Purpose: To report a case of iris synechiae formation, iris atrophy and corectopia in one eye following bilateral eyebrow laser photothermolysis.
Methods: A 39 year old caucasian female with a past ocular history of bilateral LASIK eye surgery underwent laser photothermolysis of the eyebrows and lower legs. The laser used was a long-pulsed 755nm wavelength infrared alexandrite (Cynosure, Inc., Chelmsford, MA, USA). Pulse duration was 20 msec with a spot size of 12.5mm. Initially safety glasses were used during laser epilation of the legs. The glasses were then removed for the eyebrow laser epilation. The patient reports the laser technician used his hand to shield the right eye while treating the right eyebrow and both eyes while treating the left eyebrow.
Results: Six hours later the patient noticed blurred vision, photophobia and pain in the left eye (OS). She presented to an ophthalmologist approximately 24 hours after the procedure. She was diagnosed with non-granulomatous iridocyclitis OS and placed on topical prednisolone QID OS. Initial vision was 20/20 OU with no evidence of cataract or other ocular abnormalities. On exam 4 days later the patient had pigmented cells in the anterior chamber and 4-5 clock hours of iris transillumination defects/atrophy infero-temporally. The pupil was distorted supero-temporally and 5 clock hours of posterior synechiae were seen temporally. She was subsequently placed on Atropine 1%. Over 8 weeks the iridocyclitis resolved and vision returned to baseline (20/20 OU). The posterior synechiae remained but decreased to 1-2 clock hours using topical tropicamide 1% TID OS for 4 weeks. Iris transillumination defects and pupil distortion remained. There was no cataract formation.
Conclusions: Most lasers use selective photothermolysis by targeting melanin in the dermis hair follicle as the chromophore. Commonly used lasers include the Nd:YAG (1064 nm), alexandrite (755nm) and diode (810nm). Past reports of ocular injury after laser eyebrow epilation have been reported using the diode laser, but this is the first case reported after using the infrared alexandrite (755nm). The alexandrite laser can possibly penetrate the thin skin of the eyelid and damage ocular structures containing melanin. The Bell's response when an eyelid is closed could place the iris closer to the laser source, thereby increasing the chance of damage. This case demonstrates a possible risk to ocular tissues while performing laser hair epilation.
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