Intense pulsed light may cause damage to periocular area

A study reviews two cases in which patients were injured following the treatment.

Issue: April 25, 2012

Wendy W. Lee

Two case studies have highlighted the importance of using appropriate protection to prevent ocular damage when applying intense pulsed light to the periocular area for skin rejuvenation.

The retrospective chart review, published in Ophthalmic Plastic and Reconstructive Surgery, indicated that safety goggles were removed during applications on the eyelid proper in both cases. As a result, both female patients, who were 36 and 27 years old, sustained iris atrophy and transillumination defects and are currently afflicted with severe photophobia and pain. In addition, the 36-year-old patient must wear plano colored contacts to tolerate the sun in brightly lit areas. She also has applied dark tinting to the windows of her car to lessen the pain from sun exposure.

“Although these complications are not that common with intense pulsed light (IPL) treatment, when they occur the damages are permanent and can be devastating to a patient’s quality of life,” lead author Wendy W. Lee, MD, an assistant professor of ophthalmic plastic surgery, orbit and oncology at Bascom Palmer Eye Institute, said in an interview with Ocular Surgery News. “Fortunately, these complications are easily avoidable with the correct techniques.”

Both case studies were outside referrals to Bascom Palmer.

Preventing injury

To minimize injuries from intense pulsed light when treating the eyelid proper, Dr. Lee and her colleagues advocate opaque ocular shields made of stainless steel or plastic that can be placed beneath the patient’s eyelid and conform to the globe. Another option, especially for those who are not comfortable inserting corneal shields or for treatments off of the eyelid, is for the patient to wear external metal goggles or adhesive eye shields.

Dr. Lee believes most practitioners follow these guidelines, but problems arise when the shields or goggles are repositioned in order to reach difficult-to-treat areas.

“This is where the danger comes into play,” Dr. Lee said. “Do not reposition or remove the shields during treatment and have the patient close their eyes under the shields. If repositioning is necessary, ensure that there is still good coverage of the eye before treatment is resumed.”

Closing the eyes will not only help in cases of accidental exposure to intense pulsed light, “but you can also protect your cornea from trauma from the shield application,” she said.

Damage

Because intense pulsed light consists of a broad spectrum of wavelengths, roughly 500 nm to 1,200 nm, as opposed to a laser with a single wavelength, it is “more difficult for the operator to achieve proper and full coverage of ocular safety for themselves,” Dr. Lee said. Also, handpieces for intense pulsed light systems “can be much larger than a laser handpiece, potentially exposing unwanted targets to the light.”

One of the chromophores for intense pulsed light is pigment.

“There are many pigmented structures inside the eye that can absorb the light emitted from IPL,” Dr. Lee said. “So, is the damage unexpected? No, it can absolutely happen.”

The ocular damage to the two patients “is more obvious in dim light, when the pupil dilates. The pupil irregularities become more apparent,” Dr. Lee said. Both patients experienced inflammation inside the eye, which caused irritation.

Retinal damage is also possible with intense pulsed light because the retina is a pigmented structure containing melanin and hemoglobin.

“Patients may have a false sense of security that IPL will not cause damage to the eye, but this is not true,” Dr. Lee said. “Although IPL is light therapy, it has the same potential to damage the eye as laser.”

Cosmetic patients are increasingly favoring intense pulsed light because treatment is noninvasive and nonablative and is generally associated with successful outcomes. More recently, intense pulsed light has been used by ophthalmologists to treat ocular rosacea, dry eyes, blepharitis and meibomian gland disease with promising results.

“People who are going to perform IPL procedures need to be absolutely aware of the potential risks involved and, most importantly, how to avoid those risks,” Dr. Lee said. – by Bob Kronemyer

Reference:

Lee WW, Murdock J, Albini TA, O’Brien TP, Levine ML. Ocular damage secondary to intense pulse light therapy to the face. Ophthal Plast Reconstr Surg. 2011;27(4):263-265.

For more information:

Wendy W. Lee, MD, can be reached at Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL 33136; 305-326-6434; email: wlee@med.miami.edu.
Disclosure: Dr. Lee was provided, free of charge, intense pulsed light devices from Lumenis and Cutera to temporarily demonstrate in her office.