Corneal Burn Caused by Carbon Dioxide Ultrapulsed Laser for Nevus Removal

Abstract

Purpose: Periocular carbon dioxide ultrapulsed laser surgery can induce ocular damage. Herein we report a rare case of corneal burn after carbon dioxide ultrapulsed laser for nevus removal. Case summary: A 25-year-old female patient presented with ocular pain, decreased visual acuity, and metamorphopsia in the left eye after laser surgery for nevus removal at a dermatology clinic 4 days prior. The patient's best corrected visual acuity in the left eye was 20/100. Central corneal haziness and corneal epithelial defect were observed on biomicroscopic examination. Antibiotics, steroid and artificial tear eye drops were administered for treatment. Glasses were prescribed to correct refraction errors. After 2 months of treatment, the best corrected visual acuity in the left eye recovered to 20/50, and corneal epithelial defect was mostly healed, however corneal haziness remained. Conclusions: Carbon dioxide ultrapulsed laser is commonly used in dermatological treatments. The use of an eye shield is important during this procedure, and possibility of ocular surface damage from laser treatment should be considered. J Korean Ophthalmol Soc 2014;55(9):1376-1379

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.…”

“…Our review identified 119 published case reports of ocular injury from lasers and IPL. 11,13,14,16,18–35 , 36–65 Fifty-nine of these cases resulted in a temporary (54 of 59) or permanent (5 of 59) ectropion after CO 2 laser resurfacing where the laser was directed at the eyelids. 13,14,63–65 A 1997 survey of American practitioners performing laser resurfacing found that ectropion occurs in 0.4% of cases.…”

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

“…This thermal complication either seems to be extremely rare or has been underreported in the literature as we found only five papers on this subject. In three, the authors described the thermal cause , one written in Korean , the third gave a 0.3% incidence of corneal injury after CO 2 laser blepharoplasty, however, without details. In the other two , we believe the cause was thermal but the authors proposed other mechanisms.…”

“…Fractional carbon dioxide (CO 2 ) laser treatment has become a common procedure to treat various cutaneous conditions, including periocular rhytides. Sporadically, dermal side effects and complications occur whereas very few publications address ocular complications . We present a patient who was treated for periocular rhytides with a CO 2 laser.…”

Safety Principles in the Application of Lasers in Energy-based Aesthetic Procedures from the Nurse’s Perspective

“…Many blindness accidents have been reported from the use of lasers in this wavelength range. 7,8 The eye protection must block the light from the laser as much as possible.…”