Ocular injury from cosmetic lasers refers to eye damage caused by laser light hitting the eyeball during cosmetic laser procedures such as hair removal, tattoo removal, wrinkle reduction, and facial resurfacing.
Cosmetic lasers are based on the principle of selective photothermolysis, which selectively destroys target chromophores using light of specific wavelengths. The main target chromophores are melanin, hemoglobin, and water.
However, these chromophores are also abundant in the eye. Melanin in the retinal pigment epithelium and iris, hemoglobin in blood vessels, and water in the cornea and lens can absorb laser light and potentially cause collateral damage.
Although cosmetic laser procedures are generally considered safe, ocular injury can occur during periorbital treatments if proper safety measures are not followed. Common procedures performed near the eye include:
Laser hair removal of eyebrows: One of the most frequent causes of such injuries.
Eyeliner tattoo removal: A procedure where protective goggles are difficult to use
Facial resurfacing: Skin rejuvenation treatment using CO2 laser, etc.
Ocular injury after cosmetic laser treatment has a short time from exposure to symptom onset. Therefore, the causal relationship with the procedure is usually easily identified. The main subjective symptoms are listed in order of frequency.
Visual abnormalities: including decreased vision, blurring, scotoma, and metamorphopsia. This is the most common complaint.
Pain/discomfort: Often there is a history of eye pain during the procedure.
Damage can range from the anterior segment to the posterior segment.
Anterior Segment Findings
Corneal abnormalities: swelling, abrasion, ulcer, epithelial defect. Corneal ulcers due to overheating of metal shields have also been reported with CO2 lasers 1).
Uveitis: Anterior uveitis is frequently observed.
Pupillary irregularity and iris atrophy: Iris melanin absorbs laser light, potentially causing irreversible iris damage. Accompanied by transillumination defects.
Cataract: Diode lasers can induce cataracts. Develops as nuclear cataract.
Elevated intraocular pressure: May be complicated by secondary glaucoma.
Posterior Segment Findings
Retinal opacity/hemorrhage: Subfoveal hemorrhage and intraretinal hemorrhage are observed. They appear as hyperreflective lesions on SD-OCT.
Macular hole: May be formed by high-power irradiation with Nd:YAG laser.
Accidental complications have been reported even when using a metal corneal shield. In CO2 laser resurfacing, insufficient cooling time between laser pulses can overheat the metal shield, leading to bilateral bullous keratopathy. It has also been reported that cataract formation can occur when the corneal temperature reaches 80°C for 14 seconds.
Most ocular injuries from cosmetic lasers occur due to non-compliance with safety measures. In a study of 40 individuals who sustained eye injuries, only 15% wore protective eyewear.
Iris color: Light-colored irises allow more laser penetration, increasing the risk of posterior segment damage. Dark-colored irises are more prone to iris atrophy.
Pupil size: The risk increases when the pupil diameter is 2–3 mm.
History of ocular abnormalities: A history of eye conditions increases the risk.
Bell’s phenomenon: During eyelid closure, the eye rotates upward, making the iris more likely to enter the laser treatment area.
In Japan, laser energy is limited by JIS (Japanese Industrial Standards), but some overseas products do not meet these standards. Even a few seconds of exposure to the macula can cause irreversible damage to the sensory retina.
QCan you be protected from laser by keeping your eyes closed?
A
The thickness of the eyelids is not sufficient to prevent laser light penetration. Closing the eyes alone does not protect them; protective goggles or corneal shields appropriate for the wavelength are required. For details, see the “Causes and Risk Factors” section.
Ocular injury after cosmetic laser procedures is relatively easy to diagnose because of the clear temporal relationship with the procedure. The location and extent of the injury are assessed through a combination of history taking and various examinations.
It is important to obtain information about the wavelength, power, and emission mode of the laser used. Also confirm the duration of exposure, distance from the laser, and whether protective equipment was used.
QWhat should I do if I notice changes in vision after cosmetic laser treatment?
A
If you experience decreased vision, blurring, scotomas, floaters, or other symptoms after the procedure, you should see an ophthalmologist immediately. The time from exposure to symptom onset is short, and early detailed examination is essential for assessing damage and determining treatment.
Treatment for eye injury from cosmetic lasers varies depending on the location and severity of the damage. There are no established uniform medication guidelines. The treatment plan is determined based on a detailed history and physical examination.
Treatment of Corneal Injury
Superficial lesions: Managed with topical antibiotics, topical steroids, therapeutic contact lenses, or eye patches.
Endothelial damage: Damage to the corneal endothelium can lead to bullous changes, corneal thickening, and vision loss. Corneal transplantation may be necessary.
Treatment of Retinal Damage
Steroid therapy: Topical, injection, implant, or systemic administration is selected according to the condition. The goal is to reduce inflammation and promote RPE healing.
Iritis: Anti-inflammatory treatment with steroid eye drops and mydriatics (e.g., atropine) is performed.
Ascorbic acid: Administered topically or orally to promote fibroblast activity and reduce ocular injury.
For laser-induced retinal damage, it is generally considered that there is no effective treatment. The efficacy of steroid therapy is also unclear, and prevention through the use of protective eyewear is most important.
QCan retinal damage caused by cosmetic laser be cured?
A
Prognosis varies depending on the extent of damage and the type of laser. Anti-VEGF drugs (bevacizumab) are effective for choroidal neovascularization, and visual recovery has been reported. On the other hand, macular holes or severe retinal damage caused by Nd:YAG laser may result in poor visual prognosis.
The effects of laser on living tissue are determined by irradiation power and duration, and are classified into disruption, photoablation, coagulation, hyperthermia, and photochemical reaction.
The mechanism of ocular injury depends on the wavelength of the laser.
Short-wavelength lasers (KTP, pulsed dye laser, etc.) cause photothermal damage via photocoagulation. They raise retinal temperature by 40–60°C, denaturing proteins.
The main chromophores that absorb laser light in the eye are melanin in the retinal pigment epithelium, hemoglobin in blood vessels, melanin in the uvea, and water. The absorption coefficient of melanin decreases with longer wavelengths, while hemoglobin absorption is highest in the yellow range. Tissue penetration increases with longer wavelengths.
Nd:YAG laser (1,064 nm) is prone to accidents because its wavelength is invisible. Due to its high power, it can cause physical damage to the retina, leading to retinal opacification, subretinal hemorrhage, and macular hole formation.
CO2 laser (10,600 nm) is absorbed by water and causes vaporization. It can directly damage water-containing tissues such as the cornea and lens. In CO2 resurfacing, periorbital burns and corneal ulcers due to overheating of metal shields have been reported as the most serious complications1).
Ocular adverse events reported with ablative energy devices include keratopathy (exposure keratopathy), corneal damage, retinal damage, and macular neovascularization1).
A review of 21 case reports found that severe eye injuries occurred in 33% of cases even when wavelength-specific goggles or intracorneal shields were used appropriately. Metal shields may reflect laser light, and plastic shields risk melting or igniting with long-wavelength lasers.
Sullivan DA, Rouen PA, Aragona P, et al. An update on the ocular surface and eye cosmetics and cosmetic procedures. Ocul Surf. 2024. Available in PMC 2024 July 14.
Aghamollaei H, Hashemi H, Fallahtafti M, Daryabari SH, Khabazkhoob M, Jadidi K. Applications of SMILE-extracted lenticules in ophthalmology. Int J Ophthalmol. 2024;17(1):173-187. PMID: 38239948.
Yan MK, Kocak E, Yoong K, Kam JK. Ocular injuries resulting from commercial cosmetic procedures. Clin Exp Optom. 2020;103(4):430-433. PMID: 31382317.
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