Medical education
Lessons from practice
Volume 206 - Issue 4
Light-based epilation device-related injury to the cornea
Authors: Lawrence Oh and Stephanie Watson
Med J Aust 2017; 206 (4): 157. || doi: 10.5694/mja16.00478
Published online: 6 March 2017
Published online: 6 March 2017
Safety standards need to be observed for an increasingly popular cosmetic treatment
Clinical record
In recent years, there has been a surge in the commercial availability of light-based epilation devices, developed for cosmetic purposes as a means of long-lasting hair removal.1 Intense pulsed light (IPL) therapy is commonly used for “laser” hair removal. Depending on commercial variation, devices for IPL delivery use a polychromatic, non-coherent light to produce wavelengths ranging from 515 to 1200 nm. This light is able to penetrate and induce a selective photothermolytic reaction in hair follicles.2 We discuss the case of a woman with accidental corneal exposure to IPL during epilation of her cheek while wearing inappropriate ocular protection.
A 24-year-old woman presented with a sharp pain in her right eye following exposure of the eye to IPL during facial hair epilation. She reported that during epilation of her cheek, the IPL probe slipped in the operator’s hand, knocking off the plastic protective goggles she was wearing. Her past ocular history was the use of daily disposable contact lenses to correct myopia. There was no family history of ocular disease. On examination, she achieved 6/6 best corrected in each eye, and ocular tensions were within normal limits. The right cornea had five small lesions of about 0.2 mm in size at the level of the Descemet membrane. The rest of the ocular examination was within normal limits. On review at 4 months (Figure) and 2 years, the lesions had not changed.
We performed a literature search on PubMed and MEDLINE, using search terms “laser eye injury”, “laser corneal injury”, “hair epilation therapy”, “ocular complications” and “laser ocular complications”. We found no other reported cases of direct corneal damage from IPL. In our patient, permanent corneal scarring resulted without an effect on vision. Our patient was left with five circular corneal lesions. A differential diagnosis of posterior polymorphous dystrophy was excluded based on the appearance of the lesions, normal appearance of the endothelium, normal left eye and lack of a family history. In our patient, the cornea lesions were not vesicular, and were well demarcated, circular and of uniform size. Further, there was no sign of corneal stromal oedema.
During IPL, the possibility of direct corneal damage has been highlighted in the literature,1 and indirect corneal injury has been reported.2,3 A case of corneal pigment deposition resulted from a coloured lens worn during IPL therapy to the face without an effect on vision.3 IPL hair removal is now widely available and home-based treatments are emerging. The lack of literature on corneal damage from IPL may be because many devices filter out wavelengths below 450 nm. This would theoretically minimise the risk of photochemical damage to the cornea and other ocular structures.1 Although IPL is the most common means of laser hair removal, it can also be carried out with alexandrite or diode lasers. Indeed, nuclear cataract and iris atrophy have been reported as complications of diode laser therapy.4
Increasingly, devices for hair removal are being used around the eye. Indeed IPL is now being used for patients with dysfunction of the meibomian gland of the eyelid, as it may improve the tear film and reduce dry eye symptoms.5 Our case and reports in the literature highlight that patients may be at risk of ocular complications, particularly if staff are not adequately trained in the use of the equipment and appropriate protective eye wear is not worn. Although there are no current international safety eyewear standards in place for IPL devices, the majority of IPL manufacturers provide eyewear with an optical density of 3–5. Such eyewear adheres to the harmonised American and European welding eyewear standards.1 We recommend that patients be counselled as to these risks and that efforts be made to collate cases of ocular damage associated with cosmetic lasers used around the face.Lessons from practice
Intense pulsed light (IPL) therapy, an increasingly popular cosmetic and eyelid treatment, has the potential to cause permanent ocular complications.
All operators of IPL therapy and other cosmetic laser therapies should be adequately trained in the proper use of equipment and the necessity for protective gear.
Protective eyewear with the appropriate optical density as prescribed by the harmonised American and European welding eyewear standards should be worn during IPL and other cosmetic laser therapy.
A patient or staff member suspected of having had unprotected exposure to lasers should be promptly referred to an ophthalmologist for review.
Competing interests
No relevant disclosures.
References
- Thaysen-Petersen D, Bjerring P, Dierickx C, et al. A systematic review of light-based home-use devices for hair removal and considerations on human safety. J Eur Acad Dermatol Venereal 2012; 26: 543-553.
- Raulin C, Greve B, Grema H. IPL technology: a review. Lasers Surg Med 2003; 32: 78-87.
- Hong S, Lee JR, Lim T. Pigment deposition of cosmetic contact lenses on the cornea after intense pulsed-light treatment. Korean J Ophthalmol 2010; 6: 367-370.
- Brilakis HS, Holland EJ. Diode-laser-induced cataract and iris atrophy as a complication of eyelid hair removal. Am J Ophthalmol 2003; 137: 762-763.
- Craig JP, Chen Y, Turnbull PRK. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci 2015; 56: 1965-1970.
Provenance: Not commissioned; externally peer reviewed.