Clinical Review & Education

Images in Dermatology

Occupational Vision Loss Following Alexandrite

Laser Exposure
Dimitrios Karagiannis, MD, PhD; Maria Stoupaki, MD; George A. Kontadakis, MD, MSc, PhD

A woman in her 30s presented with a 1-day history of severe vi- membrane, and choroidal neovascularization, which in this case
sion deterioration in her right eye. She worked as a nurse in a cos- developed within days. The present case reinforces the critical
metic institute and had direct exposure to an alexandrite laser beam importance of wearing eye protection during all aspects of laser
the previous day. She directly fixated on the laser probe while cali- operation.
brating the laser for epilation, and was not wearing eye protection
at the time. Her corrected distance visual acuity (CDVA) at presen- Figure. Fluorescein Angiography of Choroidal Neovascularization
tation was 20/140 in her right eye and 20/20 in her left. She re-
ported similar visual acuity in both eyes prior to the accident. Fun-
dus examination and fluorescein angiography showed a laser burn
at the fovea of the right eye. After 9 days, her CDVA deteriorated
further; she was able to detect hand motions and count fingers, but
little else. Fluorescein angiography (Figure) and optical coherence
tomography showed choroidal neovascularization of the fovea with
intraretinal fluid. The next day she had an intravitreal injection with
an antivascular endothelial growth factor agent (ranibizumab), and
the CDVA for her right eye improved to 20/140. The optical coher-
ence tomography scan showed minimal intraretinal fluid. Visual
acuity remained stable for 1 year.
Laser epilation is based on selective photothermolysis; the
laser beam causes localized damage to the hair follicle by being se-
lectively absorbed by melanin while having minimal effect on the
surrounding skin. In this case, an alexandrite laser was used. The ac-
tive medium, an alexandrite crystal, produces a precise wave-
length of light (755 nm). Protective eyewear during laser epilation
is essential to avoid inadvertent ocular injury to the patient or laser 200 µm
operator.1,2 The extent of ocular injury can vary from a relatively mi-
nor injury to the iris to permanent retinal damage.2,3 A laser beam Fluorescein angiography (late phase) of the patient showing fluorescein leakage
reaching the pigmented epithelium of the retina is likely to be ab- at the site of the laser injury at the fovea of the right eye 9 days after laser
exposure.
sorbed by melanin and cause thermal injury, rupture of the Bruch

ARTICLE INFORMATION
Author Affiliations: Ophthalmiatreio Eye Hospital
of Athens, Athens, Greece (Karagiannis, Stoupaki,
Kontadakis); University of Crete, Department of
Ophthalmology, Heraklion, Crete, Greece
(Kontadakis).
Corresponding Author: George A. Kontadakis, MD,
MSc, PhD, Institute of Vision and Optics (IVO),
University of Crete-School of Health Sciences, GR
71 003 Voutes, Heraklion, Crete, Greece (g.
kontadakis@med.uoc.gr; kontadas@yahoo.com).
Published Online: April 10, 2019.
doi:10.1001/jamadermatol.2018.5524
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for
granting permission to publish this information.
REFERENCES:
1. Asiri MS, Alharbi M, Alkadi T, et al. Ocular injuries
secondary to alexandrite laser-assisted hair
removal. Can J Ophthalmol. 2017;52(2):e71-e75. doi:
10.1016/j.jcjo.2016.09.013
2. Kontadakis GA, Karagiannis D, Kandarakis AS.
Macular injury with rapid onset of choroidal
neovascularization from laser epilation. JAMA
Ophthalmol. 2015;133(4):488-490. doi:10.1001/
jamaophthalmol.2014.5838
3. Halkiadakis I, Skouriotis S, Stefanaki C, et al. Iris
atrophy and posterior synechiae as a complication
of eyebrow laser epilation. J Am Acad Dermatol.
2007;57(2)(suppl):S4-S5. doi:10.1016/j.jaad.2006.
07.024

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