IPL is the single most effective tool to accomplish this.  I have treated several patients that had IPL elsewhere that was ineffective and were hesitant to have more due to their lackluster results.  After questioning them about how it was done, I began to realize how much both the IPL device and technique matter.  I was fortunate to spend a day with Dr. Laura Periman in Seattle, who helped pioneer the use of IPL for meibomian gland dysfunction, and it became evident that both her impeccable technique and settings led to superior results.  Incorporating that into my practice has been a game changer.  

After much deliberation, I purchased a Lumenis Optilight device despite it being much more expensive than several of the other devices on the market.  In this case, I really do believe that you get what you pay for.  The Optilight device is the only IPL FDA approved for treating dry eye and has a handpiece specifically designed to contour the eyelids, allowing you to get within a few millimeters of the eyelid margin, targeting the meibomian glands.  The other machines had large handpieces that were just not practical for treating eyelids.  

Metal shields under eyelids for IPL treatment

While the studies done for FDA approval were only done treating the lower eyelids, I strongly believe that treating both the upper and lower eyelids is more effective.  This requires placing metal shields under the eyelids to protect the eyes, and while this may sound scary, it is very well tolerated.  We talk patients through each step so they know what to expect to ease worries.  We have done this hundreds of times so we can do this quickly and easily.  

Selecting the appropriate filters and settings is also crucial.  This is done by assessing both skin type and patient tolerance.  While higher settings can be uncomfortable, the settings can be adjusted for patient comfort, and lower settings can be used just as effectively with more passes.  Some of the other IPL devices do not allow you to adjust settings and filters, rather they take a one size fits all approach, allowing them to sell the machines for a much lower cost, but at the expense of being able to tailor treatments protocols for each patient, which is absolutely essential.

The last piece is a thorough expression of the meibomian glands.  Some doctors feel that expression is not necessary, but I believe that it is.  Over the course of several treatments, I see the meibum liquefy and plugged glands become unplugged.  This is much more successfully done by applying an in-office heated mask after IPL, which makes expression easier and more effective. This is an essential part of our protocol. 

When patients ask if IPL is worth the cost, I absolutely believe that when done with the right device and by the right person, it is hands down the most effective treatment we have.  

If you’re seeking effective treatment and personalized eye care in Colorado, Dr. Lauren Zimski is here to help. With a focus on comprehensive eye exams, ocular surface disease management, and tailored dry eye solutions, Dr. Zimski offers expert care to address your eye health needs. Schedule your appointment today or call us at 303-863-1231 for more information.


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