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

• Published in: Lasers in surgery and medicine 2018-12, Vol.50 (10), p.980-986
• Main Authors: van Gemert, Martin J. C., Bloemen, Paul R., Wang, Wei‐Yong, van der Geld, Cees W. M., Nuijts, Rudy M. M. A., Hortoglu, Hayri, Wolkerstorfer, Albert, de Bruin, Daniel M., van Leeuwen, Ton G., Neumann, H. A. Martino, Jager, Martine J.
• Format: Article
• Language: English
• Subjects: burned eye lashes; Carbon dioxide; Carbon dioxide lasers; Cataracts; CO2 laser; Complications; Computation; Conduction; Conduction heating; Conductive heat transfer; Cornea; corneal melting; Deformation mechanisms; Eye; Eye (anatomy); Eye injuries; Irradiation; Laser resurfacing; Lasers; Lesions; metal eye shields; Metals; ocular complications; periocular skin resurfacing; Resurfacing; Scars; Shields; Skin; Stainless steel; Surfacing; Temperature effects; temperature–time predictions of cataract formation
• ISSN: 0196-8092; 1096-9101
• DOI: 10.1002/lsm.22951

Background and Objectives A 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. Study We 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. Results We computed that cataract can develop when the corneal temperature reaches, for example, 80 °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 °C. Conclusion Despite 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. © 2018 Wiley Periodicals, Inc.