Ocular injuries secondary to alexandrite laser-assisted hair removal

Suprachoroidal triamcinolone for alexandrite laser-induced macular burn

Two days after treatment for unwanted facial hair by alexandrite laser, a young female presented with decreased vision in the right eye. During the procedure, she was not wearing protective eye goggles. Ocular examination showed a round whitish lesion at the foveal region with visual acuity of 20/400. The left eye was unremarkable. She was treated immediately with a suprachoroidal injection of triamcinolone acetonide delivered with a custom-made needle. This resulted in the improvement of visual acuity and restoration of foveal anatomy over 1-year period.

Dermatologic laser-induced ocular and periocular complications: a review

This study aimed to discuss severe ocular and periocular complications after dermatological laser treatment. This literature review evaluated published journal articles (clinical trials or scientific reviews) extracted from electronic databases (MEDLINE and PubMed) and the reference lists of related articles. Individual eyeball structures, such as chromophores, were found to interact with laser radiation. The type of damage was found to be influenced by the wavelength emitted by the laser-active medium. Moreover, in the absence of proper protection of the eyeballs, the structures that are crucial for vision can be damaged. In conclusion, laser treatment can also cause serious and irreversible complications. Appropriate patient selection, intraoperative techniques, early identification, and interventions for adverse postoperative effects are crucial to avoid major complications and even blindness.

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.

Unintentional macular injury following high-energy cosmetic laser calibration

Unwelcome hair has become a significant issue encountered in our society by young people, particularly young women. Hair removal has been achieved through various methods, both mechanical, with intense pulse light therapy and laser photoablation of hair follicles using various energy delivery systems. There is a relative paucity of clinical trials comparing the safety and efficacy of various hair removal modalities. A comparative study between alexandrite, diode, and intense pulsed light (IPL) was conducted and found similar safety profile across all three modalities. Several adverse effects have been noted as a result of this therapy. Laser-assisted hair removal can lead to ocular anterior segment and/or retinal injury. A laser beam directed toward the eye may easily penetrate both the eyelid or the cornea and cause catastrophic ocular injury. Unfortunately, regulation and licensing of the use of laser-assisted hair removal devices has not yet been well elucidated nor standardized across Australia. There are few cases in the literature reporting retinal burns following inadvertent laser injury, with even fewer directly involving the macula. We report a case of unilateral anterior uveitis and a macular defect following inadvertent laser exposure, leading to photophobia and pain, and reduced visual acuity.

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.

Laser-induced macular neovascularization following accidental exposure to Alexandrite laser and excellent response to anti-VEGF: A case report

OBJECTIVES

This study aimed to report a case of laser-induced macular neovascularization (MVN) following accidental exposure to Alexandrite laser.

METHODS

A young female presented with a painless visual blurring of the right eye 25 days after direct inadvertent exposure to a single discharge from a 750-nm Alexandrite hair removal procedure. The best-corrected visual acuity (BCVA) of the right eye was finger count 3 m (M). Ophthalmoscopic findings, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography, and optical coherence tomography angiography were evaluated.

RESULTS

Fundus examination of the right eye revealed intraretinal hemorrhage and a round yellow-grayish subretinal lesion just beneath the fovea. SD-OCT of the right eye showed retinal thickening, subretinal hyperreflective lesion, subretinal and mild intraretinal fluid, and a small retinal pigment epithelium defect beneath the fovea. Optical coherence tomography angiography demonstrated MNV type 2. After the administration of intravitreal injection of three monthly anti-vascular endothelial growth factor, BCVA improved to 20/20.

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.

Alexandrite Laser-Induced Choroidal Neovascularization Successfully Treated With Aflibercept

A 33-year-old female was referred to the ophthalmology department after an accidental eye injury to her right eye during a hair removal session using alexandrite laser. Although she initially experienced no symptoms, when re-examined one and a half months later the best-corrected visual acuity (BCVA) of the affected eye was 20/40 secondary to choroidal neovascularization confirmed by fluorescein angiography (FA) and optical coherence tomography (OCT). Intravitreal anti-vascular endothelial growth factor (VEGF) therapy (three monthly injections of aflibercept) led to complete regression of the neovascularization and functional recovery which was maintained at one-year follow-up post original injury.

Rapid response to systemic steroid in macular alexandrite laser exposure: Multimodal imaging

PURPOSE

To report the management of accidental macular photocoagulation during a 750-nm Alexandrite laser hair removal procedure.

METHODS

Single case report with images.

RESULTS

A 23-year-old girl presented with an immediate visual field defect in her right eye after direct inadvertent exposure to a single discharge from a 750-nm Alexandrite laser used for laser hair removal. Baseline Snellen visual acuity was 20/20 in the involved right eye but the patient reported a subjective visual field defect. She was treated with oral methylprednisolone that was started at a dose of 1 mg/kg/day and then gradually reduced. Six months after the initial exposure, the final visual acuity was 20/20 and there was a significant improvement in the macular lesion. However, the subjective visual field defect continued. She underwent multimodal retinal imaging with optical coherence tomography, fundus fluorescence angiography, and optical coherence tomography angiography in addition to a visual field test and microperimety.

CONCLUSION

The present case documents a gradual visual and anatomical improvement following macular photic damage after accidental occupational exposure to a 750-nm Alexandrite laser. The treatment should be arranged according to the localization of the laser damage. Optical coherence tomography angiography also has the potential to help noninvasively detect choriocapillaris damage.

Alexandrite laser induced uveitis & pigment dispersion: A case report and review of the literature

Purpose

To describe a complication of an upper eyelid alexandrite laser procedure.

Observations

A 55-year-old woman presented with left eye blurred vision and photophobia after a left upper eyelid procedure with an alexandrite laser. She had elevated intraocular pressure (IOP), anterior chamber cell and pigment, posterior synechiae, and retroillumination defects in the left eye. She was treated with topical prednisolone and brimonidine. Six months later, although her anterior chamber had cleared and IOP had normalized, the patient reported decreased vision-related quality of life from persistent photophobia.

Conclusions and Importance

Alexandrite lasers are commonly used for hair removal and skin depigmentation. When used periocularly without proper eye protection, they have the potential to create irreversible ocular complications. This case demonstrates the importance of proper eye protection with periocular laser procedures.

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.

Inadvertent macular burns and consecutive psychological depression secondary to Alexandrite laser epilation: A case report

Unwanted hair is an important aesthetic problem in many cultures. Laser epilation devices have become commonly available at the present time. Nowadays, laser hair removal is widely practiced as a cosmetic procedure, however, some ocular complications may occur. The retina is the most vulnerable to laser-related injury which can lead to serious visual impairment. Laser epilation can cause serious complications and medical costs if not performed carefully and appropriately. The use of laser hair removal devices by unskilled aestheticians who is untrained and do not have the proper protective equipment at the beauty centers, can cause serious ophthalmological and psychological disorders and thus substantial labour productivity loss and economic loss. Therefore, the protective eyewear must be used by both the aesthetician and the patient during the procedure of laser epilation. In this way, we can improve the safety of both patients and aestheticians and at the same time ensure their healths. I reported the case of a 49-year-old female with a unilateral maculopathy responsible for an acute visual field defect and consecutive psychological depression secondary to Alexandrite laser epilation. This report is important to raise the awareness of ophthalmology and dermatology society and public about risks of their misuse.

Observation of changes after peripheral retinal injury by cosmetic laser, using wide-field scanning laser ophthalmoscope: A case report

RATIONALE

Increases in cosmetic laser use have led to recent reports of accidental retinal injuries, most of which are limited to the posterior pole. We report a case of peripheral retinal injury caused by a 1064-nm Nd:YAG: neodymium-doped yttrium aluminum garnet.

PATIENT CONCERNS

A 27-year-old Asian woman was admitted with scotoma symptoms in her right eye. The patient was a skin care technician. Three days before admission, a laser beam had struck her eye while she was preparing for a laser procedure.

DIAGNOSIS

During fundus examination, a subretinal hemorrhage with disc diameter (DD) of 4.0 and a preretinal hemorrhage of 2.5 DD in its center were found in the 2 o'clock position of the peripheral retina in the right eye.

INTERVENTIONS

We monitored the injury for > 6 months, first using fluorescein angiography, then wide-field scanning laser ophthalmoscopy and optical coherence tomography. Oral steroids and vitamins were administered.

OUTCOMES

During the 6-month follow-up period, blood from the initial sub- and preretinal hemorrhage, as well as vitreous hemorrhage, were all absorbed. Retinal detachment was not observed as scar formation and adhesions had occurred. No interventions were considered necessary.

LESSONS

When treating a patient who has experienced laser eye injury, the possibility of peripheral retinal injury should be considered. Peripheral retinal injury caused by 1064-nm Nd:YAG: neodymium-doped yttrium aluminum garnet has a relatively good prognosis, suggesting that it will not progress to retinal detachment.