Periocular CO₂ laser resurfacing: severe ocular complications from multiple unintentional laser impacts on the protective metal eye shields

Abstract

Despite uncertainties in procedural details and modeling of cataract temperatures, the eye injuries were caused beyond doubt by heating of tear-covered metal eye shields by at least 10 consecutive but unintentional laser impacts. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Review of Eye Injuries Associated With Dermatologic Laser Treatment

“…In addition to potentially causing ectropion of the eyelids, CO 2 lasers can injure the cornea, sclera, and lens. 16,54,55,63 The same potential injury pattern would be expected with the Er:YAG laser, although no published cases were found.…”

“…In theory, there is a potential for overheating of metal shields by the laser and subsequent direct thermal damage to the cornea and/or sclera. 16 However, Christian and colleagues 17 tested ferritic stainless steel eye shields and determined that the thermal transfer from a direct CO 2 laser exposure was not sufficient to cause thermal damage to the cornea. Authors concluded that the mechanism of injury in their report was chlorhexidine toxicity to the cornea by indirect transfer through the corneal shield itself.…”

Thermal eye injuries from dermatologic laser treatments—an experimental study

“…Eye comfort should be continuously monitored during treatment. As eye shields do not cover the whole frontal eye surface and eyelids often do not cover the whole eye shield area, misdirection of the laser beam should be avoided [ 4 ]. Treatment for laser-induced ocular injuries is very limited making prevention essential.…”

“…An analysis on reported laser accidents found out that the eye accounted to the majority of involved injured organs [ 3 ]. Ocular injury from laser treatment can result in loss of vision or other serious damage [ 4 ]. For that reason, sufficient ocular safety measures are essential.…”

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

“…Treatments reported in the literature include topical, injectable, implantable, or systemic corticosteroids, topical prostaglandin analogs, topical antibiotics, oral vitamin C, injectable antivascular endothelial growth factor drugs, and in extreme circumstances, surgical intervention. 11–46 It is interesting that most ocular injuries occurred on the left side, which may be related to the handedness or position in relation to the patient of the laser operator, however, further studies would need to be completed to elucidate this relationship.…”