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Ophthalmology can 'adopt' technologies from other specialties


IPL therapy

Patients can benefit as physicians take advantage of new treatment options 

Many medical specialties share medications and technologies, from various classes of drugs to diagnostic testing and surgical instruments.

In ophthalmology, we tend to see ourselves as set apart from most specialties because of the unique needs and limitations of working with the eye. We’ve seen a few crossovers, particularly from aesthetics. Here are a few “adopted” technologies we’re happy to see in the hands of ophthalmologists.

IPL therapy 
IPL therapy has been used in aesthetics since the 1990s to improve skin texture and treat rosacea. First-generation platforms required tremendous expertise, but newer, sixth-generation technologies (Optima IPL with the OPT technology, Lumenis), coupled with corneal shields, have the safety profile needed to address the eyelid and adnexa.

Also by Dr. Periman: Treating chalazion with IPL therapy 

Dozens of peer-reviewed papers report the efficacy of IPL as an effective drug-free approach to treating ocular rosacea-associated and non-rosacea-associated meibomian gland dysfunction (MGD) and DED. This effect is thought to occur via multi-level impacts on the inflammation factors that drive both the MGD and DED components of ocular surface disease.

IPL has been shown to improve noninvasive tear breakup time more than five seconds over baseline, and 86% of patients report improved symptoms. With three or four IPL treatments, spaced two to five weeks apart, we observe reductions in MMP-9 levels and improved tear osmolarity. Patients then repeat IPL one or two times per year, depending on the severity of the underlying disease comorbidities.

Topical medications 
In recent years, we have seen several topical medications migrate both ways between aesthetics and ophthalmology. Few ophthalmic pharmaceuticals have transitioned into the aesthetic world like the topical drug, bimatoprost. Widely used for glaucoma, the drug’s side effect of increased eyelash growth led to its rebranding for aesthetic treatment of hypotrichiasis (Latisse, Allergan).

In addition to the aerodynamic impacts on evaporative dry eye from the abnormal eyelash lengthening effect associated with overuse, prostaglandins can also create lid margin redness, discoloration, dermatitis, and exacerbation of MGD. XAF5, a topical prostaglandin ointment by Topokine Therapeutics, is undergoing phase IIb/III trials to assess its efficacy in treating lower eyelid steatoblepharon.

Related: (PODCAST) Episode 8: It's time to add IPL therapy to your toolbox

Hyaluronic acid gel (HAG) fillers have been used in intraocular surgery for decades. The aesthetic uses of HAG products such as Juvederm (Allergan) and Restylane (Nestle Skin Health) are well known and offer a popular method of non-invasive facial rejuvenation.

However, more recently, the functional use of fillers to improve eyelid malposition or mid-face revolumization has shown promise. HAG has been found to be as efficacious as allograft dermal grafting or hard palate grafting to improve the position of the lower eyelids, as well as to improve and restore normal eyelid anatomy.

Ophthalmology, dermatology, and aesthetics benefit each other through shared medications and technologies. In the future, we anticipate seeing many more crossovers and “adopted” technologies used routinely in ophthalmology.

Read more content by Dr. Periman

Laura Periman, MDE: dryeyemaster@gmail.com
Dr. Periman is an ocular surface disease expert and director of Dry Eye Services and
Clinical Research in Seattle, WA.

Ami A. Shah, MDE: gotox@sfgotox.com
Dr. Shah is founder of SF Gotox, a Mobile Aesthetic Care Company in the Bay Area, CA.


1. Liu R, Rong B, Tu P, et al. Analysis of Cytokine Level in Tears and Clinical Correlations After Intense Pulsed Light Treating Meibomian Gland Dysfunction. AJO. 2017 Nov;183: 81-90.
2. Craig JP, Chen YH, Turnbull PR. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2015 Feb 12;56(3):1965-70.
3. 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. Cure Eye Res. 2018 Mar;43(3).
4. Scott AB, Miller JM, Shieh KR. Treating Strabismus by Injecting the Agonist Muscle with Bupivacaine and the Antagonist with Botulinum Toxin. Trans Am Ophthalmol Soc. 2009 Dec;107:104-109.
5. Romanov A, Pokushalov E, Ponomarev D, et al. Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: Three-year follow-up of a randomized study. Heart Rhythm. 2019 Feb;16(2):172-177.
6. Park J, Park HJ. Botulinum Toxin for the Treatment of Neuropathic Pain. Toxins (Basel). 2017 Sep; 24;9(9):260.
7. Diel RJ, Kroeger ZA, Levitt RC, et al. Botulinum Toxin A for the Treatment of Photophobia and Dry Eye. Ophthalmology. 2018 Jan; 125(1): 139–140.
8. Ho MC, Hsu WC, Hsieh YT. Botulinum Toxin Type A Injection for Lateral Canthal Rhytids. JAMA Ophthalmol. 2014;132(3):332- 337.
9. Lu R, Huang R, Li K, et al. The influence of benign essential blepharospasm on dry eye disease and ocular inflammation. Am J Ophthalmol. 2014 Mar;157(3):591-7.e1-2.
10. Gumus K, Lee S, Yen MT, Pflugfelder SC. Botulinum toxin injection for the management of refractory filamentary keratitis. Arch Ophthalmol. 2012 Apr;130(4):446-50.
11. Sahlin S, Chen E, Kaugesaar T. Effect of eyelid botulinum toxin injection on lacrimal drainage. Am J Ophthalmol. 2000 Apr;129(4):481-6.
12. Fouda SM, Mattout HK. Comparison Between Botulinum Toxin A Injection and Lacrimal Punctal Plugs for the Control of Post-LASIK Dry Eye Manifestations: A Prospective Study. Ophthalmol Ther. 2017 Jun;6(1):167-174.
13. Singh S, Ali MJ, Paulsen F. A review on use of botulinum toxin for intractable lacrimal drainage disorders. Int Ophthalmol. 2018 Oct;38(5):2233-2238.
14. Mérida S, Palacios E, Navea A, Bosch-Morell F. New Immunosuppressive Therapies in Uveitis Treatment. Int J Mol Sci. 2015 Aug 11;16(8):18778-95.
15. Goldberg RA, Lee S, Jayasundera T, et al. Treatment of lower eyelid retraction by expansion of the lower eyelid with hyaluronic Acid gel. Ophthalmic Plast Reconstr Surg. 2007 Sep-Oct;23(5):343-8.
16. Mancini R. Managing eyelid malpositions with hyaluronic acid gel injections. Int Ophthalmol Clin. 2013 Summer;53(3):11-20.


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