Selective photothermolysis(SPTL) is the theoretical basis of cosmetic laser therapy, that is, different skin components have the characteristic of selective absorption of different wavelengths of laser. The key to realize selective photothermal effect is the wavelength, pulse width and energy of the laser. Wavelength determines the penetration depth, the duration of the pulse should be less than thermal relaxation time(TRT) of the targeted tissue to avoid causing damage to the surrounding tissue, and the energy determines the therapeutic effects(2).
The same principle applies to eye, which is rich in the same chromophore as skin: melanin, hemoglobin and water(1). Retina is susceptible to devices with wavelengths between 400 and 1400nm, photons in this wavelength range can penetrate lens and focus on the retina, which can be seen in the use of 1064nm Nd:YAG laser. The danger zone of cornea and lens is ultraviolet light, medium infrared light and far infrared light. This damage can be seen in CO2 laser and Erbium:YAG laser(3). Upon detailed questioning, the patient in this case was treated with a 755nm Alexandrite laser from a picosecond laser device, no ocular protection was used during the treatment.
We searched in PubMed and found 6 cases of cosmetic laser-related cataract (Table 1). Almost all patients complained of pain, photophobia and blurred vision, which may caused by iris damage and cataract. One of the patients had heat-induced cataract combined with corneal injury, which is significantly different from the other cases. 3 patients had posterior subcapsular cataract and 1 patient had nuclear-sclerosis change of lens. 3 patients had cataract surgery, 2 others had anti-inflammatory treatment. The follow-up VA ranging from HM to 20/20. Diode laser assisted eyebrow epilation is most common, and the use of eye shield was reported in only one patient with thermal eye injury(4–8)(Fig. 3).
Table 1
cosmetic laser-related cataract
author | year | laser | Age and gender | Ocular protection | symptom | Laterality and VA | Ocular injury | treatment | Follow-up and VA |
Garcia et al.(4) | 2021 | Diode laser assisted eyebrow epilation | 30/F | none | Pain, photophobia, blurred vision | OS, 20/28 | Corectopia, iris atrophy, posterior subcapsular cataract | Topical steroid, mydriatics | 9m, 20/28 |
Germert et al.(5) | 2018 | Periocular CO2 laser resurfacing | 36/F | Stainless steel Cox II ocular shields | Pain, blurred vision | OS, 20/100 | Corneal ulceration and scarring, deformed iris, cataract, eye lashes signs of acute burns | Rinse, corneal debridement, cataract surgery | 7y, HM/2m |
Parver et al.(6) | 2012 | Diode laser eyebrow epilation | 34/F | Unknown | Pain, blurred vision | OS, 20/20 | Iris transillumination defects, posterior subcapsular cataract | Cataract surgery | 4y, 20/20 |
Unknown | 37/F | Unknown | Pain, photophobia, blurred vision | OD, 20/40 | Iris epithelial defects, posterior synchiae, 1 + posterior subcapsular cataract | Cataract surgery | Several month, 20/20 |
Herblod et al.(7) | 2005 | Diode-laser epilation of eyebrow | 27/F | None | Oval pupils, photophobia, blurred vision | OS, 20/40 | Superior iris atrophy, anterior subcapsular cataract | Topical and oral steriod | 9m, 20/32 |
Brilakis et al.(8) | 2004 | Diode-laser epilation of eyebrow | 61/F | unknown | Pain, photophobia, blurred vision | OS, 20/30 | Superior iris atrophy, nuclear-sclerosis change | unknown | unknown |
In conclusion, we report a case of traumatic cataract caused by cosmetic laser. Although the patient was very lucky to recover her vision, she still had photophobia in her left eye when exposed to bright light and was left with irreversible lens damage in both eyes. The asymptomatic opacification of the lens in the right eye suggests that there may be many undetected cosmetic laser related ocular injuries in clinical practice, which reminds cosmetic laser therapists to be aware of the importance of eye treatment.