Intense Pulse Light (IPL) Risks and Retinal Detachment

Intense Pulsed Light (IPL) Risks and Retinal Detachment

Currently there are no reported cases of a retinal detachment after Intense Pulsed Light in any patients even patients who have previously had a retinal detachment on PUBMED, the Johns Hopkins Medical Center Search Engine, or on the internet. If you have ever heard of an association, please let me know.

IPL helps get rid of pigmentary lesions it is thought by inducing rapid differentiation (makes these cell divide fast & get older faster) of keratinocytes with the thermal heat. This makes the pigmented cells called the melanosomes and the necrotic (dead) keratinocytes move forward in the skin. This leads to their elimination from the skin as microcrusts at the skin surface. These effects have been demonstrated in vivo using both reflectance-mode confocal microscopy and optical coherence tomography: where you can actually see with the naked eye melanosomes moving up in the skin: reference below.

Likely IPL works at the Meibomian Glands the same way, though no one has seen this yet with the human eye. Likely IPL makes the meibum cells differentiate fast and moves them towards the surface. 

Interestingly as well, I must add, Harvard phD in String Theory–Physics friend, swears that using diluted tea tree oil daily (after even washing it off fully each time) makes his eyes feel better and he can feel more oil pumping out of his eyelids. Who knows: does anyone want to contribute to our research fund and help us figure out how IPL really works for Dry Eyes? And see if his theory about Tea Tree Oil really is true. 

Currently there are are few reported complications of using IPL around the eye. 
Here is a list of all complications I could find. 
1. Hyperpigmentation: too much pigment on area treated
2. Hypopigmentation: loss of pigment in treated area
3. Folliculitis: inflammation of the hair follicles
4. Paradoxical hypertrichosis: too much hair and irregular hair growing in treated area
5. Iritis: when IPL was treated near the eye. Could only find 1 case report when this was first posted. 

Since we started using IPL to treat patients with Dry Eyes, I have had a 85% success rate in patients satisfaction. I have had now 5 patients where the Lipiview/Lipiscan looked better with more oil lighting up on the scan after treatment. I am still not sure how to explain this as we have always thought that once a gland is “gone” it cannot come back. Likely it is not gone and it can come back in some patients. 4 of the 5 patients had 6 treatments. 1 of these patients, it was noted after the 4th session. 

We have not seen any of the above complications, likely because we are very careful with using metal eye shields always and begin with the lowest energy needed to express the meibomian glands. 

Below are studies noting the risks of IPL in general.

Sandra Lora Cremers, MD, FACS

Radmanesh M, Azar-Beig M, et al. Burning, paradoxical hypertrichosis, leukotrichia and folliculitis are four major complications of intense pulsed light hair removal therapy. J Dermatolog Treat. 2008;19(6):360–363.

A 2014 Nov;55(4):289-91. doi: 10.1111/ajd.12137. Epub 2014 Jan 14.

Intense pulsed light therapy (IPL) induced iritis following treatment for a medial canthal capillary malformation.


The popularity of intense pulsed light (IPL) therapy continues to increase due to its relative safety, high skin coverage rate and ability to treat both vascular and pigmented lesions. An often-overlooked risk is the potential for IPL-induced ocular damage. The damage sustained can cause significant, persistent morbidity and can occur even with very limited IPL exposure to the eye.

 2009 Sep;41(7):534-9. doi: 10.1002/lsm.20801.

Assessment of the optical radiation hazard from a home-use intense pulsed light (IPL) source.



Intense pulsed light (IPL) systems have evolved and crossed over from the clinic to the home. Studies have shown home-use IPLs to be clinically effective but there has been no published data on ocular safety. It was our aim to measure the spectral and temporal optical radiation output from a home-use IPL and assess the ocular hazard.


The iPulse Personal is a new home-use IPL hair reduction system. We measured its optical radiation spectral output using a calibrated diode array spectrometer that was traceable to national standards. Pulse duration was determined by measurement with a fast photodiode. The results from these measurements were used to assess the optical radiation hazard to the human eye. Retinal thermal hazard (RTH), blue light hazard (BLH), and infrared radiation hazard to the cornea and lens were assessed in accordance with IEC TR 60825-9 and the International Committee on Non-Ionizing Radiation Protection (ICNIRP) Guidelines on Limits of Exposure to Broad-band Incoherent Optical Radiation, as there are no specific international IPL standards.


Neither the BLH radiance dose nor the infrared radiation hazard to the cornea and lens irradiance exceeded the exposure limit values (ELVs) set by the ICNIRP. The RTH radiance, however, was exceeded at a fluence of 11 J cm(-2) and pulse duration of 16 milliseconds. Following these results the settings on the IPL were adjusted and the RTH was no longer exceeded at a new fluence of 10 J cm(-2) and pulse duration of 26 milliseconds.


The home-use device that we assessed does not present an optical hazard according to currently available international standards.

 2016 Dec;35(4):218-222. doi: 10.12788/j.sder.2016.061.

What devices to use or not use in skin of color.


Lasers and light sources, as well as other energy devices, including radiofrequency, ultrasound, and cold-based therapies, can be used for treatment of aging, dyschromic, or texturally uneven skin. In patients with ethnic skin (ie, skin of color), energy devices are used more cautiously to avoid adverse events. The most common and concerning adverse event is postinflammatory hyperpigmentation. Lower fluence, longer pulse durations, and careful device selection can mitigate the risk of scarring and pigmentary abnormality. Modified treatment approaches can allow physicians to safely treat patients with skin of color with energy devices.

Intense pulsed light

From Wikipedia, the free encyclopedia
For other uses, see IPL (disambiguation).Intense pulsed light (IPL) is a technology used by cosmetic and medical practitioners to perform various skin treatments for aesthetic and therapeutic purposes, including hair removalphotorejuvenation (e.g. the treatment of skin pigmentation, sun damage, and thread veins) as well as to alleviate dermatologic diseases such as acne.[1][2][3][4][citation needed] IPL is increasingly used in ophthalmology as well, to treat evaporative dry eye disease due to meibomian gland dysfunction.[5][6][7][8] The technology uses a high-powered, hand-held, computer-controlled flashgun to deliver an intense, visible, broad-spectrum pulse of light, generally in the visible spectral range of 400 to 1200 nm. Various cutoff filters are commonly used to selectively filter out lower wavelengths, especially potentially damaging ultra violet light. The resulting light has a spectral range that targets specific structures and chromophores (e.g. melanin in hair, or oxyhemoglobin in blood vessels) that are heated to destruction and reabsorbed by the body. IPL shares some similarities with laser treatments, in that they both use light to heat and destroy their targets. But unlike lasers that use a single wavelength (colour) of light which typically matches only one chromophore, and hence only one condition, IPL uses a broad spectrum that when used with filters, allows it to be used against several conditions. This can be achieved when the IPL technician selects the appropriate filter that matches a specific chromophore.[9]


Intense pulsed light is the use of intense pulses of non-coherent light over a range of wavelengths from 500 nm to 1200 nm.[10] Xenon flashlamps produce high output bursts of broad spectrum. Cooling is used to protect the skin in contact with the device.
Regulations governing IPL vary by jurisdiction.[11] “Intense Pulsed Light” is not a registered trademark. A distinction is sometimes made between beauty-grade and medical-grade machines, mainly to get around regulations. Under the CE marking system no such distinction exists.
The first FDA approval of IPL was for telangiectasias in 1995. Use quickly spread to a variety of medical and cosmetic settings. Treatment is generally safe and effective, but complications can occur such as hyperpigmentation.[12] The polychromatic light can reach multiple chromophores in human skin: mainly hemoglobin, water, and melanin. This results in selective photothermolysis of the target, which can be blood vesselspigmented cells, or hair follicles.

Hair removal[edit]

IPL can permanently reduce hair growth, most effectively in darker, coarser hair. There are many names and devices for pulsed light treatments such as E-Light, ELOS, and M-Light.[citation needed] Laser hair removal is different and uses coherent, monochromatic laser light.


Broad-spectrum light is applied to the surface of the skin, targeting melanin. This light travels through the skin until it strikes the hair shafts or the bulb (root). The bulb is usually where the highest concentration of melanin is located. As the light is absorbed, the bulb and most of the hair shaft are heated, destroying the hair-producing papilla. It is also claimed that heat conversion occurs directly in the darker capillaries that bring blood to the follicle.
At any one time, not all hair follicles are ‘active’, and only active hair follicles can be affected by the treatment. ‘Inactive’ hair follicles can be treated as they become ‘active’ over time. For IPL treatments, an average of 8–10 treatments are required to remove most visible hair.[13][citation needed] No common treatment protocol exists and it depends on the equipment used and patient skin type. The area to be treated should be clean shaven and free of sunburn. Treatment sessions are usually 4 to 6 weeks apart. Treatments are often given in doctors’ offices and so-called “medspas” by trained practitioners. Avoid treatment by inexperienced and/or unlicensed practitioners.
Contrary to what is often claimed, photoepilation is not a permanent hair removal method but a permanent hair reduction method. Although IPL treatments will permanently reduce the total number of body hairs, they will not result in a permanent removal of all hair.[14] This distinction is only relevant in the USA because of FDA wording.
Certain skin conditions, health irregularities, and medications can impact whether it is safe for a person to receive a light based hair removal treatment.[15][unreliable source?] Photo-sensitizing medications, or damage to the skin are contraindications to treatment. According to Remington, manufacturer of an IPL device, all IPL and laser devices should only be used on light to medium skin tones, and work best on darker hair.[16]

Efficacy[The first use of a specific IPL system developed for hair removal is reported in the literature in 1997.[17] Hair count reduction was found to be ~60 % (12 weeks), 75% (1 year), 60% (2 year). Various treatment protocols have been studied.[18][19]

It is important to note that these studies utilized a variety of IPL devices on various skin areas, and used patients with varying hair and skin types. Thus the results are not directly comparable. In evaluating these results it is also important to remember that even a reduction of 75% indicates that 25% of the hair regrew after treatment. Permanent hair removal in these studies, as defined by the FDA, means the “long-term, stable reduction in the number of hairs regrowing after a treatment regime”. The number of hairs regrowing must be stable over time greater than the duration of the complete growth cycle of hair follicles, which varies from four to twelve months by body location.[20] No treatment to date has shown the ability to permanently eliminate all hair growth, however many patients experience satisfaction with a significant and permanent reduction.
A 2006 article in the journal “Lasers in Medical Science” compared IPL and both alexandrite and diode lasers. The review found no statistical difference in effectiveness, but a higher incidence of side effects with diode laser treatment. Hair reduction after 6 months was reported as 68.75% for alexandrite lasers, 71.71% for diode lasers, and 66.96% for IPL. Side effects were reported as 9.5% for alexandrite lasers, 28.9% for diode lasers, and 15.3% for IPL. All side effects were found to be temporary and even pigmentation changes returned to normal within 6 months.[21]

Medical useIPL was first developed for vascular conditions. It is at least as effective as pulsed dye lasers and can penetrate deeper with reduced risk of purpura and hyperpigmentation. IPL can also be used for the treatment of dry eye conditions such as meibomian gland dysfunction.[22][23] IPL can treat pigmented lesions with rapid recovery. Dyschromia can be cleared after repeated sessions. Photoaging treatment has been explored. A series of IPL can be used for facial rejuvenation, improving skin laxity and collagen production. IPL combined with facial injections can be used for dynamic rhytids. Home devices have been developed recently.

IPL is employed in the treatment of a range of dermatological conditions[24] including photodamage induced dyspigmentation and vascular changes, poikiloderma of Civatterosaceaacne vulgaris, sebaceous gland hyperplasia, broken capillaries/telangiectasesvascular lesions (small blood vessels), pigmented lesions (freckles, liver spotsbirth marks ), melasmaactinic keratosisphotorejuvenation, basal cell carcinoma, and Bowen’s disease (squamous cell carcinoma).[citation needed]
Shopping Cart