Adding thermal pulsation
With a keen understanding of the pathophysiology of dry eye disease and the roles of ocular rosacea and MGD, we knew that IPL would work synergistically with thermal pulsation for many patients. MGD is perhaps the most significant contributor to evaporative dry eye (and a factor in aqueous deficient dry eye as well). It is caused by inflammation.
In the presence of chronic inflammation, the meibum’s composition changes to include more mono-unsaturated fats. Those fats have a higher melting point of close to 113 F (45 C)–warmer than body temperature (or the sustained heat of warm compresses). This “buttery” meibum does not melt into the tear film’s lipid layer as it should, and it clogs the glands.
Thermal pulsation therapy combines sustained heat and pressure to liquefy the meibum and clear the glands. Manually expressing glands is less effective, uncomfortable for patients and potentially scarring. Thermal pulsation is gentle and effective. After a single session, patients can experience improvement in signs and symptoms for nine months to one year.4 Anecdotally, we have seen the results last much longer.
Steven J. Dell, MD, is medical director of Dell Laser Consultants in Austin, TX. He is a consultant Johnson & Johnson Vision, Bausch + Lomb, Presbyopia Therapies, Ocular Therapeutix, Optical Express, Tracey Technologies, Advanced Tear Diagnostics, and Lumenis.
Neel R. Desai, MD, is director of Cornea, Cataract, and Refractive Services at The Eye Institute of West Florida; medical director of the Lions Eye Institute for Transplant Research; and president and CEO, Clarity Visionary Consulting. He is a consultant to Allergan, BioTissue, Lumenis, Johnson & Johnson Vision and Shire.
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2. Greiner JV. Long-term (12-month) improvement in meibomian gland function and reduced dry eye symptoms with a single thermal pulsation treatment. Clin Exp Ophthalmol. 2013; 41:524-530.
3. Liu R, Rong B, Tu P, et al. Analysis of Cytokine Levels in Tears and Clinical Correlations After Intense Pulsed Light Treating Meibomian Gland Dysfunction. Am J Ophthalmol. 2017;183:81-89.
4. Yin Y, Liu N, Gong L, Song N. Changes in the Meibomian Gland After Exposure to Intense Pulsed Light in Meibomian Gland Dysfunction (MGD) Patients. Curr Eye Res. 2018;43:308-313.