docet

Key Points

• The application of pulses of high energy ultraviolet light to the skin surface has long been used by dermatologists in the treatment of conditions such as acne rosacea. 
• Intense pulsed light (IPL) therapy has been used for some years in the cosmetics industry for removal of skin lesions such as telangiectasia, port-wine stains and haemangiomas.
• Application to the eye lids appears to show benefit in the longer-term management of meibomian gland dysfunction and tear instability related ocular surface disease.
• IPL treatment has been cited in the TFOS DEWSII recommended staged management plan for dry eye disease, and is considered a second stage management option.
• A Xenon flash lamp will emit wavelengths from between 400 and 1200nm. When this light passes through a filter cut-off at around 500nm, it causes the blood within telangiectatic blood vessels exposed to the incident light to coagulate, so causing them to close.
• Benefits of the treatment are thought to include the following:
• An increase in mitochondrial function
• Increased calcium channel flow
• Increased collagen synthesis
• Modulation of the secretion of anti-inflammatory molecules
• Suppression of matrix metalloproteinases (or MMPs) which are proteolytic enzymes that degrade the extracellular matrix and so influence cellular migration 
• Demodex necrosis and death (a chromophore in the exoskeleton of the mite absorbs IPL energy).
• Indications for treatment include lid margin telangiectasia and persistent MGD symptoms even after good compliance with conventional treatments.
  
• Contraindications include systemic use of drugs causing photosensitivity, history of high sun or artificial tanning treatment, conditions such as lupus, and adnexal ketosis, melanin aggregation and tattoos.
  
• Most clinicians suggest three initial treatments and the need for follow-up is patient dependent.