Periocular CO2 laser resurfacing: severe ocular complications from multiple unintentional laser impacts on the protective metal eye shields

Martin J. C. van Gemert*, Paul R. Bloemen, Wei-Yong Wang, Cees W. M. van der Geld, Rudy M. M. A. Nuijts, Hayri Hortoglu, Albert Wolkerstorfer, Daniel M. de Bruin, Ton G. van Leeuwen, H. A. Martino Neumann, Martine J. Jager

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Web of Science)

Abstract

Background and ObjectivesA 36-year-old woman underwent CO2 laser resurfacing for periocular rhytides using protective stainless steel Cox II ocular shields. Immediately after the treatment, corneal lesions were seen in both eyes. The left eye subsequent developed corneal ulceration and scarring, a deformed iris, cataract, and lower eye lashes showing signs of acute burns. The right cornea had a small inferior mid-peripheral superficial lesion and concomitant lower mid-peripheral burned eye lashes. Our objective was to determine the most likely cause of these ocular complications.

StudyWe estimated temperature-time combinations that could induce corneal injury and cataract. Heat conduction effects from a heated cornea to the lens and from a heated ring of periocular skin to the cornea were computed. The temperature response of a shield following CO2 laser irradiation was determined.

ResultsWe computed that cataract can develop when the corneal temperature reaches, for example, 80 degrees C for 14 seconds. A periocular ring of heated skin contributes little to the corneal temperature. After 7 pulses of consecutive CO2 laser bursts in 7.5 seconds, the total shield area already reached a homogeneous temperature of 63 degrees C.

ConclusionDespite uncertainties in procedural details and modeling of cataract temperatures, the eye injuries were caused beyond doubt by heating of tear-covered metal eye shields by at least 10 consecutive but unintentional laser impacts. Lasers Surg. Med. 50:980-986, 2018. (c) 2018 Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)980-986
Number of pages7
JournalLasers in Surgery and Medicine
Volume50
Issue number10
DOIs
Publication statusPublished - Dec 2018

Keywords

  • CO2 laser
  • periocular skin resurfacing
  • ocular complications
  • temperature-time predictions of cataract formation
  • corneal melting
  • burned eye lashes
  • metal eye shields
  • CORNEAS
  • DAMAGE

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