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We have been performing intense pulse light (IPL) therapy with the Quadra Q4 system (Dermamed Solutions) since December of 2011. I was trained to perform the IPL procedure by Rolando Toyos, MD, and have had great success with this in my dry eye practice, particularly with rosacea patients.

How It Works
The Quadra Q4 is a compact device and is very inexpensive to operate. We use it regularly and keep it on a mobile cart in one of our exam lanes. Maintenance simply requires periodic bulb replacement.

To operate the device, we program the appropriate settings once the device is turned on. The trigger button is depressed to activate the light and the hand piece is then moved along from the right tragus, across the cheek, the bridge of the nose, then across the opposite cheek to the left tragus. The lightheats the meibomian secretions while destroying the small blood vessels near the surface of the skin that cause inflammation associated with rosacea. The Quadra Q4 emits light in the visible region of the spectrum. Because of the heat generated with the treatment, cool ultrasound gel is used and care must be taken to avoid complications such as burns. Heavily pigment patients are not candidates for IPL treatment.

I make two applications with the patient in the reclining position and then express their meibomian glands immediately afterwards. We perform an initial series of four treatments over four months and have patients return for a re-treatment every 4 to 6 months. IPL is not covered by insurance so patients pay for the procedure out-of-pocket.

I do not delegate IPL procedures to my optometrist or technicians. While it’s a simple procedure, I prefer to perform IPL myself due to the inherent risks involved. You have to be selective with regard to which patients have the procedure performed. I must stress again that IPL cannot be performed on patients with heavily pigmented skin.

IPL is a simple and effective treatment for meibomian gland dysfunction (MGD). I would highly recommend including this as part of your dry eye practice.