Admin_Adham
Jump to Key Points SAN DIEGO — Dermatologists and their staff members must take special precautions to protect the eyes when using lasers for facial procedures, a Boston dermatologist cautioned colleagues.
Catherine M. DiGiorgio, MD, who spoke on laser safety at a presentation here at the Masters of Aesthetics Symposium and in a follow-up interview with Medscape Medical News, provided the following recommendations about eye protection and other laser safety precautions:
Use Corneal Shields When Treating Near a Patient’s Eyes
“If you’re treating the periocular area with any laser, you have to place a corneal shield” because of the associated risk for significant ocular damage to a patient, particularly when performing elective procedures, DiGiorgio said. She highlighted injuries that can occur, such as laser retinopathy, when the laser injures the retina, and thermal burns of the cornea.
Make Sure to Use the Proper Corneal Shield
Metal corneal shields should always be used when laser devices are used, DiGiorgio said. “If a plastic shield is used, the shield can be heated by the laser and result in thermal burns to the cornea,” and it is important to know the correct shield to use for each device, she added.
- Periocular laser use requires corneal shields to prevent retinal/corneal injury.
- Use metal, not plastic, corneal shields; plastic may heat → corneal burns.
- Contact lens wearers + ocular anesthesia: avoid immediate lens reinsertion; abrasion/keratitis risk.
- Facial topical anesthetics are ocular toxic; eye exposure = immediate saline irrigation + ophthalmology.
- Staff need wavelength-matched goggles; plume control requires smoke evacuator + N95.
She also suggested using “the biggest eye shield that you can place into the eye” and being aware that placement can “take a little bit of nudging.” She noted that she uses tetracaine eye drops to anesthetize the eye during eye shield placement to make the procedure more comfortable, but not to reduce pain. Even without anesthetic drops, eye shield placement is “not a painful part of the procedure,” DiGiorgio said.
Take Care With Contact Lens Wearers
DiGiorgio is especially cautious regarding ocular anesthetic use in patients who wear contact lenses. She prefers they don’t put in their contact lenses immediately following the use of an eye shield.
“If you’re using an anesthetic drop to anesthetize the eye prior to placement of the eye shield, they’re not going to have that sensory nerve functioning to be able to tell if something is under the contact lens,” she explained. “This can cause a corneal abrasion or keratitis, which can cause an ulceration, which can cause blindness.”
Be Cautious With Facial Anesthetics and the Eyes
Keep in mind that routinely used topical anesthetics for the face are toxic to the eye and can cause corneal ulcerations, DiGiorgio said. “Monitor patients so they do not get this in their eye,” she advised. “Corneal burns are an emergency,” she said, and in the case of exposure, “the eye should be flushed immediately with saline drops. Patients need to see an ophthalmologist should the topical anesthetic used to anesthetize the face gets into the eye.”
Eye Protection Is Crucial for Staff Members Too
In regard to the staff, before a laser treatment is started, “I always make sure I look around and make sure everyone has their appropriate goggles on,” even though staff members are trained to select the goggles, DiGiorgio said.
“It’s the dermatologist’s responsibility,” she said, to make sure staffers are wearing the correct goggles that are appropriate for the laser’s wavelength. To do this, check the eyewear’s optical density. “If you can’t read it because it’s rubbed off or [the goggles are] too old, then you have to replace them with new goggles that can be read.”
Watch Out for Other Laser Hazards
On another laser safety front, DiGiorgio highlighted the use of smoke evacuators to address the risk of laser plume during laser hair removal. Smoke evacuators must be held within 5 cm of the handpiece and have a capture velocity of 30-45 m/min, she said. For protection against plume, “respiratory masks must filter particles from 0.1-0.3 µm,” she said. “N95 masks do this, but regular surgical masks do not.”
She added that it’s especially important to clean laser handpieces between multiple procedures in the same session, such as filler followed by laser. Finally, she noted that “electrical and fire hazards should be appreciated by anyone who owns a laser.”
DiGiorgio reported having no disclosures.
