Intense Pulsed Light to treat Ocular Rosacea - Appalachian Spring Dermatology

My eye doctor recommended I have IPL for my rosacea in my eyes, what do you think?

I have been asked this question at least dozens of times in the past few months. As a rosacea sufferer, the eye doctor recommended IPL for me as well. I passed, not understanding how it could possibly work. Not to mention, it requires multiple treatments and is not covered by insurance. So, I thought it was time to do some research.

Let’s start at the beginning. Rosacea is a skin condition that causes redness, flushing, bumps and pimples, and visible blood vessels on the skin. Patients with rosacea have inflammation in the superficial blood vessels of the skin that perpetuates the condition. We have been treating patients with rosacea with NdYag Laser and Intense Pulsed Light (IPL) since 2005, so the concept of using this technology for rosacea is not new or new to us. What is newer is the use of IPL to treat ocular rosacea.

Ocular rosacea is a different subset of rosacea, causing dryness and irritation of the eyes. For many patients, treating their ocular rosacea has a huge impact on their quality of life. Most commonly, we treat ocular rosacea with oral antibiotics to reduce the inflammation in the eyes. Some data suggests that there is some mild bacterial infection of the eyes in rosacea patients that is helped with the oral antibiotics. However, for many patients, long term oral antibiotics are required to maintain the improvement. How rosacea has this impact on the eyes was never very clear to me. I just know how to make people better, and that is what counts in the end!

So how does IPL work? There are a few scientific theories I found…

Reduction of extraneous blood vessels and the inflammatory mediators they carry in the skin. This is how IPL is believed to help the skin of rosacea patients.

Improvement in Meibomian Gland Dysfunction (MGD). More recent scientific research has demonstrated that many patients with ocular rosacea have dysfunction of their Meibomian Glands. Meibomian glands supply moisture to the eyes but secreting a substance called meibum. Initial studies suggest that treating the blood vessels on the skin reduces the blood vessels supplying inflammation to these glands. However, additional studies show that by heating the skin with IPL, the material in the Meibomian Glands is heated and liquified, unclogging the glands and allowing the meibum to flow more freely during blinking.

Improving the structure of the Eyelid. It is well known that IPL stimulates growth of collagen, elastin and fibroblasts in the skin, which as dermatologists we appreciate as a more youthful appearance to the skin over time. Some scientists suggest that treating the area with IPL strengthens the skin to allow more effective blinking and less sagging of the eyelids causing them to dry out.

Destruction of Demodex Mites. Remember my post about those pesky mites that can live in our skin. LINK. Turns out they can also live in the Meibomian Glands. Heating the Meibomian glands with IPL destroys the Demodex mite. The demodex mite is also killed by a topical medication for rosacea called Soolantra. So, I think I’ll keep the in mind for the future.

So, the questions remain, does it actually work and is it worth it?

Does it actually work? Anecdotal reports, meaning word of mouth reports of single patients, is that it does help immensely, and my eye doctor says he’s getting great results. However, randomized control trials (real science) has limited evidence that it works. There is something in medicince called a Cochrane Review. This is where someone analyzes all the scientific evidence to come to a conclusion of scientific evidence for a treatment. Here are the findings of a Cochrane Review in 2019.

This systematic review finds a scarcity of RCT evidence relating to the effectiveness and safety of IPL as a treatment for MGD. Whether IPL is of value for modifying the symptoms or signs of evaporative dry eye disease is currently uncertain. Due to a lack of comprehensive reporting of adverse events, the safety profile of IPL in this patient population is also unclear. The current limitations in the evidence base should be considered by clinicians using this intervention to treat MGD, and outlined to individuals potentially undergoing this procedure with the intent of treating dry eye disease. The results of the 14 RCTs currently in progress will be of major importance for establishing a more definitive answer regarding the effectiveness and safety of IPL for treating MGD. We intend to update this review when results from these trials become available.

—Cochrane Database Syst Rev. 2020 Mar 18;3(3):CD013559.

Another, more recent analysis showed the results are short lived.

IPL combined with MGX (Meibomian Gland Expression – sort of like milking the glands) may be an effective and safe treatment for MGD, but it cannot improve all symptoms. IPL alone is not superior to MGX. The efficacy is also affected by the number and average frequency of treatments. The efficacy of IPL may decrease within 6 months after the last treatment, so it should be considered a long-term adjuvant therapy combined with MGX. When patients receive 3 or 4 treatments (once every 3-4 weeks), a return visit at 6 months after the last treatment is required.

—Graefes Arch Clin Exp Ophthalmol. 2020 Jul 28. doi: 10.1007/s00417-020-04834-1.

Is it worth it? Now that is a very subjective question. Ocular rosacea can be very distressing to patients and can subjectively impact their vision because their eyes are so dry. If nothing else works, IPL may be a reasonable consideration but will be costly and results will likely be temporary and require ongoing maintenance therapy.

Do we do IPL in the office for ocular rosacea? Not exactly, but after review of the articles, turns out the device and technique are exactly the same as what we use treat rosacea on the skin with IPL. So, we may consider it in the future. One final step of the treatment that improved outcome in most studies was that they “expressed”, meaning they sort of milked, the meibum out of the glands after the IPL treatment. This part is obviously not something that I do, so I think I’ll leave this to the eye experts for now.

To learn more about rosacea, check out our Rosacea 101 post.

To learn more about Intense Pulsed Light for the skin for rosacea, check out our recent post, and our Youtube videos.

If you know someone who may find this article helpful, please share it with them! Follow us on social media this week, and subscribe to our growing YouTube channel!

If you would like to receive these posts in your email inbox, Subscribe to our Site.