Iris atrophy and posterior synechiae as a complication of eyebrow laser epilation

Is It Possible for Light-Based Hair Removal Home Devices to Induce Ocular Damage? Systematic Review

Light-based hair removal home devices emit intense pulse light (IPL) or Diode laser. While the Food and Drug Administration controls them in the US, Europe continues to classify them as cosmetic products. Emerging concerns are: what if an unprotected eye is inadvertently exposed to light emission? Or if the consumer tries to overcome the protective safety features? We performed this systematic review by searching the Medline, CENTRAL, and Google Scholar databases to investigate the ocular damage reported after exposure to IPL for hair removal. We could not identify any case reported following exposure to home devices; however, a total of 20 patients were identified with iris atrophy, anterior chamber inflammation, and/or retinal pigment epithelium damage following exposure to office IPL or Diode lights. 40% were not using any protective eyewear during the light procedure. The reported fluences were in the range of 20-24 J/cm2. Although the ocular damage was identified following office devices, the reported fluences were within the home device's limits. For that, manufacturers should provide clear instructions on the package regarding the ocular hazards, the importance of using protective goggles, and a firm warning not to overcome the contact sensors. Home device-induced ocular damage is still a concern, perhaps under-reported.

Adverse Events of Light-Assisted Hair Removal: An Updated Review

BACKGROUND

With light-assisted hair removal becoming widely used, reports of adverse effects are increasing.

OBJECTIVE

To review all the reported optical incidents and cutaneous complications of laser or intense pulse light-assisted hair removal.

METHODS

A PubMed database systematic search was performed to identify studies reporting such adverse events before July 2022 using the Mesh terms "adverse effects" AND "hair removal" AND ("laser" OR "intense pulse light").

RESULTS

Altogether, 358 references were identified. After excluding duplicates, unrelated articles, guidelines, and conference abstracts, then adding references from studies bibliography, 104 publications were included. Ocular incidents consisted of anterior uveitis, iritis and iris atrophy, pupillary distortion, posterior synechiae, anterior chamber pigment, and cataracts in the anterior subcapsular region. Cutaneous complications consisted of pain, burns, folliculitis, leukotrichia, paradoxical hypertrichosis, pigmentary changes, changes in nevi, pili bigemini, herpes infection, hyperhidrosis, bromhidrosis, Fox-Fordyce disease, and frostbite from the cooling system. They were mostly correlated to skin type and body area as well as to light device and set parameters. Intense pulse light devices were found to be less painful than alexandrite laser, yet more painful than diode laser; Nd:YAG laser had the highest pain score.

CONCLUSION

Optical incidents can be systematically avoided. Cutaneous complications are usually related to professional errors and patient characteristics. Better knowledge of laser physics and adequate training of laser operators are key recommendations to avoid undesirable side effects. Safety recommendations help prevent most of the reported complications.

Review of Eye Injuries Associated With Dermatologic Laser Treatment

BACKGROUND

The eye is susceptible to damage during dermatologic laser treatments.

OBJECTIVE

Discuss the anatomy of the eye related to these procedures, the principles of laser-eye interactions, and ocular injuries reported with dermatologic laser treatments.

METHODS

PubMed and Embase searches were conducted to identify cases of eye injuries associated with dermatologic laser treatments.

RESULTS

One hundred nineteen cases of eye injury associated with dermatologic laser treatments were identified. Fifty-nine cases targeted the eyelid during resurfacing and caused ectropion, while 60 cases resulted from direct injury of ocular structures. In most of the cases of the latter, improper eye protection was used (44 of 60, 73%). In nearly all these cases, it was the patient who sustained a potentially avoidable ocular injury (52 of 60, 87%). Thirty-one patients had persistent ocular symptoms at follow-up (52%). The most common procedure in this context was laser hair removal of the face (35 of 60, 58%). Most of the cases developed injuries specific for the particular laser based on its wavelength and affinity to target certain ocular chromophores (59 of 60, 98%).

CONCLUSION

Most of the dermatologic laser-associated eye injury cases have occurred in the context of laser resurfacing or laser hair removal and are potentially preventable.

Ocular complications secondary to diode laser-assisted eyebrow epilation

We describe two cases of ocular complications secondary to Diode laser assisted eyebrow epilation. Both included patients were women who underwent an eyebrow epilation procedure with Diode laser. A few hours after the procedure they started complaining with photophobia and blurred vision. They were diagnosed with anterior acute uveitis and treated with topical steroids and mydriatics. During the follow-up the presence of sequelae derived from the laser procedure (mydriasis and corectopia in both patients, cataract in the second one) was confirmed. Laser hair removal of the eyebrows can induce irreversible eye damage. Complete and reliable information regarding the potential side effects of this procedure and proper use of appropriate safety devices is mandatory. We point out the importance of the potential ocular side effects associated with these cosmetic devices.

Ocular Complications After Laser or Light-Based Therapy-Dangers Dermatologists Should Know

BACKGROUND

Laser and light-based technologies have been used in the medical field for over 50 years. In dermatologic and cosmetic practice, cutaneous side effects are commonly discussed; however, ocular injury may also occur.

OBJECTIVE

To complete a systematic review of the current literature regarding ocular complications in the dermatologic field after laser and/or light-based therapies.

MATERIALS AND METHODS

A systematic review of the Medline database was performed in August 2020 using the search terms "laser or light and ocular and complication." The inclusion criteria were articles written in English discussing ocular complications after laser or light-based therapy for dermatologic or cosmetic indications.

RESULTS

A total of 36 articles were included for review. Carbon dioxide was the most frequently used laser causing ocular damage, and the most common ophthalmologic complication was temporary ectropion. Patients described visual disturbances and pain as the most common symptoms. A large proportion of articles did not report the use of appropriate eye protection at the time of injury.

CONCLUSION

Although ocular injury post-laser or light-based procedures are rare, clinicians must be acutely aware of the signs and symptoms associated with eye damage. The informed consent process should thoroughly describe the possibility of ocular complications post-treatment, and medical practices should have appropriate emergency plans and protective equipment in place to decrease both patient and staff risk of injury.

Ocular complications secondary to diode laser-assisted eyebrow epilation

We describe two cases of ocular complications secondary to Diode laser assisted eyebrow epilation. Both included patients were women who underwent an eyebrow epilation procedure with Diode laser. A few hours after the procedure they started complaining with photophobia and blurred vision. They were diagnosed with anterior acute uveitis and treated with topical steroids and mydriatics. During the follow-up the presence of sequelae derived from the laser procedure (mydriasis and corectopia in both patients, cataract in the second one) was confirmed. Laser hair removal of the eyebrows can induce irreversible eye damage. Complete and reliable information regarding the potential side effects of this procedure and proper use of appropriate safety devices is mandatory. We point out the importance of the potential ocular side effects associated with these cosmetic devices.

Adherence to optical safety guidelines for laser-assisted hair removal

BACKGROUND

In recent years, there was a rise in ocular injuries secondary to cosmetic laser-assisted hair removal.

PURPOSE

To assess the level of adherence to optical safety guidelines during laser-assisted hair removal performed by nurses or physicians in private practice.

METHODS

A cross-sectional study was conducted at thirty-one private laser-assisted hair removal clinics. An electronic random number generator using a cluster random sampling technique was used to select the clinics. The Alexlazr™ (Candela Corp.) device operator's manual checklist was modified to collect data from laser device operators and patients by surveying the laser rooms, interviewing the patients, and observing the treatments.

RESULTS

Ninety-four patients treated by different service providers were included from 31 private centers. All treatment sessions were delivered by trained nurses. Only 9.5% had acceptable adherence to optical safety guidelines during hair removal treatment, while the majority (90.5%) of service providers were poorly adherent. None of the providers achieved excellent adherence to optical safety guidelines. The item with the least adherence was the lack of non-reflective floors inside laser rooms in 72.3% of centers. All service providers were familiar with the laser system controls and emergency shutdown (100% adherence).

CONCLUSION

There is a significant deficiency in the safety precautions at laser-assisted hair removal centers that can result in devastating ophthalmic injuries. Companies providing laser-assisted hair removal machines should be involved in aiding these centers to implement safety procedures.

Ocular complications after cosmetic periocular diode laser application to the eyelids

A 25-year-old woman underwent diode laser application on the both upper eyelids in the dermatology department of a private hospital to obtain a cosmetic healing of the reddish look on her eyelids without any protective lenses. The patient experienced severe uveitis, atonic pupils, raised intraocular pressure, and increased sensitivity to light in her eyes on the following day of the procedure. Topical steroids and pressure-lowering agents were able to treat the acute uveitis and glaucoma, unfortunately the patient suffered from irreversible atonic and atrophic pupils and photosensitivity. It is recommended that cosmetic laser application on the periocular area should be avoided, and if it is still to be performed, it should be applied cautiously and the patient should be informed of the potential ocular complications.

Lichen sclerosus associated with Nd:YAG laser therapy

Laser is the most efficient and popular method in hair removal. The most common side effects of laser assisted hair removal are pain, erythema, edema, hypopigmentation, hyperpigmentation, blistering, crusting, erosions, purpura, folliculitis, and scar formation ( 1 ). Herein, for the first time we describe a case of lichen sclerosus (LS) following hair removal with long pulsed 1064 nm Nd:YAG laser therapy.

Ocular injuries secondary to alexandrite laser-assisted hair removal

PURPOSE

The aim of this study was to describe the clinical manifestations and outcomes of 4 patients who had sustained eye injury during alexandrite laser-assisted hair removal.

METHODS

This was a retrospective case series of 4 patients who presented to 2 tertiary eye care hospitals over 2 years. Data on ophthalmic examination, spectral domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany), and fundus fluorescein angiography were collected.

RESULTS

Four female patients sustained injuries during alexandrite laser hair removal. One patient presented with acute anterior uveitis, 2 patients with subfoveal choroidal neovascularization, and 1 patient with intraretinal foveal hemorrhage. Visual acuity at last follow-up (range 3-6 months) was 20/15 to 20/20.

CONCLUSIONS

Ocular injuries can occur as a result of incorrect use of laser-assisted hair removal devices. Ophthalmologists should be aware of ocular damage caused by these devices.

Laser treatment of periocular skin conditions

Advances in laser technology in recent decades have increased the options for the treatment of dermatologic conditions of the eye and eyelid. Benign tumors can be laser-ablated with relative ease, and vascular and melanocytic lesions can be precisely targeted with modern lasers. In this contribution, we review treatment of periocular pigmented lesions, including melanocytic nevi and nevus of Ota; vascular lesions including telangiectasias, port wine stains, and infantile hemangiomas; hair removal; eyeliner tattoo removal; laser ablation of common benign periocular tumors, such as syringomas, xanthelasma, milia, and seborrheic keratoses; and laser resurfacing. The recent advent of fractionated laser technology has resulted in dramatically decreased healing times for periocular skin resurfacing and fewer adverse effects. Fractionated laser resurfacing has now nearly supplanted traditional full-field laser resurfacing, and safe treatment of rhytides on the thin skin of the eyelids is possible. Proper eye protection is, of course, essential when using lasers near the eye. Patient preparation, safety precautions, and risks--intraocular and extraocular--are discussed herein. As laser technology continues to advance, we are sure to see improvements in current treatments, as well as development of new applications of cutaneous lasers.

Anterior uveitis following eyebrow epilation with alexandrite laser

Ocular tissues are known to be sensitive to damage from exposure to laser emissions. This study reports the case of a female patient with acute unilateral anterior uveitis caused by alexandrite laser-assisted hair removal of the eyebrows. We report a 38-year-old female who presented with unilateral eye pain, redness, and photophobia after receiving alexandrite (755 nm) laser epilation of both eyebrows. Best corrected visual acuity was 20/20 in both eyes. Right eye examination was normal. Left eye examination showed conjunctival injection and 2+/3+ cells in the anterior chamber. Intraocular pressure and fundus examination were normal. Topical steroids and cycloplegic drops were prescribed for 3 weeks. At the end of the 3-week follow-up, best corrected visual acuity was 20/20, and intraocular pressure and fundus examination were normal in both eyes. The left eye was white, and the anterior chamber was clear. The patient continues to be monitored. In conclusion, without adequate protective eyewear, laser hair removal of the eyebrows with alexandrite laser can lead to ocular damage.

Two cases of anterior uveitis after laser eyebrow epilation

PURPOSE

Laser-assisted epilation of eyebrow hair has become a common practice, but a number of ocular complications can occur. We report the cases of 2 patients who had unilateral anterior uveitis after having undergone laser removal of eyebrow hair.

METHODS

This report describes 2 patients who experienced eye pain, photophobia, redness, and edema after undergoing alexandrite (755 nm) laser epilation of the eyebrow area while not wearing protective eyewear or a corneal shield.

RESULTS

Eye examinations revealed that both patients had conjunctival injection, endothelial keratic precipitates, and cells in the anterior chamber of one eye. They were treated with topical cyclopentolate and steroid eye drops. Within a week, their symptoms had disappeared, and anterior chamber reactions were not seen. At their 3-month follow-ups, their visual acuity was 20/20, and eye examination results were normal for both eyes of each patient.

CONCLUSIONS

Laser-assisted epilation of eyebrow hair can lead to unilateral anterior uveitis, and individuals must be informed about the risks involved in laser eyebrow epilation.

Anterior uveitis associated with laser epilation of eyebrows

Background

The objective of the study is to report a case of unilateral anterior uveitis after laser hair removal of the eyebrows with an alexandrite laser.

Findings

A 36-year-old female presented with painful red eye and photophobia in her left eye 2 days after receiving alexandrite (755 nm) laser epilation of both eyebrows. Visual acuity was 20/20 in both eyes. Right eye examination was normal. Left eye examination showed conjunctival injection, 2+ cells in the anterior chamber, and local posterior synechiae. Intraocular pressure and fundus examination were normal in both eyes. Topical steroids and cycloplegic drops were prescribed. Three days after the initiation of topical treatment, there was a reduction in anterior chamber cells to 1+, but posterior synechiae was enhanced. One week after, there were 0.5+ cells in the anterior chamber and no further enlargement of posterior synechiae. At the 2-month follow-up, uncorrected visual acuity remained 20/20 in both eyes. Slit-lamp biomicroscopy of the right eye was normal. Intraocular pressure and fundus examination were still normal in both eyes. Although anterior chamber of the left eye was clear, posterior synechiae persisted. We are still following the patient.

Conclusion

Laser hair removal of the eyebrows can lead to ocular damage and should be avoided.

Laser hair removal: a review

BACKGROUND

Unwanted hair growth is a common aesthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation.

OBJECTIVES

To extensively review the literature on laser hair removal pertaining to its theoretical basis, current laser and light-based devices, and their complications. Special treatment recommendations for darker skin types were considered.

MATERIALS AND METHODS

A comprehensive literature search related to the long-pulse alexandrite (755 nm), long-pulse diode (810 nm), long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG; 1,064 nm), and intense pulsed light (IPL) system, as well as newer home-use devices, was conducted.

RESULTS

The literature supports the use of the alexandrite, diode, Nd:YAG and IPL devices for long-term hair removal. Because of its longer wavelength, the Nd:YAG is the best laser system to use for pigmented skin. Further research is needed regarding the safety and efficacy of home-use devices.

CONCLUSION

Current in-office laser hair removal devices effectively provide a durable solution for unwanted hair removal.

Guidelines on the safety of light-based home-use hair removal devices from the European Society for Laser Dermatology

In the past 5 years since their US introduction, there has been a rapid proliferation of light-based hair removal devices intended for home-use. In the last 2 years in Europe, sales already run into many tens of thousands of units with well-known multi-national companies entering the market. These guidelines provide a definition of light-based home-use technology, to inform healthcare professionals about home-use light-based technology and encourage manufacturers wishing to sell in Europe to adopt 'best practice'. The review presents the current status on standards and regulation issues and considers home-use safety issues, encompassing human, device and electrical safety, given risks to the eyes and skin from optical radiation both to the consumer and persons in the vicinity. Proposed technical measurement methodology is considered with focus on recognized critical parameters for the safe use of light-based hair removal technology including recording the technical performance and safety claims of a range of home-use hair removal devices. The literature review emphasizes potential adverse incidents and safety aspects of treating cosmetic conditions, such as unwanted hair growth. Although some regulations exist, they differ from region to region and there is a specific need for international common principles and guidelines relating to the manufacture, marketing and use of intense pulsed light and laser devices, including manufacturing standards for home-use products intended, amongst others, for cosmetic hair removal and photo-rejuvenation procedures. In these guidelines, the European Society for Laser Dermatology (ESLD) provides a professional view of what 'best practice' may imply for manufacturers and consumers alike.

Iritis and iris atrophy after eyebrow epilation with alexandrite laser

Purpose

To report a case of bilateral iritis and transillumination defects after laser hair removal of the eyebrows with an alexandrite laser.

Methods

A 41-year-old male presented with bilateral eye pain and mild photophobia 2 days after receiving alexandrite (755 nm) laser epilation of both eyebrows. Examination showed visual acuity of 20/20 in both eyes, 2+ conjunctival injection in both eyes, 1+ cells in the anterior chamber of right eye and trace cells in left eye, poor right pupil dilation, and left pupil without movement. Intraocular pressure and fundus examination were normal. He was diagnosed with iritis and iris atrophy, associated with laser epilation. Topical steroids and cycloplegic drops were prescribed for 1 month.

Results

After 1 month of treatment, transillumination defects remained in both eyes, but greater in right. In dim light, the right pupil was 4 mm and oval and the left pupil was 6 mm and round. Visual acuity remained 20/20 in both eyes.

Conclusion

Laser hair removal of the eyebrows can lead to permanent ocular damage even with eye protection, and should be avoided.