IPL is the one treatment I keep going back to. Here's exactly what intense pulsed light is like, the cold gel, the little zaps, the cost, and whether it actually helps, from someone who's been having it since 2018.
IPL stands for intense pulsed light. It was recommended to me because, as well as being tear-deficient, I also have meibomian gland dysfunction: the little glands along your eyelids that are supposed to produce the oily part of your tears weren't doing their job properly. And out of everything I've tried over the years, IPL is the treatment I've stuck with. Eight years and counting.
Here's the cycle it's trying to break. When your eyes are inflamed, that inflammation affects your meibomian glands: they can get blocked and start producing less oil. And if oil stops flowing through a gland for long enough, the gland can actually atrophy, basically waste away and disappear for good. Once they're gone, they're gone. So keeping the oil flowing and the inflammation down really matters, and that's exactly what IPL is for.
IPL works in a few ways at once. The light is absorbed by the abnormal little blood vessels around your eyelids and closes them off, which reduces the inflammatory signals that wind your glands up. At the same time, the heat helps melt the hardened oil so it can actually come out of the glands again. It even helps reduce the tiny mites and bacteria that can build up along the lash line.
Funnily enough, it came from dermatology: IPL was being used on facial rosacea, and doctors noticed patients' dry eye got better as a side effect. Now it's used specifically for dry eye. If you want the proper reading, here's a good review of how IPL works for gland dysfunction, and a randomised trial showing IPL plus gland expression works better than expression on its own, which matters, as you'll see in a second.
I first had it done at the Dry Eye Centre in London with Dr Tam, back in 2018 when all of this began. I honestly can't remember exactly how many sessions I had there. I definitely did the initial four back-to-back, then a good few maintenance ones on top that I've long since lost count of. The usual protocol is four sessions, one every two weeks to get things under control, and then maintenance sessions after that.
I was nervous the first time, but there's really no need to be. Here's how it goes:
The best way I can describe the sensation is someone flicking you gently with an elastic band. That's it. And the machine makes a little "zap" noise with each pulse. It's completely normal, just the sound of the device.
After the light, Dr Tam would do gland expression, using a little tool to gently squeeze the glands and get the oils moving, and to see what was actually coming out. This is the bit the research backs up: IPL works best when it's paired with expression straight afterwards, which is exactly what he did.
Honestly? The IPL itself doesn't hurt. The expression can be a bit uncomfortable, bearable, but I wouldn't call it nothing. Worth it, though.
And it wasn't just a feeling that it was working. After my initial four back-to-back sessions, when he checked how my glands were flowing, you could genuinely see the difference: more oil coming through than before. That was the proof, for me, that it was actually doing something.
There's basically no downtime. You can go straight back to your day. Occasionally I've had a little redness on my face afterwards, and my skin can feel a bit hot, but it always calms down quickly. My eyes do feel a little more tired than usual right after, which makes sense: they've just been poked and prodded. By the next day I'm completely fine.
After that initial run of four, it becomes maintenance. For me, the sweet spot is every four months, so three times a year. If I leave it closer to six months, I start to feel myself getting "bunged up" again.
And here's something you'll only really understand if you live with this: dry eye doesn't feel the same all the time. Sometimes your eyes feel dry, sometimes sticky, sometimes they're actually watering. I can tell when my glands are getting clogged again because my eyes start to feel sticky, and sure enough, when I go in, they'll say "yep, you're a little bunged up." I can feel it before they even tell me.
Life doesn't always fit the schedule, mind you. I live abroad for chunks of the year, so recently I went about eight months without any IPL. So right now I'm doing what you do to restart: two sessions close together (I had one two weeks ago and I've got another tomorrow) to kickstart it, then back to every four months.
Back in 2018, the closest place I could find doing IPL for dry eye was London, a good hour and a half to two hours on the train each way. These days I go somewhere much closer to me: Matheson Optometrists, at their Alresford practice, and Mr Matheson has been brilliant.
He does it a little differently. Rather than just doing under and above my eyes, he does my whole face, forehead, chin, the lot, which helps with overall facial inflammation. And instead of the manual expression I had in London, he uses a heated, vibrating eye wand to loosen the oils. I bought one myself to use at home (the Peep Club Heated Eye Wand). Little bonus: IPL is also great for fine lines and wrinkles, so at least my skin gets to look fresh while I'm at it. Every cloud.
One genuinely good thing: IPL is far easier to get hold of than it used to be. When I started in 2018 I had to trek all the way to London; now it's popping up in opticians all over. I even had it done once at a Boots opticians a few years back, a single session, along with some red light therapy (low-level light therapy, which is often paired with IPL).
I'll be honest, though: I didn't rate that particular visit. There was no gel on my face (I'm fairly sure there's meant to be), it was just one pass across my eyes rather than the two Mr Matheson does across my whole face, and there was no gland expression afterwards at all. It felt like whoever did it was still finding their feet, and to be fair, I think it was a brand-new service for them at the time.
So I really don't want to put anyone off, especially if a nearby Boots is what's realistically accessible to you. In fact, I looked it up: Boots opticians do still offer IPL at various branches (it's franchised, so it varies from place to place), and the current versions I found even include gland expression and a follow-up, so it may well have come a long way since my one visit. I just haven't been back to try again, because Mr Matheson works so well for me.
This is the important bit. IPL is really aimed at the oil side of dry eye: the meibomian glands. So if you've been properly assessed and told your oil production is the problem, IPL is a great route to consider. If your issue is tear production (like mine also is), IPL isn't really targeted at that; it won't magically make you produce more tears. I have both problems, so for me it's one piece of the puzzle, not the whole thing.
That's why getting a proper assessment first matters so much: you want to know what you're actually treating. I've written about getting diagnosed here.
I've paid around £250 a session, and that seems to be roughly the going rate across the country; it's what I paid in London and what I pay now. It adds up, I won't pretend otherwise. But eight years on, IPL is the treatment I keep choosing to go back for, which tells you everything about whether I think it's worth it. I genuinely believe it helps keep my inflammation down and my glands working.
Both places I've been, the Dry Eye Centre in London and my current practice, I'd happily recommend; both are very qualified and do a good job. So if you're in the south of England, or willing to travel, either is a solid place to start.
More of my journey: How I got diagnosed → · My punctal plugs → · My iKervis experience → · Vevizye first impressions →