Journal of Clinical and Aesthetic Dermatology

FEB 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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17 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY February 2018 • Volume 11 • Number 2 R E V I E W Cooling devices. Cooling devices integrated into most laser modalities offer a protective mechanism against epidermal injury and pain during laser procedures. Cooling of the epidermis before, during, and after treatment can protect against thermal damage in darker skinned patients, who are more susceptible to dyspigmentation, blistering, scarring, and pain. 36 Two types of cooling methods are employed: contact cooling and non-contact cooling. Contact cooling is achieved by either active (copper or sapphire tips) or passive (ice or cold gels) methods, of which cooling by aqueous gels is the least effective and often discouraged method. 36 Non-contact cooling is achieved by cold air or cryogen (liquid nitrogen or R-134a) spray. These cooling devices are difficult to maneuver around the eye. Contact cooling is exceedingly difficult to use in the periorbital areas, due to the contours of the eye and difficulty in maintaining constant, complete contact with the skin. Non-contact cooling is also challenging, as the intense blasts of cold air might accidentally injure the eye. There are currently no studies in the literature that mention the use of cooling devices in cosmetic laser procedures in the periorbital and eyelid areas. However, corneal cooling TABLE 1. Reports in the literature on laser-induced ocular injury during cosmetic treatments of the face REPORT LASER PROCEDURE INJURY OCULAR PROTECTION Widder et al 25 Pulsed carbon dioxide Laser skin resurfacing of face, including upper and lower eyelids Corneal ulcer, bullous keratopathy, and intrastromal hemorrhage Eye shields Brilakis and Holland 3 800nm diode Laser epilation of eyebrows Iris atrophy, nuclear sclerosis in left eye None 755nm alexandrite Laser epilation of eyebrows Pupillary distortion, anterior uveitis, posterior synechiae, iris atrophy Safety glasses, which were removed during procedure 755nm alexandrite Laser epilation of eyebrows Pupillary distortion, photophobia Eye shields 800nm alexandrite Laser epilation of eyebrows Posterior subcapsular cataract, posterior synechiae Unspecified 755nm alexandrite Laser epilation of eyebrows Pupillary distortion, conjunctival hyperemia, cell, flare, and large iris transillumination defect Safety glasses Herbold et al 19 800nm diode Laser epilation of upper eyelids Anterior subcapsular cataract and iris atrophy Safety glasses, which were removed during procedure Carrim et al 20 755nm alexandrite Laser epilation of eyebrows Anterior uveitis None Sheikh et al 18 800nm diode Laser epilation of upper eyelids Anterior uveitis and visual field defect Protective metal goggles Hammes et al 24 755nm alexandrite Laser treatment of periorbital port-wine stain Decreased pupillary motility, photophobia None Park and Kim 27 1,064nm Nd: YAG Unspecified cosmetic procedure of face Mascular laser burn and vitreous hemorrhage None Lee et al 28 Intense pulsed light Laser treatment of pigmented lesions to right and periocular region Pain, severe photophobia, permanent iris atrophy, pupillary distortion, corneal scars Safety glasses, which were removed during procedure Intense pulsed light Laser treatment of eyelid freckle Iris atrophy, pupillary distortion, photophobia Safety glasses, which were removed furing procedure Lin et al 6 755nm alexandrite Unspecified cosmetic procedure to the left upper eyelid area Acute anterior uveitis, iritis, and pupillary distortion None Parver et al 16 800nm diode Laser epilation of eyebrows Pupillary distortion Unspecified shield Yalçındağ & Uzun 755nm alexandrite Laser epilation of eyebrows Anterior uveitis None Chen et al 26 1,064nm Nd: YAG Unspecified cosmetic procedure of the face Inferior retinal burns and vitreous hemorrhage None Karabela & Eliaçık 22 755nm alexandrite Laser epilation of eyebrows Anterior uveitis None Gunes et al 21 755nm alexandrite Laser epilation of eyebrows Anterior uveitis None Shum et al 7 1,064nm Nd: YAG Unspecified cosmetic procedure of the face Dense scotoma, preretinal hemorrhage "Sunglasses" Huang et al. (unpublished) 532/1,064nm Nd: YAG Vein ablation of the eyelids and periorbital area Corneal epithelial injury Metal intraocular shields Nd: YAG: neodymium-doped yttrium aluminium garnet

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