The need for non-invasive procedures for treating oculofacial disorders has led to the expansion and advancement of various innovative laser and light therapy techniques. These options consist of using lasers that pulse (IPL) as well as Photodynamic Therapy (PDT) and devices using light-emitting diodes and non-ablative and ablation lasers. The periorbital region may involve the treatment of telangiectasias, vascular lesions and depigmentation, photodamage hypertrichosis, rhytids, and scars. Lasers and light-based technology give patients treatments that range from moderate to abrasive, possibly achieving subtle results that require little or no downtime or a dramatic effect with more time to recover. The advantages of laser treatments, in comparison to conventional procedures for medical and surgical use, include a longer-lasting result than other traditional therapies and the capacity to provide a pleasant middle between non-invasive topical therapy and invasive surgical methods. For patients seeking alternatives that are non-invasive treatments, lasers offer the most significant benefit over surgical incisions. Knowing the proper use, adverse effects, and results before treating cosmetic and functional problems. This article briefly overviews the current treatment options, their services, and the consequences and side effects. Keywords: Intense Pulsed light, Ablative lasers, Fractional lasers, Non-ablative photodynamic therapies, lasers non-invasive procedures. Light and laser treatments are now a must-have component of the oculoplastic armamentarium of services to treat various oculofacial system diseases and improve aesthetics. The distinct structure of the periocular region and the specific treatment objectives for each patient will help to tailor the selection of laser as well as the intensity of the laser and the intensity of treatment to get the most optimal result. Citation: Portaliou DM, Liao SD, Shields RA, Lee WW. Review the use of light and laser therapy for treating Oculofacial disorders.

World J Ophthalmol 2014 DOI: 

INTRODUCTION

The demand for non-surgical treatment options for cosmetic and functional periorbital pathology has grown in recent years. Injectable fillers for soft tissues[1] and neurotoxins have maintained their popularity because they effectively address dynamic and resting rhytids and volume deficiency. However, they’re unable to correct issues with the surface of the skin or the quality of it. Chemical facial peels that differ in strength from alpha-hydroxy acids that are mild to more intense phenol-based treatments are a viable option to firm and smooth the skin[3[3]. The gentle peels are, however, not able to offer long-lasting, dramatic results[4and the more intense peels are not suitable to treat skin types with darker pigments as they can be painful and are only available to certain patients with heart conditions[55. Many laser-based and light-based therapies have been developed to meet more diverse needs. Concerns about excessive upper and lower lid skins, the periorbital Rhytids, and poor skin texture, pigmentation, and vascular lesions or scarring may be dealt with using these methods[66. Present treatment options include laser-based devices like Intense Pulsed Light (IPL) Therapy[7Photodynamic Therapy (PDT)[7 and light emitting diode devices[7]. Laser options include non-ablative[8] as well as ablative devices[8[8], both of which offer the possibility of fractionated delivery. A more recent modality not covered in this review is radiofrequency energy for tightening the skin and rejuvenation[6[6]. Each of these laser – and light-based techniques are described below.

IPL THERAPY

IPL Therapy is a safe method based on light that uses light within the range of 500 nm-1200 nm to focus on the chromophores hemoglobin and melanin[9[9, 10]. IPL has been successfully utilized to treat vascular and pigmented lesions of the oculofacial area[9] and may be used for hair removal[10] and photorejuvenation[11] as well. IPL is an FDA-approved therapy for removing the signs and symptoms caused by photoaging. There is a possibility that IPL might be successful in alleviating symptoms and reducing the stigmata that come with dry eye syndrome that is associated with meibomian gland dysfunction among patients suffering from facial Rosacea[12[12, 13]. The exact mechanism for action is not known. However, theories suggest obliteration of blood vessels causing inflammation in the eyelids or heating of meibomian glands, which allows for a more efficient expression of meibum. IPL is administered using the flash lamp, emitting light with different wavelengths. The filters are individually selected to target specific absorption by pigment or blood vessels by the type of pathology needing treatment. Contrary to lasers, IPL employs a non-collimated, not coherent light source. Moreno Arias and co[9have proved that various filters can target red pigmentation to treat vein lesions like spider angiomas and Telangiectasias. Another option is melanin for the treatment of lesions that are pigmented, like actinic lesions or freckles. Goldberg and co[11] have demonstrated that IPL for photorejuvenation is safe for the epidermis and targets the dermis, producing collagen and facilitating skin to tighten and contract. Zandi and colleagues[10] studied the application of IPL to remove hair and concluded that it’s restricted to follicles with pigmentation because the primary chromophore is melanin. The chromophores targeted for IPL also limit the use of IPL to people with milder skin types. Since the light is absorbed into the pigment on the skin, patients with Fitzpatrick skin types VI or V are unsuitable for IPL treatment, and those with a skin type IV might require the test area before IPL treatment is contemplated[13[13, 14]. Erythema of the areas treated occurs for several days but is self-limiting. Sun protection is essential for all patients before and after treatment. Common side effects are discomfort, hyper- or hypo-pigmentation, and an appearance of a superficial crust or vesicle [1414. PDT PDT was initially used to treat malignant cells through a photosensitive agent [5-aminolevulinic Acid (ALA) in addition to ALA Methyl Ester (Me-ALA) when oxygen is present[15[15,16]. PDT is frequently utilized to treat premalignant and malignant lesions, such as Bowen’s disease, keratosis actinic, basal cell carcinoma that is superficial, and various other non-melanotic skin cancers. PDT effectively treats other inflammation-related conditions, like acne vulgaris or psoriasis. It is also used to treat infected lesions, such as leishmaniasis and dermatophytosis, as well as onychectomy warts, molluscum contagiosum, and warts, as well as benign conditions like sebaceous hyperplasia as well as nevi. MacCormack[16] recently demonstrated that

PDT

PDT is effective in the cosmetic treatment of wrinkles, telangiectasias, and hyperpigmentation. One of the major advantages of PDT treatment is that it targets certain areas without harming the tissues around it. Contraindications are rare and restricted to particular photodermatoses and allergic reactions with ALA or Me-ALA. Lesions with pigmentation are unsuitable for PDT since melanin acts as an inhibitor of fluorescence and could hinder the penetration of light[1616. The most frequent adverse reactions are pain and a burning sensation that lasts only for the duration of the radiation and for a few hours following. Other adverse effects include photosensitivity, ALA or Me-ALA application duration, and skin necrosis with consecutive scarring and hypo- and hyper-pigmentation[16].

ABLATIVE LASERS

ABLATIVE lasers As the desire for aesthetic perfection increased, doctors started looking for alternative alternatives that are not surgical to treat Oculofacial disorders. In the 1980s, ablative lasers were utilized extensively to treat scarring and photoaging. Several short-pulsed, high-peak powered lasers were developed to avoid any adverse reactions in the first lasers, including the CW CO2 laser and the erbium-yttrium-aluminum-garnet (Er: YAG) laser. These new lasers are more efficient at limiting the severity of thermal damage within an exact pulse duration, providing greater precision and less overall damage, as Alster[17] has shown. The CO2 laser, with an increased ablation threshold and thus targets the dense tissues and is the most effective surgical laser that can be used for cutting, burning, and carbonizing. It emits a wavelength of 10600 nanometers and is highly absorbed by water in the tissue. In an analysis study, alexiades-Armenakas and colleagues[18] concluded that the CO2 laser is distinctive in that its penetration depth is not dependent on hemoglobin or melanin. It has proven beneficial in skin resurfacing, rejuvenation, and blepharoplasty procedures (Figure 1.). The CO2 laser is also helpful in the reduction of wrinkles that appear around the eyes. The ablative laser is generally safe for skin types I to III.