Clinicians combine IPL and heat pulsation in dry eye treatment plan
McGee S, Devries D. Aesthetics in optometry – A therapeutic approach. Presented at: Vision Expo East; Orlando Florida; June 2-5, 2021.
Disclosures: Devries and McGee report that they are consultants for Lumenis.
ORLANDO – Two practitioners have advocated for a treatment package for ocular surface diseases that includes four sessions with intense pulsed light and one with thermal pulsation in the office.
Selina R. McGee, DO, FAAO, and Douglas K. Devries, DO, stated that this treatment regimen is appropriate for patients with moderate to severe dry eye disease, meibomian gland dysfunction (MGD), or blepharitis.
McGee performs a number of dry eye diagnostic tests at his clinic. She said she started with the Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire.
“If they answer positively to two of the SPEED questions, we proceed with the tests,” she said, which includes tear osmolarity, InflammaDry (Quidel), lissamine green stain and fluorescein, time of tear rupture, the height of the tear meniscus and the Meibomian gland. assessment and imaging.
“There should be a catch rate of around 30%,” she said.
“Press the meibomian gland,” Devries said. “If it looks like baby oil or olive oil, it’s normal. If not, it’s not. If I don’t deal with it, it will progress.
One in 10 people are affected by rosacea, he said.
“If they have rosacea, they probably have MGD,” Devries said.
McGee noted that ocular rosacea often presents before cutaneous rosacea.
“Sometimes we’re the first-line diagnosis,” she said.
Devries said it’s important to tell patients you understand why they have their symptoms because they often think it’s just on their minds.
“Some of them suffer for years before they come for help,” McGee added. “These patients are loyal, regardless of their insurance.”
Intense pulsed light (IPL) was used to treat dry eye and meibomian gland dysfunction for several years until the recent FDA de novo approval in late April for Lumenis’ device, now marketed as of OptiLight.
Both Devries and McGee have an M22 from Lumenis, which is used by dermatologists for vascular and pigmented lesions and hair removal. Dermatologists began to see improvements in their dry eye patients, leading to initial off-label use in eye care.
The Fitzpatrick Skin Type Scale should be used to determine the appropriate IPL setting, they said.
Contraindications to IPL include: infections, dysplastic nevi, concurrent skin conditions, active cold sores, open lacerations or abrasions, chronic or skin diseases, recent sun exposure and tattoos, said McGee.
McGee and Devries recommended treating patients with IPL at 3-week intervals and then performing thermal pulsing at the fourth IPL visit.
In preparation for the IPL treatment, paper eye shields are placed over the patient’s eyes and isopropyl alcohol is used to remove makeup and oils from the face. An ultrasound coupling gel is applied to the face, and the clinician and anyone else in the room should wear safety glasses.
Devries said he applies pulses from tragus to tragus, then to the rest of the face and forehead for a more even treatment appearance.
“Stay at least 2mm away from any eyebrow tattoos or eyeliner,” McGee said, and also treat around a mustache or beard.
Then clean the treatment area and advise patients to avoid sun exposure and use sunscreen.
Devries said the device’s head will need to be replaced about every 100,000 pulses, but there’s no click-through charge.
McGee noted that DOs are prohibited from performing this procedure in only three states.