First Author: T.Paraskevopoulos GREECE
Co Author(s): A. Meidani A. Kouroupaki D. Pagoulatos P. Kosmidis
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To present a case of acute visual deterioration in a patient after accidental occupational exposure to Alexandrite laser, applied in hair removal procedures.
A 25-year-old female patient presented to our department complainig about accute visual impairment in her right eye, following accidental exposure to Alexandrite laser 12 hours earlier. The patient was the operator of the laser and did not wear the appropriate protective goggles.
The best-corrected visual acuity was 20/60 in her right eye, and 20/20 in her left eye. The slit-lamp examination was unremarkable in both eyes. The intraocular pressure was measured 13mmHg and 12mmHg in her right and left eye respectively. The fundoscopy of the right revealed a pale white round lesion in the foveal area. The fundoscopical examination of the left eye was normal. The patient underwent fundus photography to record the lesion, and Spectral-domain optical coherence tomography (OCT) examination, which demonstrated increased reflectance in the fovea, due to disruption of all retinal layers, with absence of intraretinal or subretinal fluid.
Alexandrite laser is broadly used in hair removal procedures. Its wavelength (755 nm) provides increased efficacy in hair follicle photothermolysis, since it is absorbed by tissues containing melanin. The retinal pigment epithelium absorbs the energy of the applied Alexandrite laser, as a melanin-containing tissue. Consequently, the current type of laser may cause severe injury if it is applied on the retinal tissue, due to its photochemical, photomechanical and photothermal impact. The retinal layers are susceptible to damage by the laser beam, as a result of its thermal effect upon the retinal tissue. The most common ocular complications of the Alexandrite laser application involve the anterior segment and include anterior uveitis, iris atrophy and pupillary distortion. On the contrary, the cause of foveal burn, as a result of the Alexandrite laser application is very rare, since very few cases have been reported, but may lead to permanent visual loss. Therefore, the use of the appropriate protective goggles is required in all patients undergoing hair removal procedures, and all the operators of the laser devices.