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What an amazing interview we had with Dr. Laura Periman, aka the Dry Eye Master. She's also an IPL expert and creator of the Periman IPL Protocol. We cover a plethora of information in this interview, but more specifically talk about what you need to be doing to heal your rosacea, meibomian gland dysfunction, dry eyes, blepharitis, and any other inflammatory disease that affects your eyes or skin.
I will put some of the great talking points below, but tune in to the whole video above.
Trust me, you’ll want to listen to the WHOLE thing!
I want to dig a little deeper into a topic that Dr. Periman discusses in depth from this study… the BEISTO. The BEISTO is the six interrelated mechanisms that we need to be thinking about when treating MGD (blepharitis, dry eye, and rosacea too).
I have never seen such a well put together reasoning behind meibomian gland dysfunction and how we need to address six different mechanisms of MGD. She goes into this in depth around the 18 minute mark of the video, but I wanted to explain what each part means and how you can help with it. She later explains how IPL address FIVE of these six.
With meibomian gland dysfunction and blepharitis there is always a bacterial component involved. With that being said, we need to have a great eyelid hygiene routine that helps reduce this bacteria load. With rosacea, MGD, dry eye disease, and blepharitis you should never use harsh, chemically-ridden soaps or surfactants (like eyelid scrubs) and stick to using a hypochlorous acid eyelid cleanser on your eyelids.
Also, wash your face and eyelids with a face wash that does not contain harsh chemicals, detergents, and artificial ingredients. Choose something that uses all natural ingredients.
When it comes down to your routine, use simple products that contain ingredients that you can pronounce and that contain very few ingredients (this goes for your food too). Your twice daily routine should look something like this:
Meibomian gland stem cells have to go through a biochemical conversion to create meibum from cholesterol and lipids. Since this meibum comes from cholesterol and lipids, a diet filled with HEALTHY oils is necessary. The healthier the oils that you consume, the better the building blocks are that your body has to use. Give the meibomian gland stem cells healthier building blocks with a better diet.
This all starts with an organic plant-based, alkaline diet, that is rich in healthy oils. We discuss this in depth with our book, Rethinking Dry Eye Treatment (get the PDF for free here or purchase the paperback here).
T-cells are a part of our immune system and are responsible for cleaning up the inflammatory mess caused from foreign invaders and cancer cells. Unfortunately when chronic inflammation is around for an extended period of time, these “helpers” can cause more harm than good by releasing toxic cytokines over an extended period of time, which are further damaging the meibomian gland stem cells (where meibum, or your oily layer of tears, starts). This prevents the meibomian glands from creating a good quality oil.
Stasis’s definition is a slowing or stoppage of the normal flow of a bodily fluid or semifluid. This is most easily thought of through an analogy with your meibomian glands. They are constipated (just like going number two)! We need to get them functioning and moving again.
Temperature is more easily thought of as warm compresses, or heating up the glands. A question we get quite often is “Should I do warm compresses?” This depends on other factors as well. If warm compresses seem to make things worse, then stop doing them. This usually occurs in the case of rosacea and can be a telling sign that you have rosacea. If you notice symptom relief and do NOT have rosacea, then continue doing warm compresses.
Obstruction is just a simple blockage and occurs at some point in the meibomian gland, which can be cleared, but is reserved for special cases.
11:00 - Lysate probiotics have a great healing on the eyes, gut, and brain and should be put in your green smoothies. Rosacea, specifically, usually has big problems with the gut and diet is where treatment needs to start. The LAST thing we want to do with rosacea is throw Doxycycline on it (AMEN)!
13:45 - How Dr. Periman interprets MGD and rosacea… Rosacea is more of a clinical diagnosis where she sees telangiectasia on the eyelids. This makes her assess the meibomian glands and score them based on the reduction of the oil and the quality of the oil, which becomes her target for IPL. With IPL she is able to reduce the treatment time for MGD and rosacea from one to two years to three to four months.
15:15 - What is the cause of rosacea, meibomian gland dysfunction, and dry eye?
How does she treat the different causes (we discuss this in depth in our book, Rethinking Dry Eye Treatment)?
She loves using this for the patient that has “tried everything.”
17:30 - What about expression after IPL? Dr. Periman reviews the peer reviewed literature.
18:30 - The Six Interrelated Mechanisms - BEISTO
22:00 - When you should NOT do warm compresses and she lets us know what the triggers for rosacea are.
25:00 - What you should be cleaning your face and eyelids with when you have rosacea and MGD.
28:45 - Dr. Periman discusses the cost of IPL and why some procedures cost more than others.
30:00 - How IPL addresses five of the six mechanisms of the BEISTO
35:00 - Dr. Periman, future author?
36:00 - Side effects of IPL
40:00 - Is it FDA approved for your eyes and eyelids?
47:00 - How to set an appointment with Dr. Periman (Seattle Dry Eye Specialist) and how to follow her.
49:00 - Lisa Murphy - Is gland expression necessary after an IPL treatment?
49:20 - Christine Miller - Is there a place for IPL in cases of MGD due to Sjögrens?
49:50 - Sonia Oxford - How close to the eye does IPL take place?
50:50 - Kim Johnson - Are steroid drops helpful after IPL?
51:40 - Tracy Galloway - Does it help eliminate the redness in the white part of the eye?
53:00 - Tracy Galloway - Do you recommend warm compresses following IPL? It seems counterintuitive?
53:45 - Barbara Gruccio - Has anyone had improvement in red eyelids and/or broken capillaries on the eyelids or under the eyes with IPL treatment ?
54:45 - Barbara Gruccio - Is IPL better without shields?
55:10 - Sheila Clemons - Is there any reason a BBL machine can’t be used for this treatment instead of the m22 Ipl?
56:00 - Sheala Clemons - I am having IPL done without treating the eyelids. Is there a point (# of treatments) where you should switch over to treating the eyelids if you don’t see significant results? Can Dr Periman weigh in on the fact that many doctors refuse to treat full face when dealing with OR and facial rosacea? Have studies been done proving that full face treatment makes a significant difference?
57:40 - Terry Lemke - Is there added benefit in having Blephex just prior to an IPL treatment?
59:00 - Tracy Galloway - Are you seeing any growth in atrophic glands following IPL?
1:01:50 - Nadine Nehme - How do patients do with IPL if their dry eye is due to Accutane?
1:02:40 - Linda Cline - Is this useful for someone with no ocular rosacea?
1:03:00 - Anu asks - IPL works for telangiectasia, but does it also work for pustules in rosacea?
References:
https://bjo.bmj.com/content/bjophthalmol/early/2016/01/18/bjophthalmol-2015-307415.full.pdf
