Occupational Vision Loss Following Alexandrite Laser Exposure

Abstract

A woman in her 30s presented with a 1-day history of severe vision deterioration in her right eye. She worked as a nurse in a cosmetic institute and had direct exposure to an alexandrite laser beam the previous day. She directly fixated on the laser probe while calibrating the laser for epilation, and was not wearing eye protection at the time. Her corrected distance visual acuity (CDVA) at presentation was 20/140 in her right eye and 20/20 in her left. She reported similar visual acuity in both eyes prior to the accident. Fundus examination and fluorescein angiography showed a laser burn at the fovea of the right eye. After 9 days, her CDVA deteriorated further; she was able to detect hand motions and count fingers, but little else. Fluorescein angiography (Figure ) and optical coherence tomography showed choroidal neovascularization of the fovea with intraretinal fluid. The next day she had an intravitreal injection with an antivascular endothelial growth factor agent (ranibizumab), and the CDVA for her right eye improved to 20/140. The optical coherence tomography scan showed minimal intraretinal fluid. Visual acuity remained stable for 1 year.Laser epilation is based on selective photothermolysis; the laser beam causes localized damage to the hair follicle by being selectively absorbed by melanin while having minimal effect on the surrounding skin. In this case, an alexandrite laser was used. The active medium, an alexandrite crystal, produces a precise wavelength of light (755 nm). Protective eyewear during laser epilation is essential to avoid inadvertent ocular injury to the patient or laser operator. 1,2 The extent of ocular injury can vary from a relatively minor injury to the iris to permanent retinal damage. 2,3 A laser beam reaching the pigmented epithelium of the retina is likely to be absorbed by melanin and cause thermal injury, rupture of the Bruch membrane, and choroidal neovascularization, which in this case developed within days. The present case reinforces the critical importance of wearing eye protection during all aspects of laser operation.

Review of Eye Injuries Associated With Dermatologic Laser Treatment

“…Our review identified 119 published case reports of ocular injury from lasers and IPL. 11,13,14,16,18–35 , 36–65 Fifty-nine of these cases resulted in a temporary (54 of 59) or permanent (5 of 59) ectropion after CO 2 laser resurfacing where the laser was directed at the eyelids. 13,14,63–65 A 1997 survey of American practitioners performing laser resurfacing found that ectropion occurs in 0.4% of cases.…”

“…Details of the 60 case reports of direct laser eye injury are shown in Table S1 , Supplemental Digital Content , http://links.lww.com/DSS/B35. 11,16,18–35 , 36–62 Most of the patients were female (55 of 60, 92%), and the age range was 21 to 67 years. The location of eye injury by laser type is demonstrated in Figure 2.…”

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

“…Laser operators should report novel adverse events in the literature and share them with the medical community. 107 -139…”