CRUCIAL EYE PROTECTION

A recently published case study involving a woman blinded in one eye by a misdirected laser beam while undergoing laser epilation, highlights the need for eye protection at all times for both client and practitioner. 

“Our experience shows that laser epilation carries the risk of severe damage to the eye if any precaution is neglected. A rushed and reckless procedure performed by a practitioner who has not received proper training may easily cause a vision-threatening accident. Therefore, ensuring adequate safety training for all practitioners is a prerequisite, and laws requiring this will help,” Georgios A Kontadakis MD, MSc, Ophthalmiatreion Eye Hospital of Athens, Greece, a co-author of the study, told EuroTimes.

The study, published online in the January 2015 issue of JAMA Ophthalmology, involved a patient in her early 30s in good health with no history of ocular morbidity. At the time of the incident, she was undergoing laser epilation of the hair on her forearms with an alexandrite (755-nm) laser and was without eye protection. During the procedure, the laser beam went through the pupil of her right eye and she immediately felt severe ocular pain and had a severe loss of visual acuity. 

She presented at the Ophthalmiatreion Eye Hospital in Athens four days after receiving the laser injury, at which time her uncorrected visual acuity was 20/200 in her right eye and 20/20 in her left eye. Fundus examination of the right eye revealed severe retinal pigment abnormalities in her fovea. 

Five days later, the uncorrected visual acuity in her right eye had decreased further to counting fingers. Moreover, macular optical coherence tomography (OCT) revealed signs of choroidal neovascularisation (CNV) and the presence of intraretinal fluid, which was confirmed by fluorescein angiography. 
Treatment with intravitreous injection of an anti-vascular endothelial growth factor (anti-VEGF) brought about a complete regression of intraretinal fluid within one month and there was no relapse of the fluid during the following five months. However, the patient’s uncorrected visual acuity did not improve due to macular scar formation.

The study’s authors noted in their discussion of the case that the wavelengths used for laser hair removal, between 700nm and 1,000nm are absorbed by the hair follicle melanin and destroy the follicle by thermal injury. The high melanin concentration in the retinal pigment epithelium (RPE) make it vulnerable to damage by laser beams with those wavelengths. In this case, the alexandrite laser used had a wavelength of 755nm and a fluence usually up to 40 J/cm2. Therefore, before she was even able to blink, the damage was done. 

The authors noted that the thermal injury caused by melanin absorption of the laser energy can result in the rupture of the Bruch’s membrane, development of CNV and severe vision deterioration. “Close follow-up of the patient is essential the first weeks after the accident,” Dr Kontadakis said.

Georgios A Kontadakis: g.kontadakis@med.uoc.gr