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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18 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY February 2018 • Volume 11 • Number 2 R E V I E W is occasionally used in ophthalmologic laser procedures to prevent corneal injury. In these procedures, the surgeons irrigate the eye with chilled balanced salt solution either between ablation passes and immediately after the end of ablation or continuously. 37, 38 Corneal cooling has been found to prevent ocular injury. 39 While corneal cooling by cool water irrigation might not necessarily be practical in cosmetic eyelid procedures, the use of non-contact cooling, together with ocular shields, might be feasible. TREATMENT OF OCULAR INJURY Treatment of the eye after laser injury is largely determined by the extent of injury and can include medical and/or surgical management. Superficial lesions to the corneal epithelium can be treated with topical antibiotics and contact lenses or patching. 14 Corneal endothelial injury leading to bullous changes, corneal thickening, or vision loss requires surgical intervention with corneal transplantation. Topical steroids (e.g., methylprednisolone) at varying treatment lengths are also the preferred medical treatment for ocular injury and reduce the damaging inflammatory response to injury. 15 Steroid-treated retinas have been shown to have rapid reestablishment of retinal and choroidal vasculature, healing of the retinal pigment epithelium, less macrophage activity, and reduced photoreceptor damage. 40,41 Treatment of laser-induced ocular injury can involve a combination of topical antibiotics, topical or systemic steroids, and vitamins, although there are currently no guidelines on dosing and preferred medications. Vitamins include topical and oral ascorbic acid (vitamin C) to promote fibroblast activity. 42 All patients with laser- induced eye injuries need to be referred to an ophthalmologist for detailed evaluation. CONCLUSION Lasers are effective modalities for facial cosmetic treatments, but can cause injury to the eye when used periorbitally or on the eyelids. Several safety measures can prevent laser ocular injury. First, the treating physician must be properly trained to operate the laser, and should have basic knowledge in laser physics and safety. Second, lesions around the eye or on the eyelids should not be treated without metal ocular shields or wavelength-specific glasses, including eye protection for operating personnel. Care must be taken to ensure eye protection is not removed or moved, especially during long procedures. Third, frequent and sufficient cooling of the treated areas must be ensured to prevent thermal injury and overheating of the metal corneal shields. And finally, we recommend that only core physicians administer laser treatment to periorbital or eyelid regions (e.g., board-certified dermatologists, plastic surgeons, ophthalmologists, or otolaryngologists with advanced training in cosmetic surgery and medicine). Despite these precautions, laser ocular injury might still occur, though rarely. Superficial injury to the cornea can be treated with topical antibiotics. topical steroids, and contact lens or patching. More severe corneal damage requires corneal transplantation. All patients described in the 21 case reports we reviewed were treated with topical steroids and antibiotics, and some with systemic steroids. Patients should always seek immediate consultation from an ophthalmologist. REFERENCES 1. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220(4596):524–527. 2. Adamic M, Troilius A, Adatto M, et al. 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Jalian HR, Jalian CA, Avram MM. Common causes of injury and legal action in laser surgery. JAMA Dermatol. 2013;149(2):188– 193. 24. Hammes S, Augustin A, Raulin C, et al. Pupil damage after periorbital laser treatment of a port-wine stain. Arch Dermatol. 2007;143(3):392–394. 25. Widder RA, Severin M, Kirchhof B, et al. Corneal injury after carbon dioxide laser skin resurfacing. Am J Ophthalmol. 1998;125(3):392–394. 26. Chen SN, Lu CW, Zhou DD. A case of accidental retinal injury by cosmetic laser. Eye (Lond). 2014;28(7): 906–907. 27. Park DH, Kim IT. A case of accidental macular injury by Nd: YAG laser and subsequent 6 year follow-up. Korean J Ophthalmol. 2009;23(3):207–209. 28. Lee WW, Murdock J, Albini TA, et al. Ocular damage secondary to intense pulse light therapy to the face. Ophthal Plast Reconstr Surg. 2011;27(4):263–265. 29. McKenzie AL. Aspects of laser safety in surgery and medicine. J Radiol Prot. 1988;8(4):209–219. 30. Biesman BS, Khan JA. 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Corneal cooling and rehydration during photorefractive keratectomy to reduce postoperative corneal haze. J Refract Surg. 1999;15(2 Suppl):S232–S233. 38. Kitazawa Y, Maekawa E, Sasaki S, et al. Cooling effect on excimer laser photorefractive keratectomy. J Cataract Refract Surg. 1999;25(10):1349–1355. 39. Kataoka T, Zako M, Takeyama M, et al. Cooling prevents induction of corneal damage by argon laser peripheral iridotomy. Jpn J Ophthalmol. 2007;51(5):317–324. 40. Lam TT, Takahashi K, Fu J, et al. Methylprednisolone therapy in laser injury of the retina. Graefes Arch Clin Exp Ophthalmol. 1993;231(12):729–736. 41. Takahashi K, Lam TT, Fu J, et al. The effect of high-dose methylprednisolone on laser-induced retinal injury in primates: an electron microscopic study. Graefes Arch Clin Exp Ophthalmol. 1997;235(11): 723–732. 42. Scott R. The injured eye. Philos Trans R Soc Lond B Biol Sci. 2011;366(1562):251–260. JCAD

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