For a long time, I thought I understood why IPL was part of my MGD treatment. My meibum was extremely thick, my glands were badly blocked, and heat helped. So IPL seemed like an obvious choice.
Today, I look at that logic very differently.
Not because I now think IPL is a bad treatment. I don't. And I can't even tell you that it didn't help me — it may have. The problem is that throughout my treatment I was doing several things at the same time, and only much later did I start asking myself a question that seems incredibly obvious now:
What exactly were we trying to achieve with IPL in my particular case?
That question changed the way I think about my whole treatment.
I Used to Put IPL and Expression Into the Same Box
My main problem was very easy to see. The meibum in my glands was unbelievably thick. At the beginning, my doctor could barely express anything at all. Later, we started getting material that looked nothing like normal oil — it was thick, almost like toothpaste or clay.
So I didn't really separate IPL and meibomian gland expression in my mind. They were one treatment. IPL warmed everything up, and then my doctor expressed the glands. Since warm compresses also helped me, the whole thing seemed perfectly logical.
I ended up having eight IPL sessions, with expression after each one.
And my glands did improve.
The problem is that this tells me almost nothing about which part of the treatment was responsible for what.
That's something I didn't think about at the time.
What My Glands Were Doing Was Much More Interesting Than the Number of IPL Sessions
I sometimes see people asking, “Which IPL treatment was the one that finally worked for you?” I don't really have an answer. There wasn't one. My glands changed gradually over a very long period. In the beginning, almost nothing could be expressed. Then tiny amounts of extremely thick meibum started coming out. Much later, it became softer. Eventually, we began seeing much more normal-looking oil. It was such a slow process that if I looked at two appointments next to each other, sometimes I couldn't see progress at all. I could only see it when I looked much further back. There was one spectacular exception, though. After one of my later treatments, a single gland suddenly started releasing an enormous amount of oil. I could literally see lipid spreading across my eye every time I blinked. It continued for hours — enough to blur my vision and actually become irritating. That one little gland taught me something I hadn't really appreciated before: a gland can be tiny and still have an astonishing amount of material behind an obstruction. But none of my other glands behaved like that. There was no dramatic opening. Clearing them was more like slowly working through something that had accumulated over a very long time. And that, looking back, may be one of the reasons I misunderstood what was helping me. If you're interested in understanding more about the different methods for treating MGD, check out the insights in this article on Probing vs. IPL & Expression.
Then IPL Disappeared From My Treatment
This is where my story gets interesting.
After my eighth IPL, I had a skin injury and couldn't continue. Some of the changes to my eyelid skin turned out to be permanent, so IPL was simply off the table.
I continued having my glands expressed.
And they kept improving.
I had roughly another eight expressions without IPL and without special in-office heating. The process remained frustratingly slow, but I didn't suddenly stop making progress when I stopped IPL.
This doesn't prove that IPL hadn't helped me before. It only means I can't separate its contribution from everything else I was doing.
Maybe IPL had reduced inflammation if there was any. Or maybe not. There is simply no way for me to know now.
But it did make me reconsider the explanation I had carried around for a long time:
My meibum is very thick, therefore I need IPL.
Today, I wouldn't make that connection automatically.
I Think I Was Asking the Wrong Question
When I started treating my MGD and dry eyes, my question was basically:
What treatments are used for MGD?
IPL was one of them. I had MGD. End of story.
If I were starting again today, I'd ask something different:
What part of my particular MGD are we trying to treat?
That sounds like a tiny difference, but I think it's a huge one.
If inflammation is an important part of the picture, that's one thing. If there is rosacea or a vascular component, that's useful information too. If the most obvious problem is severely obstructed glands full of thick meibum, I would want to know what part of the treatment plan is specifically intended to deal with that.
And of course, several of those things can exist together.
This is something I didn't understand at the beginning. MGD was one diagnosis in my head, so I expected there to be one standard collection of MGD treatments.
My experience eventually taught me to think about it almost backwards: first understand as much as possible about what's actually going wrong, and then ask what each treatment is supposed to do about it.
Do I Regret Doing IPL?
This is actually difficult for me to answer.
The skin damage obviously makes me wish I could go back and make different decisions. That's probably unavoidable.
But medically, I don't know what would have happened if I had never done IPL. Maybe my recovery would have been exactly the same. Maybe it would have been slower. Maybe IPL played an important role that I simply couldn't see.
So I don't think my story supports saying “IPL didn't work for me.”
It also doesn't support saying “IPL fixed my glands.”
The most accurate answer is much less satisfying:
I don't know.
What I do know is that my glands continued changing after IPL was gone, while expression and my home routine continued. And that made me much more careful about attributing improvement to whichever treatment happened to be happening at the same time.
What I Would Do Differently Today
I would ask more questions before starting.
Not “Is IPL good for MGD?”
But:
Why do you think IPL is appropriate for my eyes? What are you seeing that we're trying to change? What is expression supposed to accomplish? What is IPL supposed to accomplish? How will we know whether either of them is working?
I think those questions would have helped me understand my own treatment much better.
And maybe that's the most useful thing I can take from the whole experience.
After eight IPL treatments, around sixteen gland expressions and a ridiculously long MGD recovery, I've become much less interested in whether a treatment is generally considered “good for MGD.”
I want to know:
Good for which part of MGD? And why?
That is the question I wish I had asked from the beginning.
