Laser Danger – January, 2025
History:
A 54-year-old female was referred after accidentally stepping on a facial laser pedal without eye protection. The patient was performing an Intense Pulsed Light (IPL) laser therapy on herself using a commercial IPL machine at work. The laser was used for removal of hyperpigmentation on her face. She had accidentally pressed the pedal to her right eye for “1 quick second” after which she had ocular pain and a shadow with a black scotoma with “splatters around it”.
Exam:
Visual acuity (VA) was 20/70 in the right eye (OD) and 20/40 in the left eye (OS). Intraocular pressure (IOP) was normal. Anterior exam was normal. Fundus exam revealed superior retinal whitening within the posterior pole with a central retinal hemorrhage and a pre-retinal hemorrhage inferiorly OD (Fig 1) Fundus exam was normal OS. FAF OD showed hypoautofluorescence with surrounding hyperautofluorescence at the site of laser impact (Fig 2). FA showed mild late staining where the laser impacted with blocking from preretinal heme (Fig 3). Optical Coherence Tomography (OCT) through the site of laser impact showed disruption of all layers to the retinal pigment epithelium (RPE) (Fig 4).
Clinical Course:
Two weeks later, VA improved to 20/50, and fundus exam showed retinal whitening in the area of laser impact with persistent preretinal hemorrhage (Fig 5).
Discussion:
Laser Danger
IPL consists of a high-intensity broad spectrum of light and can be used for a variety of cosmetic reasons as hair removal to treatment of vascular lesions to skin resurfacing. Devices for home and commercial use are available, however most reported cases of ocular complications involve commercial devices.
The most common adverse effects include anterior uveitis, iris atrophy, and pupillary muscle dysfunction from laser being applied close to the eyes on the eyelids without sufficient ocular protection. In another reported case, a patient suffered from a full thickness macular hole.
Given the potential severe visual-threatening adverse effects of IPL and its increasing use, it is imperative to use adequate ocular protection when using these devices.
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References:
- Tony Ho and Limei Teo. “Retinal Toxicity from Intense Pulsed Light Therapy: A Case Report”. EC Ophthalmology 11.2 (2020): 01-04.
- Rozanowska MB. Light-induced damage to the retina: current understanding of the mechanisms and unresolved questions: a symposium-in-print. Photochem Photobiol. 2012 Nov-Dec;88(6):1303-8. doi: 10.1111/j.1751-1097.2012.01240.x. PMID: 23106541.
- Maganti N, Kalbag NS, Gill MK. MACULAR HOLE FORMATION ASSOCIATED WITH INTENSE PULSED LIGHT THERAPY. Retin Cases Brief Rep. 2022 Mar 1;16(2):161-164. doi: 10.1097/ICB.0000000000000947. PMID: 31851048; PMCID: PMC8860208.