Several reports that have advocated the use of intense pulsed light (IPL) for the treatment of acne also suggest some efficacy against Demodex.

Dr. Neil Sadick of Cornell University in New York, conducted an investigation of 24 patients with a mean age of 47 years and Fitzpatrick skin types I-IV. He treated them with an IPL device (Quantum SR, ESC-Lumenis), which emits a noncoherent, multiwavelength of light of 500 nm to 1,100 nm. Patients were treated monthly, up to five times, using an average fluence of 25 to 45 J/cm2. At a recent conference he reported that IPL appears to kill mites around hair follicles and sebaceous glands, which could make it useful in treating rosacea. However, the use of this device in other conditions is not yet standard of care, and these procedures should be performed under dermatologic supervision.5

The role of IPL in OSD treatment: Page 2 of 3

• Harvey A. Fishman, MD, PhD

June 12, 2019

• Let’s Chat, Blogs

The mechanism, although not entirely clear, appears to be caused by the reduction of telangietic blood vessels that supply inflammatory factors to the eye. When these pathways are closed, the inflammatory cycle is reduced. In the aesthetic/cosmetic world, IPL has been long known to improve OSD symptoms in facial rosacea patients.

Deeper in the ocular microbiome

Demodex is associated with both facial and ocular rosacea. The parasite is a component of MGD, which in turn, is part of DED—it is a vicious cycle. In large numbers, Demodex itself becomes an inflammatory nidus for the eye, consuming bacteria called Bacillus oleronius. It is hypothesized that the interaction of the parasite and the lid’s bacterial load underlies eye lid margin inflammation.14-17

IPL has been shown to dramatically reduce Demodex when studied via punch biopsy before and after treatment. IPL lowers the inflammatory cytokine matrix metalloproteinase 9, a protease that literally “eats” the cornea. Questions remain around the exact mechanism at work and if IPL is definitively killing Demodex—I am in the process of gathering this evidence.

IPL protocol

In my practice, I take a comprehensive “holistic” approach to OSD. I consider everything from the gut microbiome—recommending an anti-inflammatory diet (e.g., omega-3 supplementation)—to devices like IPL and manual expression of the glands to prescription drops to scleral contact lenses for crippling disease.

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