I have come to realize that the reason eye doctors have found the treatment of “dry eye” to be so challenging, is that for most patients, this is neither a “dry” nor an “eye” problem.
Our patients often tell us as much. They say “my vision is blurry”. “My eyelids are stuck together in the morning”. “My eyes are red”. “It feels like there’s sand or grit in my eyes”
While some people have a decrease in the production of the “watery” or aqueous tears, made in the lacrimal glands, thus creating a dry ocular surface, the majority of the patients we see with “dry eye” have normal or excessive production of the aqueous (watery) tears. Often my patients are surprised when they are told that their eyes are “dry” because they are bothered by excessive tearing. I’m often told by my patients: “I don’t have dry eye!! My eyes water all the time!!”
In fact, “dry eye” is a misnomer and a very inaccurate and confusing term for this condition. For most of my patients, these symptoms (crusty eye lids, blurry vision, redness, eye “awareness” or ache, discomfort and foreign body feeling) is neither a “dry” nor an “eye” problem.
Rather, we realize now, that these symptoms are due to a dysfunction of the oil glands of the eyelids. These oil glands, called the meibomian glands (MG), produce an oily tear, which is an essential component of the tear film. Just as we have oils in our skin which can be blocked, we have oils in our eyelids, which can be blocked.
We need these oils, made in the meibomian glands, to flow and coat the surface of the eye. Without these oils, the liquid tears evaporate too quickly, and the symptoms occur. Just as you cannot “lick” chapped lips better (licking chapped lips may provide momentary relief but makes the lips feel worse) – just applying more moisture in the form of eye drops may not help.
Vaseline or Chapstick is needed for chapped lips to “lock in” the moisture and make the lips feel better.
IPL functions in a similar fashion. IPL heats up the meibomian gland oils and allows the blocked oils to be expressed. This allows the glands to produce functional oils and for them to flow.
IPL has been used by dermatologists for years to treat facial rosacea, and the problem in the eyelids is quite similar. Ocular rosacea, which manifests as redness of the eyelids, causes the inflammation which eye doctors often call Blepharitis. This inflammation causes the oils to not function properly and cause symptoms.
IPL was first popularized for treating MGD by Dr. Rolando Toyos, in Memphis, Tennesse. Dr. Toyos started to treat patients for their facial rosacea, and he noticed that their dry eye symptoms were improving. Read more about this here.
IPL has 2 effects on the eye lids and the eyes. The short term effect is that the blocked MG oils are heated up, (similar to microwaving butter that had been in the freezer) and the oils can be expressed. (You can see some videos of eyelid expression here).
The long-term effect is that there is a reduction in the inflammation of the eye lids and thus the underlying cause of MGD is treated. In our clinical experience, people tell us that that the IPL feels “less hot” and the lid expression is less uncomfortable, the more times the procedure is performed. We believe this is due to a decrease in the inflammation of the eyelid tissue. People also tell us that their eyelids look less red.
Many patients find that their eyes feel “lighter” and they have relief in their symptoms and their vision is “crisper” and “sharper” and the ocular discomfort resolves, and this effect can occur within a few minutes, but often takes a few days or weeks. Most people will need several treatments (2 or 3) to get the full effect. (Dr. Toyos recommends 6 treatments) However, we find that most people need 2 or 3 initial treatments, which are performed 3-4 weeks apart. We then find that most people benefit from a repeat treatment every 4- 6 months. (Just as we need to have our teeth cleaned every 6 months, we recommend repeating the procedure to ensure maximum benefits).
Here is a video of the procedure being performed on a patient (my grandmother).
We have found the IPL procedure, in conjunction with meibomian gland expression (MGX) to be highly effective in the treatment of meibomian gland dysfunction.
If you are interested in learning more about Intense Pulsed Light (IPL) and Meibomian Gland Expression (MGX) for Meibimian Gland dysfunction, please call our office for a consultation.