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Addressing the Lid Gap in Dry Eye Care

KOLs shared case studies and clinical pearls about how IPL and DMSt has helped their dry eye patients at the Lumenis Accelerate event.

By: Sarah Fackler, managing editor, Optometric Management
Optometric Management September 4, 2026

At the Lumenis Accelerate Owner’s Summit in Chicago from August 27 to August 29, Laura Periman, MD; Cory Lappin, OD, MS, FAAO; and Celesta Ferreira, OD, discussed how dynamic muscle stimulation technology (DMSt) and intense pulsed light (IPL) can be incorporated into dry eye treatment where incomplete blinking and eyelid laxity are contributing factors. They described their treatment approaches in several clinical cases to discuss the relationships among orbicularis muscle function, complete blinking, meibomian gland secretion, and ocular surface health.

Drs. Ferreira, Lappin, and Periman discussed a gap that these treatments fill. Traditionally, they said, patients struggling with incomplete blinking and lid laxity could use blinking exercises, overnight ointments and taping, or undergo surgery. However, blinking exercises are largely ineffective, they agreed, and can actually cause blepharospasm. Patients also generally do not like taping, they said. In addition to being invasive, blepharoplasty and myectomy can also result in lid laxity and an inability to close the eyes completely, which they described in one case study during the session.

Dr. Periman described how age-related muscle loss, prolonged screen use (even among younger patients), previous eyelid surgery, and other factors may compromise the function of the orbicularis skeletal muscle. This makes assessment of blink completeness and lid laxity particularly important for patients whose dry eye does not respond adequately to conventional treatment, the presenters stressed. Previous research found lid closure issues in 60% of patients whose dry eye didn’t respond to traditional treatment, they said.

Agnostic of Fitzpatrick skin assessment, DMSt delivers a small electrical current to produce muscle contractions, with the goal of strengthening the orbicularis muscle. Lumenis' OptiLift—one of the technologies showcased throughout the weekend—combines DMSt with radiofrequency, which Drs. Periman, Lappin, and Ferreira described as a preparatory component that warms the muscle before stimulation.

Dr. Periman presented preliminary findings from her own work that quantifies blink changes following treatment. Her team developed a Python-based system that analyzes standardized 60-second videos frame by frame and measures blink characteristics based on changes in visible fluorescein. In one patient, she said, the proportion of complete blinks increased from 25.7% before treatment to 94% after the third TriLift treatment—another DMSt device in Lumenis’ treatment armamentarium. Further, she described, patients’ irregular blinks became regular following treatment, “like a metronome.”

Several cases demonstrated how the speakers are incorporating lid function into more complex dry eye treatment plans. Dr. Ferreira described a 38-year-old man with facial and ocular rosacea, persistent conjunctival hyperemia, lid laxity, and corneal exposure. An initial series of 4 OptiLight IPL treatments (another technology focus of the meeting) improved his facial pigmentation and rosacea, but ocular redness persisted. After additional treatment and the introduction of DMSt, she reported improved lid position and resolution of the hyperemia. The patient subsequently moved to a treatment every 3 months for maintenance, which is essential, Drs. Ferreira, Lappin, and Periman agreed; otherwise, they said, the patient may experience regression as the orbicularis muscle weakens.

Practice Pearl:

Drs. Ferreira, Lappin, and Periman added that it’s essential to set clear expectations with patients from the initial exam about treatment timeframes, possible results, and maintenance schedules so they not only understand the doctor’s decisions but also so they can be active participants in their own care, rather than dropping out after the initial treatment regimen.

Be sure to ask about and address any patient concerns or misconceptions, as well, they said.

Another case involved a 73-year-old woman with more than 20 years of dry eye symptoms and chronic pain. Dr. Ferreira initially used IPL to reduce inflammation because the patient could not comfortably tolerate heat-based treatment. Once inflammation was better controlled, radiofrequency and DMSt were added. She said the patient currently receives monthly maintenance treatment.

The presenters also highlighted patients with incomplete blink following blepharoplasty and other eyelid procedures. Dr. Periman demonstrated one post-blepharoplasty patient who was unable to completely close her eyes before treatment but showed improved closure following a single DMSt session.

The speakers recommended beginning the evaluation outside the ocular surface itself by systematically assessing lid position, laxity, blink completeness, and orbicularis function before moving to the cornea and tear film.

Practice Pearl:

Blepharoplasty changes anatomy. It doesn’t change function, Dr. Periman said. If the muscle is weak before surgery, it will still be weak after, which is where DMSt can help.

They also stressed that patients with functional deficits or significant anatomic abnormalities may still require evaluation by an oculoplastic surgeon. Dr. Lappin advised building a relationship with an oculoplastics surgeon whom you can trust to work in tandem with IPL and DMSt treatments. The relationship can be mutually beneficial, he said, not just from a practice management perspective, but also because some patients will still need blepharoplasty, and the OD can help to prepare the patient’s ocular surface for surgery.

 

Find our additional coverage of the summit here: