Intense Pulsed Light: Put the Best Face on It

Are your eyes red and burning? The problem may extend past your eyelids.

Many skin conditions affect the eyelids and ocular surface, especially oil gland and blood vessel problems like rosacea. Often this may cause a minor eye nuisance, easily managed with relatively simple intervention, like an occasional artificial tear drop. When the eye issues are more annoying, however, available treatments may include frequent lid scrubs, prescription topical or oral medication, and light therapy.

Intense pulsed light has become an increasingly useful tool in the treatment of ocular rosacea, styes (chalazia), and dry eyes. Intense pulsed light (IPL) is not a laser, but rather just what the name sounds like = high-powered flashes of light, using mostly visual spectrum, along the wavelengths of 500-1200 nm.

Often filters are used to selectively select for certain wavelengths; certain wavelengths are preferentially absorbed by different skin structures or chromophores, and may activate cytochrome C. IPL has been shown to treat inflammation; on confocal microscopy, activated T-lymphocyte burden is reduced following IPL treatment. IPL also may kill Demodex and bacteria. A version of IPL technology is even used to clean surgical instruments.

At Ticho Eye Associates, we have evolved a “step-by-step” IPL treatment regimen for rosacea, chalazia, and dry eyes:

Pretreat: Clean face; clean of all makeup.

Step 1: Treat the entire face with rosacea treatment settings

Step 2: Photomodulatory settings

Step 3: Treat along the eyelids (with eye protector shields)

Step 4: Aesthetic clean up (on angiomas, telangiectasias, and chalazia)

Total treatment: around 120-130 pulses

Total treatment time: 20 minutes

Post treatment: Topical antibiotic-steroid ointment in-office and Paraben-free sunblock

Monitor with MMP: 9 levels from the tear film— these may be used to quantify ocular surface inflammation.

Although most patients do see a benefit from a single treatment, often repeated sessions (6 weeks to 3 months apart) are advised to achieve higher effectiveness.

Once a successful initial response has been achieved, I usually recommend maintenance IPL sessions a little more often than dental cleanings.

Benjamin Ticho, MD