Mechanism of Action of IPL

[NeedMyEyes]

I don't think anyone is exactly sure how IPL treats dry eyes, not even Dr. Toyos, but I have been reading a bit about it and I thought I would put all the possibilities together in one place:

1) Hot compress - IPL heats the oil, melts it, and then makes expression easy afterwards (not everyone I talked to agrees with this)

2) Kills bacteria in the eyelid margin

3) Kills demodex

4) Stimulates the meibomian glands to secrete oil (actually, I noticed this with both of my IPL treatments. The sebaceous glands on my face were really stimulated and were producing oil a few days after the IPL session. I assume the meibomian glands will also be stimulated)

5) Destroys thin blood vessels under the skin that carry inflammatory mediators to the eyelids and the glands thus reducing the inflammation in the glands (I don't know if everyone believes this either. This might only be true in Rosacea patients)

6) Dilates and opens the ducts and orifices thus making expression easier.

Does anyone have any idea which of these is the main mechanism? Or does anyone have any thoughts on which of these mechanisms is what worked for them? If we can figure this out, we may be able to figure out which patients will benefit and which will not.

NME

[Spoon]

Hi, I think the main mechanism is simply that it effectively heats and loosens or expels the pathologic meibum. IPL can remove small surface vessels but blood vessels aren't the problem unless they are in excess like rosacea. The MG's in the lower eyelid are only 4-6mm long, if IPL light was heating blood vessels in this area enough to coagulate them i would expect that you would also be loosing all your eyelashes because the black hair root in the lash follicle will absorb a lot more heat energy than the red hemoglobin in the blood vessel. A counter argument would be that IPL destroys the lager vessels feeding these small ones but IPL doesn't have the energy intensity like a laser does to achieve this.

If it were 2&3 i doubt you would see results lasting longer than a week. #4 could well be true but wouldn't expect it to be the main mechanism.

[Spoon]

Also note that the small blood vessels are what feeds your meibomian glands and destroying these would be a problem - a starving MG wont make any better meibum that an angry one.

The inflammation is a problem but needs to be treated at the cause, whether that be meibum stasis which increases ductal pressure and bacterial colonization or allergic inflammation etc.

[bp77]

Is ipl effective without getting gland axpression and useing steroieds? since i can not have any of them! thanks.

[NeedMyEyes]

Yes I think 1, 4, and 6 are the most reasonable with number 1 seeming to be the most convincing mechanism.

bp77: I have heard there are doctors that do IPL and don't do any expression and still get good relief from symptoms. This is how Dr. Toyos originally found that his rosacea patients got better and he wasn't doing any expression.

Also, he hasn't always given steroids either. He only gives 3 days of lotemax and then a month of Xibrom.

[NeedMyEyes]

Sorry to bring back this thread, but after having gone to Lipiflow and experiencing the treatment, I have to say I am coming to the conclusion that all good MGD treatments essentially involve:

Heating the glands
Expressing the glands

And the more effective you are at doing this, the more successful you will be at treatment.

So, it makes me think that IPL's real mechanism of action is number 1 above - a very effective hot compress and gland expression.

[Angela]

I have a weird question/concern with IPL. You say that IPL causes stimulation of the sebaceous glands causing oily skin. The problem for me is that my MGD or at least one part of it is caused by my skin problems (acne, oily skin, dandruff, etc.). I was on Accutane a year and a half ago and it dried out my skin for a while but the oil came back with a vengeance after getting Fraxel laser done in September and November of this year. I have been wondering if the Fraxel was a possible cause or contributor for my MGD. If IPL has the same effect, is it possible that for a case like mine it might actually cause it to worsen? I wonder how many people with the OVER production of oil had IPL done and whether it was beneficial or detrimental. Thoughts?

[NeedMyEyes]

I actually don't know if Dr. Toyos does IPL for seborrhea... Does anyone know?

I thought it was mostly for the "obstructive" type of of meibomian gland dysfunction and not the overproduction type...

I really am not sure if Fraxel can cause Dry Eye or MGD. I know Accutane can and I have a feeling that was the culprit in your situation, but reallly I'm just guessing.

Also, I have no idea if IPL works for Accutane induced MGD, thought it would seem like it could help. If you Call Dr. Toyos' office, I guess they would tell you to come see him so he can examine you....

[NeedMyEyes]

Oh, I'd like to add another:

7) firms up the tissue and improves apposition of the lids