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This unfortunate case should serve as a reminder that permanent eye injury can result when lasers are used without appropriate eye protection. This risk is especially high when treating periocular regions with deeply penetrating wavelengths of light. Three main factors contributed to the severity of the complication reported in the case above:
*The treatment was administered without appropriate eye protection, which in this case would have required metal eye shields
*The long-pulsed alexandrite laser is a deeply penetrating infrared laser capable of reaching and thermally injuring the melanin-rich iris and pupillary sphincter; and
*The treatment used high fluences, resulting in significant injury.
[1-3] When treating lesions around the eye, the beam should be directed away from the ocular globe and treatments should generally be avoided within the orbital rim. When treating eyelids, metal eyeshields should be placed directly on the conjunctival surface. It also seems prudent to avoid using deeply penetrating lasers with high melanin absorption -- including many used for hair removal -- directly around the eyes.
Obviously, laser treatments should never be administered without appropriate eye protection, but the case reviewed above begs another important question: Is it ever safe to use deeply penetrating lasers with high melanin absorption within or around the ocular rim, even when using eye protection? This question has yet to be definitively answered.