What is a Stye (a.k.a. Sty or Hordeolum)?

A stye is a red, tender bump on your eyelid caused by an infection in one of the glands in your eyelid known as Meibomian glands. A stye is sometimes accompanied by swelling of your eyelid.

What is a Chalazion (plural: chalazia)?

A chalazion is also a bump on your eyelid. It is the more chronic form of a stye, also having developed when one of the glands in your eyelid, known as Meibomian glands, became clogged and infected.

What is the Difference Between a Stye and a Chalazion?

They are both bumps involving your eyelid.

A stye is often tender, or painful, and is caused by an infection; it can progress to involve and inflame the entire eyelid which is known as cellulitis.

A chalazion is usually not red or painful, but can be large enough to distort your eyelid, even placing enough pressure on the surface of your eye to result in blurry vision. Less commonly, it can become red, swollen and tender.

What Causes a Stye or a Chalazion?

The most common cause of a stye or a chalazion is the clogging, and secondary infection, of one of the glands in your eyelid known as Meibomian glands. The most common bacteria involved is Staphylococcus.

Symptoms of a Stye or Chalazion:

Signs and symptoms of a stye and chalazion include:

• A bump on your eyelid (similar to a pimple). It may be red and inflamed
• Eyelid pain and tenderness
• Eyelid swelling
• Crustiness along your eyelid margin, with “dandruff” in your eyelashes

Who is at Risk of Developing Styes and Chalazia?

Anyone can develop a stye or a chalazion, but people who have the following are at greater risk:

• Blepharitis
• Ocular rosacea and/or rosacea of your face
• Meibomian gland dysfunction
• Seborrheic dermatitis (patches of scaly, red skin, mainly on the scalp)
• People with diabetes, or other chronic medical problems
• People experiencing hormonal changes
• People with Demodex
• People experiencing stress
• People who have had a stye or a chalazion before
• People who wear eyelash extensions or fake/false eyelashes
• People with a history of acne, with or without Accutane treatment

How are Styes and Chalazia Diagnosed?

The diagnosis of both styes and chalazia are made by taking a thorough medical history, listening to your symptoms and examining your eyes with a biomicroscope (slit lamp). Special attention is paid to evaluating your eyelids, eyelid margins, eyelashes, and Meibomian gland orifices (openings). Gentle digital pressure is applied to your eyelids to assess the quality and quantity of the oils secreted by your meibomian glands which reflects the functioning of your Meibomian glands.

The gold standard to directly evaluate your Meibomian glands structurally and anatomically is to image them using advanced technology known as LipiScan. LipiScan is a Meibographer which captures images of your Meibomian glands. Using this state-of-the-art technology your Meibomian glands can be viewed to assess and quantify them structurally.

When you have either functional or structural issues with your Meibomian glands this is known as Meibomian gland dysfunction, or MGD. Blepharitis, Meibomian gland dysfunction, and ocular rosacea are extremely closely related conditions which, to a large extent, have the same treatment protocols.

What is the Treatment for Styes and Chalazia?

Education:

Dr. Muller and her staff place a huge emphasis on education. They spend a lot of time explaining your diagnosis, treatment options, and what you can do to have the healthiest, most comfortable eyes and eyelids, and maintain your best vision, always.

Eyelid Hygiene:

Twice each day, in the morning and in the evening, you should apply warmth to your closed eyes for 20 minutes. This application of heat serves to loosen, or soften, the contents of your Meibomian glands. Warmth is best applied using the Wizard Research Electric Heated Dry Eye Mask. Gel packs, heat masks (Optase, Bruder, other) which are heated in a microwave, and washcloths are not as effective or convenient.

The application of warmth should be followed immediately by washing your eyelids, also referred to as eyelid hygiene. This will wash away the contents of your Meibomian glands you just loosened or softened with the application of the heat, wash away the bacteria that gather at the base of your eyelashes and on your eyelids, and mechanically milk, or massage, your glands helping to keep their contents flowing. Eyelid hygiene is best accomplished by closing your eyes and using gentle soap and water to “shampoo” your eyelashes/eyelids for a full minute (which is a very long time with your eyes closed). You can simply use your face soap, mild bar soap, or Optase gel cleanser.

While in our office Dr. Muller and her staff will teach you how to perform eyelid hygiene optimally. Eyelid Hygiene

EYELID CLEANSING IS ANALOGOUS TO BRUSHING YOUR TEETH

Most of us know that brushing our teeth prevents the accumulation of plaque, and the development of cavities and gum disease. Another part of your daily hygiene should be taking the time to clean your eyelids and eyelashes. Cleaning your eyelids removes debris that can build up over time causing obstruction and loss of your Meibomian glands, known as Meibomian gland dysfunction (MGD). Prevention of MGD using early detection and intervention is essential to the long-term health and comfort of your eyes.

Prescription medications:

Dr. Muller may prescribe antibiotics in the form of eye drops, ointment and/or tablets by mouth depending upon the extent of your infection.

In Office Procedure/Drainage:

If your stye or chalazion does not resolve using warmth and antibiotics, Dr. Muller may recommend drainage. This is easily performed in the office; it is not painful as Dr. Muller anesthetizes the area using local anesthetics.

Note: Please do not try to pop or squeeze a stye or chalazion yourself as this can cause the infection to spread throughout your eyelid.

Depending upon the extent of your Meibomian gland dysfunction (MGD), blepharitis and ocular rosacea the following treatments may be recommended:

Omega-3 fatty acid supplements, in addition to a diet rich in Omega-3s:

Omega-3 supplements should be purified and from re-esterified triglyceride EPA and DHA. Please note that 3000 mg/day are recommended.

https://prnomegahealth.com/products/dry-eye-omega-benefits/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975557//

Manuka Honey – Optimel Brand:

Manuka honey has both natural antibiotic and anti-inflammatory properties. Dr. Muller is always looking for natural ways to treat ocular inflammation (i.e., dry eye, Meibomian gland dysfunction, blepharitis, ocular rosacea). Since these conditions are chronic Dr. Muller would rather emphasize natural treatments rather than medications.

Dr. Muller recommends Manuka honey in two forms: drops and gel.

Manuka honey eye drops consist of 16.5% honey and contain a food preservative (Benzoic acid). We recommend our patients use these drops four times each day.

Manuka honey gel consists of 98% honey and are preservative free. We recommend our patients apply the gel to their eyelids one to two times each day.

Manuka honey products usually sting or burn. The stinging/burning can last for seconds or minutes. This usually dissipates over time.

Possible Additional Prescription Medications:

• Antibiotic ointment at bedtime
• Antibiotic eye drops massaged into the base of your eyelashes at bedtime. These antibiotic eye drops also have anti-inflammatory properties and have proven to be an effective treatment for blepharitis, ocular rosacea, Meibomian gland dysfunction, styes, chalazia and dry eye by relieving symptoms, while enhancing the overall health of the eyes and eyelids.
• Antibiotics by mouth (doxycycline, tetracycline, minocycline, etc.)
• Restasis, Cequa, and/or Xiidra
• Mild steroid drops such as Alrex, Inveltys, Flarex, FML, or Lotemax
• Miebo (perfluorohexyloctane ophthalmic solution) prescription eye drops four times daily. These drops mimic the Meibomian gland secretions reducing the rate of evaporation of your tears from the surface of your eyes. This is especially important when engaged in visually intense tasks such as watching television, driving, reading hard copy, the screens on your devices, and/or your computer.
• Other

Dr. Muller Recommends Using a Nanodropper:

The use of a Nanodropper Adaptor on your eyedrops to reduce the eyedrop volume released each time you use your eyedrops. This reduces cost, waste, and the mess of excess drops running down your face.    https://nanodropper.com/

Mechanical Treatments:

Blepharoexfoliation: Golf Club Spud Exfoliation

Blepharoexfoliation, or exfoliation of the eyelids, unclogs or uncaps your Meibomian glands at their openings called orifices. This has proved to be an effective treatment for blepharitis, ocular rosacea, Meibomian gland dysfunction, styes, chalazia, and dry eye by facilitating the ongoing flow of the oils from the Meibomian glands.

This enhances the health of your eyes, eyelids and Meibomian glands and makes you much more comfortable.

A numbing drop is placed in each eye prior to treatment. Using a handheld instrument known as a golf club spud Dr. Muller painlessly cleans and exfoliates your eyelids removing keratin, debris and the biofilm* plugging, or blocking, the openings of your Meibomian glands.

After the procedure, you are instructed as to how to maintain the benefits. The procedure is typically repeated at intervals which vary based upon each person’s individual needs.

• https://www.ncbi.nlm.nih.gov/pubmed/24145633
• https://www.youtube.com/watch?v=j57ffQ4Olao

 

MicroBlepharoexfoliation (MBE) using BlephEx:

BlephEx™ is a comfortable in-office procedure performed by Dr. Muller using a revolutionary new patented medical device which employs a high-speed rotating micro-sponge to deep clean and exfoliate your eyelids and eyelashes, removing dandruff, scurf, debris and the biofilm* plugging, or blocking, the openings of your Meibomian glands.

This procedure an effective treatment for blepharitis, ocular rosacea, Meibomian gland dysfunction, styes, chalazia, and dry eye. It enhances the health of your eyes, eyelids and meibomian glands.

A numbing drop is placed in each eye prior to treatment. The procedure lasts about 6 -8 minutes, is comfortable and soothing. Most patients simply report a tickling sensation.

After the procedure, you are instructed as to how to maintain the benefits. The procedure is typically repeated at intervals which vary based upon each person’s individual needs.

Heat Treatments:

iLux:

iLux is a handheld medical device which gently and comfortably heats your eyelids to a safe, therapeutic temperature which softens the contents of your Meibomian glands. Once the contents are softened, manual pressure is applied to your eyelids to evacuate the contents of your glands. iLux treatments can be customized to optimize your results by applying more compressions combined with a longer heating time in the areas where you need it most.

iLux is an effective treatment for blepharitis, ocular rosacea, Meibomian gland dysfunction, styes, chalazia, and dry eye. It enhances the health of your eyes, eyelids and Meibomian glands. It makes you much more comfortable by reducing your symptoms.

Not all LipiFlow Treatments are Created Equal: Dr. Muller’s Unique Approach

The results achieved by Dr. Muller’s patients from LipiFlow treatments performed in her office have proven significantly more effective and longer lasting when compared with the results from LipiFlow procedures performed elsewhere.

This is due to Dr. Muller’s thoughtful and intensive methodology which consists of a unique pre-LipiFlow treatment process including  blepharoexfoliation to uncap or unclog your Meibomian gland orifices (the glands' openings in your eyelids). Immediately after your LipiFlow treatment Dr. Muller manually expresses any remaining contents from your glands, all of which is followed by her exclusive, proprietary post-LipiFlow treatment protocol.

Dr. Muller participates in each LipiFlow procedure performed in her office (the procedure is not simply performed by a technician).

It is these distinct differences, combined with the extensive education that each patient is provided, that ensure that Dr. Muller’s patients receive the most effective and longest-lasting results from their LipiFlow treatment.

LipiFlow:

LipiFlow is the “gold standard” for treating blepharitis, ocular rosacea, Meibomian gland dysfunction, styes, chalazia, and dry eye.  This is because LipiFlow is the most effective way to unclog and evacuate your Meibomian glands. LipiFlow is an FDA-cleared electronic medical device that removes Meibomian gland blockages and restores gland function. Through advances in the application of Vectored Thermal Pulsation (VTP) technology, the LipiFlow treatment utilizes a patented algorithm of heat applied comfortably to your eyelids, followed by massage, to remove the obstructions and evacuate the contents of your glands. This deep cleaning allows the Meibomian glands to resume proper oil production and flow, once again contributing the oil layer to your tear film. The entire treatment takes approximately 12 minutes, is comfortable and is extremely effective. LipiFlow enhances the health of your eyes, eyelids and Meibomian glands.

A frequently asked question about iLux and LipiFlow treatments is "How often will I benefit from/need one of these in office deep heat treatments?" The answer is twofold: Dr. Muller explains that most medical conditions exist on a spectrum. You can have mild, moderate, or severe diabetes, hypertension, Meibomian gland dysfunction, blepharitis, or ocular rosacea. You have limited control over this. The part of the equation over which you do have control is your compliance with the home care/maintenance Dr. Muller recommends. People who follow Dr. Muller's instructions go for much longer intervals, or periods of time, between heat treatments because the home care is designed to keep your Meibomian glands flowing (and keep them from clogging). After a deep cleanse is performed in our office each patient is given a proprietary regimen which Dr. Muller has developed over decades and continues to hone. Part of this regimen includes, but is not limited to, using the Wizard electric heat mask twice daily for 20 minutes at a time followed immediately by proper eyelid cleansing (which we teach in our office). By using the Wizard mask to apply the highest heat you can tolerate (without hurting yourself) to your closed eyelids you loosen, or soften, the contents of your Meibomian glands. This should be followed immediately by proper lid hygiene which washes away the contents of the Meibomian glands you just loosened or softened, washes away the bacteria which tend to gather at the base of your lids and lashes, and mechanically massages, or milks, your Meibomian glands keeping their contents flowing.

*A biofilm is a slimy, sticky film of bacteria that coats the surface of the eyelids. A biofilm is composed of a well-hydrated matrix of bacteria and their glycocalyx, a sugary coating that allows cells to adhere to and communicate with each other. The eyelid margin with its moisture, nutrients and warmth, is the perfect environment to cultivate a thriving bacterial biofilm. Some people experience an increased frequency of accumulation of a tenacious biofilm along their eyelid margins. These individuals benefit from periodic exfoliation of their eyelids to keep their Meibomian gland orifices (openings) uncapped or unclogged. This helps ensure the health of the Meibomian glands, decrease irritation and inflammation, and keep the eyes and eyelids their healthiest and most comfortable.

Meibomian Gland Probing (MGP):

A safe, effective, restorative treatment.

Meibomian gland probing (MGP) is a safe and effective procedure for treating obstructive Meibomian gland dysfunction (OMGD). Meibomian gland probing should be considered when more conservative, first line treatments such as warmth, eyelid hygiene, medications and in-office deep heat treatments haven’t been sufficiently effective, the patient continues to experience unwanted symptoms, and/or continues to suffer with recurrent infections (stye, hordeola, chalazia, cellulitis).

What is Obstructive Meibomian Gland Dysfunction (OMGD) and how does it differ from “traditional” Meibomian Gland Dysfunction (MGD)?

In “traditional” Meibomian gland dysfunction (MGD), the Meibomian glands are clogged; in obstructive Meibomian gland dysfunction (OMGD), the Meibomian glands are mechanically obstructed or blocked.

There’s a distinct and very important difference between the clogged Meibomian glands seen in “traditional” Meibomian gland dysfunction (MGD) and the mechanically obstructed Meibomian glands seen in obstructive Meibomian gland dysfunction (OMGD).

In “traditional” Meibomian gland dysfunction (MGD) the oils inside the Meibomian glands, which in normal, healthy glands have the consistency of, and flow like, olive oil become viscous (with a thicker, firmer consistency than lard) clogging the glands resulting in back pressure which stresses the glands causing the glands to shorten, atrophy, and ultimately be lost. These cases can typically be successfully managed with natural remedies, medications, and the application of heat at home coupled with proper lid hygiene, often followed by an in-office deep heat treatment known as a LipiFlow, iLux, or TearCare treatment. These deep heat treatments comfortably apply heat and pressure to liquify and express the solidified contents of the Meibomian glands, thus cleaning the Meibomian glands out. LipiFlow, iLux, and TearCare treatments are extremely effective at melting and cleaning out the contents of the glands, thereby allowing the Meibomian gland oils to flow freely again, unless there are also intraductal, or periductal, mechanical obstructions or blockages…

Obstructive Meibomian gland dysfunction (OMGD) is Meibomian gland dysfunction with either fixed, focal intraductal mechanical obstructions (cellular debris, granulation tissue, fibrosis) or periductal fibrosis, resulting in blockage of the Meibomian gland ducts or pathways. These blockages obstruct the flow of oils, creating increased pressure behind the blockages. This pressure can result in lid tenderness and inflammation, gland shortening, atrophy and loss, recurrent eyelid infections (stye, hordeola, chalazia, cellulitis), and the classic symptoms of ocular irritation associated with dry eye, Meibomian gland dysfunction, blepharitis, and ocular rosacea.

Obstructions can occur at various points in the glands, allowing glands to be partially functional and secreting some oil, or entirely blocked. This is why some glands may produce a little oil, but still not be healthy.

The standard, first line medical treatments and in-office heat procedures used to clear clogged glands when treating patients with traditional Meibomian gland dysfunction (MGD) cannot provide sufficient relief for Meibomian glands with fixed mechanical obstructions found in patients with obstructive Meibomian gland dysfunction (OMGD). The obstructions must first be removed or released for the patient to obtain relief from his/her symptoms, and halt the progression, damage, and loss of Meibomian glands. This is when Meibomian gland probing is medically indicated and invaluable.

If the Meibomian gland obstructions are not mechanically cleared the condition will progress. While symptoms can be episodic, the ongoing irritation, inflammation, and back pressure from the mechanical obstructions can result in cumulative, irreversible damage to the meibomian glands, the eyelids, and the surface of the eyes.

How is Obstructive Meibomian Gland Dysfunction Diagnosed?

The clinical diagnosis of obstructive Meibomian gland dysfunction (OMGD) should be considered when the standard, traditional, first line treatment modalities for Meibomian gland dysfunction have failed to provide sufficient relief of symptoms, the patient’s condition progressively worsens with continued loss of Meibomian glands as seen on meibography, or the patient continues to have recurrent infections of the eyelids (styes, hordeola, chalazia, cellulitis, etc.).

In this situation, Dr. Muller may suggest a diagnostic Meibomian gland probing to obtain additional information. During diagnostic Meibomian gland probing, Dr. Muller probes a few of your Meibomian glands to determine if mechanical obstructions are present. Such probing can firmly establish the diagnosis of obstructive Meibomian gland dysfunction (OMGD).

How Does Meibomian Gland Probing Work/Help?

Meibomian gland probing (MGP) effectively treats obstructive Meibomian gland dysfunction (OMGD) by mechanically clearing the obstruction or blockage of each gland’s lumen/pathway, or releasing the periductal cinching around the gland thus restoring the integrity and patency of the glands’ central ducts. This improves gland form and function, improves the flow of oil secretions, equilibrates intraductal pressure, relieves symptoms, and can stimulate repair of damaged glands and regeneration of missing glands.

Meibomian gland probing is followed immediately by a deep heat treatment (i.e. LipiFlow) which clears the glands allowing oil secretions to flow freely into the tear film relieving symptoms of ocular irritation and dryness making patients much more comfortable.

How is Meibomian Gland Probing (MGP) Performed?

Meibomian gland probing (MGP) is a comfortable in-office procedure. The procedure is performed using a combination of topical anesthetic drops and surgical grade anesthetic gel applied directly to the eyelids.

Once the eyelids are anesthetized, Dr. Muller gently exfoliates all four eyelids to uncap, or unclog, the Meibomian gland openings (orifices) located along the eyelid margins.

Next, ultra-fine specially designed intraductal Meibomian gland probes of varying lengths are delicately passed through the natural openings of the glands and into the Meibomian gland ducts to physically unclog them. Resistance from obstructions is typically encountered. With a bit of additional advancement of the probe, a painless “pop” can be felt and heard by both the patient and Dr. Muller. The successful popping through and release of the obstruction confirms the presence of obstructive Meibomian gland dysfunction (OMGD) and restores the patency of the gland duct.

There are approximately 30- 40 Meibomian glands per eyelid; each should be probed to obtain maximum relief of symptoms and protect against continued progression of damage.

Once Meibomian gland probing (MGP) has mechanically relieved the intraductal and periductal obstructions and re-established the patent outflow channels of the Meibomian glands, a deep heat treatment (i.e. LipiFlow) is performed to completely clean out, or evacuate, the Meibomian gland contents. Patients are then placed on a medical regimen which combines the use of various topical antibiotic and anti-inflammatory medications to optimize their results. Additionally, patients are instructed regarding an at home treatment regimen designed to maintain the benefits of their Meibomian gland probing (MGP) and avoid the development of future obstructions.

Meibomian gland probing (MGP) of all four eyelids takes about 25- 30 minutes and is followed by a 12-minute deep heat procedure (i.e. LipiFlow). Patients typically return to work immediately with no downtime.

Outcomes:

Patients experience maximum symptomatic relief and protection against ongoing progression of disease, with longest lasting results, when they have undergone intraductal Meibomian gland probing (MGP) and a deep heat treatment, followed by the afore referenced medical regimen/at home maintenance program.

It has been reported in the medical literature that 92% of patients experienced immediate relief of their symptoms and that all patients experienced relief by four weeks after probing.

The reported lasting relief of symptoms is thought to be due in part to the re-establishment of Meibomian gland orifice and central ducts after the removal of debris and obstructions. This improves gland function by allowing the Meibomian gland oils to flow freely again. There are also reports in the medical literature of Meibomian gland probing slowing further loss of glands, stimulating repair of damaged Meibomian glands, and the regeneration of missing or atrophied Meibomian glands secondary to stem cell stimulation, activation, and cellular proliferation.

How Frequently Do Meibomian Glands Need to be Probed?

Inflammation is known to contribute to the formation and reformation of Meibomian gland obstructions. As a result, all sources of irritation and inflammation of the eyes and eyelids should be identified and properly treated to minimize the possibility of the glands becoming obstructed again.

The specific answer regarding the frequency with which any given patient would benefit from repeat Meibomian gland probing is multifactorial, unique to each individual, and based on a variety of factors including:

Whether or not that person has coexisting ocular surface issues such as dry eye, environmental allergies, ocular rosacea, blepharitis, Demodex, etc. contributing to the irritation and inflammation of his/her eyes and eyelids.

And, if the person has coexisting conditions, are the conditions mild, moderate, or severe?

Are these coexisting conditions being treated?

How compliant is the person with regard to following Dr. Muller’s recommended medical regimen/home maintenance program?

Is the person remaining comfortable and asymptomatic over time, or has he/she started to have symptoms again?

On objective diagnostic testing in the office, is there evidence of progression of Meibomian gland dysfunction or have we been successful at halting the progression of the condition?

Is there evidence of recurrent obstructive Meibomian gland dysfunction (OMGD)?

Both initial and maintenance probing are intended to mechanically open Meibomian gland orifices and ducts, remove obstructions, maintain patency of orifices and ducts, and restore functionality of glands thus relieving symptoms of Meibomian gland dysfunction, blepharitis, ocular rosacea, and dry eye. In addition, the goal is to halt the progression of Meibomian gland dysfunction by stopping the progressive shortening and loss of glands, promoting repair and recovery of damaged glands, increasing oil production, and potentially stimulating regeneration of missing Meibomian glands.

How Long has MGP Been Around and is it Safe?

MGP has been around for over 15 years. Studies analyzing Meibomian gland probing (MGP) focusing on the procedure’s safety and efficacy have been conducted in the United States, Mexico, China, Russia, Cuba, Turkey, India, and Japan with peer reviewed articles having been published supporting the effectiveness of MGP for patients refractory to standard care as a first-line treatment for Meibomian gland dysfunction. In the studies reviewed, 94% of patients treated with MGP benefited from relief of their symptoms when compared with patients in the control groups.

No negative side effects or complications were reported.

Articles from the Medical Literature:

https://www.tandfonline.com/doi/abs/10.1080/09273948.2018.1522357?journalCode=ioii20

https://bjo.bmj.com/content/102/1/59

Intense Pulsed Light (IPL) Therapy:

While there are many IPL devices, there’s only one that's FDA approved specifically for the treatment of dry eye and Meibomian gland dysfunction. OptiLight by Lumenis was specifically designed to reach the delicate contours around the eyes. It uses patented state-of-the-art Optimal Pulse Technology (OPT) to deliver a safe, comfortable, effective in office treatment for dry eye, Meibomian gland dysfunction (MGD), blepharitis, styes (hordeola), chalazia, ocular rosacea and Demodex.

Intense Pulsed Light (IPL) therapy has been used in dermatology for decades demonstrating a long history of safety and efficacy. The first Intense Pulsed Light (IPL) device became available commercially in 1994 for use in the treatment of rosacea and acne. In 2015 Intense Pulsed Light (IPL) was used for the first time to treat dry eye and Meibomian gland dysfunction (MGD).

In combination with other treatments, Intense Pulsed Light (IPL) therapy can achieve long lasting relief of symptoms and slow, or stop, the progression of dry eye disease, Meibomian gland dysfunction (MGD), blepharitis, styes (hordeola), chalazia, ocular rosacea and Demodex.

How Does Intense Pulsed Light (IPL) Therapy Work?

Intense Pulsed Light (IPL) therapy successfully treats dry eye disease, Meibomian gland dysfunction (MGD), blepharitis, styes (hordeola), chalazia, and ocular rosacea by improving the health and functioning of damaged Meibomian glands. With IPL treatment the Meibomian glands recover in both form and function resulting in the glands producing oil of better quality and quantity, stabilizing the tear film, thus reducing patients' symptoms (making them much more comfortable), while enhancing their vision by supporting a smoother, healthier ocular surface.

The three biggest issues which adversely affect the health and functioning of the Meibomian glands are inflammation, dilated, damaged and leaking blood vessels, and Demodex. IPL works by targeting and treating all three. Inflammation is also the underlying cause of dry eye (keratitis sicca). This inflammation harms blood vessels in the area causing them to dilate and rendering them hyperpermeable, or leaky, releasing plasma* into the surrounding tissue. The plasma released into the tissue contains pro-inflammatory mediators which fuel a vicious cycle of inflammation adversely affecting the health and comfort of the eyes and eyelids.

Intense Pulsed Light (IPL) utilizes light energy of specific wavelengths to precisely target the leaky, damaged, dilated blood vessels in the skin around the eyes rendering these vessels healthier. Inflammation in the area is dramatically reduced by stimulating constriction of dilated blood vessels and suppressing their leakage. IPL reduces inflammation by breaking the cycle of inflammation.

This reduction of inflammation allows for recovery of the Meibomian glands in both form and function, improves the quality of the tear film, enhances tear film stability, reduces evaporation of the tears from the surface of the eyes, and improves ocular lubrication, thus improving dry eye signs and symptoms. In addition to making patients much more comfortable, IPL therapy can also reduce reliance on medications. Lastly, Intense Pulsed Light (IPL) therapy stimulates collagen production in the skin which can improve the overall health and appearance of the eyelid area and surrounding tissues.

*The plasma which leaks from damaged blood vessels contains pro-inflammatory mediators including, but not limited to, vascular endothelial growth factor (VEGF), prostaglandin E2 (PGE2), and pro-inflammatory cytokines.

What To Expect on The Day of, and Following, Your Intense Pulsed Light (IPL) Treatment:

On the day of your treatment you can eat and drink normally.

Please do not wear any make-up on the day of your treatment. You can bring your makeup with you and apply it after your treatment.

Anesthetic eye drops will be placed in your eyes. Your eyes will then be covered with protective shields. This will be followed by the application of a thin layer of cooling gel to the area being treated (similar to the gel used for ultrasounds). Next, a handheld Intense Pulsed Light (IPL) device will be used to deliver gentle pulses of light.

A typical Intense Pulsed Light (IPL) treatment session for dry eye, Meibomian gland dysfunction (MGD), blepharitis, styes (hordeola), chalazia, and/or ocular rosacea lasts about 10-15 minutes.

Cold gel packs are then applied to the treated area.

There may be some redness, a warm sensation, and slight inflammation in the treated area which, if present, typically disappears in 1-72 hours.

There are no restrictions on activities following the treatment; patients can resume their normal activities as no downtime is required.

To ensure the best results you must protect your skin from the sun.  Following your IPL treatment it's essential to protect your skin from direct sun exposure for the first 72 hours and apply paraben-free sunscreen (SPF 30 or more) several times a day. Applying sunblock and moisturizer should be/become part of your daily routine.

Please follow the post-treatment regimen Drs. Malawer and Muller have provided.

Treatment Schedule:

The treatment protocol needed to achieve optimal results includes 4 treatment sessions spaced 2-4 weeks apart. While some patients report improvement after 2 or 3 sessions, maximum improvement is achieved after 4 treatments.  Improvement in both the way you feel and look generally takes place gradually over weeks. The frequency of subsequent maintenance treatments varies from person to person, however, are generally performed every 6-12 months to ensure long-term benefits. Your custom treatment plan will be individualized and tailored to your personal needs.

Intense Pulsed Light (IPL) Therapy’s Safety Over Decades Has Been Established in the Treatment of:

Skin rejuvenation: Improving skin tone and texture. Reducing fine lines, wrinkles and signs of aging by stimulating collagen production thus giving skin a firmer, more voluminous, youthful appearance.

Ameliorating unwanted pigmentary changes, sunspots, age spots, and sun damage.

Rosacea and vascular lesions (spider veins, broken capillaries).

Enlarged pores by reducing pore size.

Treating acne by targeting the bacteria (p. acne) that causes breakouts and reducing inflammation.

Treating acne scars.