5 Ries et al 7 found that the temperature elevation in the Stefanovsky metallic eye shield at three intensity settings (5, 10, and 20 watts of continuous energy for 10 seconds) of the CO 2 laser was quite small Δ T 0-5☌) due to the highly reflective surface of the shield itself. However, it was found that the metallic corneal shields did not produce enough heat transfer to cause damage to the eye. 6, 7 Plastic corneal shields showed significant thermal damage with the lasers tested in several studies. 5 Several studies have evaluated unintentional CO 2 laser contact to the eye throughout such procedures, which can heat a corneal shield adequately enough to result in ocular injury. Injury due to the retention of thermal energy within eye shields during laser skin resurfacing has been proposed. Dislocation of the shields during treatment or transfer of thermal laser energy to the eye may also lead to corneal damage. Although these devices are meant to protect the patient’s eyes from injury, improper placement or preparation of the shields may result in corneal abrasion. When laser treatment takes place on the eyelids or near the periorbital region, corneal shields, in this case metal, are typically used. These lens changes were consistent with the patient’s past medical history of a cataract of the left eye.Ĭharacteristic corneal abrasion possible found inconsistent with thermal, chemical or mechanical damage to cornea However, her final vision was back to normal with measurements of 20/40 OD and 20/80 OS. On her final visit, the right cornea was completely healed, while the left cornea showed persistent punctate changes. The patient had a total of three ophthalmology appointments for evaluation and treatment in the five days following injury. Homatropine ophthalmic drops and Tylenol with codeine were given for pain. Treatment consisted of tobramycin ophthalmic ointment and a headband patch to the right eye since marked skin inflammation after laser therapy made occlusion with tape difficult. Ophthalmologic evaluation of the patient revealed a large corneal abrasion of the right eye and severe punctate keratopathy of the left eye. Slit lamp evaluation of the eye shields found no irregularities or defects. She was then taken to the ophthalmology department for emergency examination. After flushing both eyes with ophthalmic normal saline continuously for 15 minutes, the patient complained of blurry vision. Following removal of the eye shields, the patient complained of stinging, burning, and difficulty opening her eyes. The entire procedure was performed with a single pass technique. The shape, size, and density setting were three. The laser settings used during treatment of the periorbital region were 125mJ. When the BLT cream was removed, the patient noted a stinging sensation at the corner of her right eye however, she felt that her face was sufficiently anesthetized. One hour prior to the procedure, a topical anesthetic compound of benzocaine, lidocaine, and tetracaine (BLT, CAP Pharmacy) 20:8:4% cream was applied to the patient’s entire face, including the upper and lower eyelids. Tetracaine 0.5% ophthalmic solution was applied to both eyes, and bacitracin ophthalmic ointment was applied to the inner surface of the Stefanovsky metallic eye shield prior to intraocular insertion. ![]() Full-face laser resurfacing with the Active FX™ application of the Lumenis UltraPulse® Encore™ was selected. The authors present this case to alert physicians to be aware of the potential for such complications and suggest the need for better formulation of these topical anesthetic creams.Ī 64-year-old Caucasian woman presented for treatment of fine lines and wrinkles, seborrheic keratoses, and lower and upper eyelid dermatochalasis with marked hyperpigmentation. ![]() ![]() The bilateral corneal abrasions occurred after skin resurfacing treatment despite the use of corneal shields throughout the procedure. In this article, the authors report the case of corneal abrasions due to a compounded topical anesthetic: benzocaine 20%, lidocaine 8%, tetracaine 4% (BLT). Improper use of topical anesthetics can lead to severe consequences, including death. However, no standard guidelines exist for optimal use, dosage, formulation, and safety of all topical anesthetics. ![]() One of the most commonly used is benzocaine, lidocaine, tetracaine, which can vary in percent as well as rheology, namely yielding a gritty or smooth texture. 1, 2 To date, there are several compounded topical anesthetics available for physicians for in-office use on their patients. Application of topical anesthetics has proven to decrease pain and discomfort associated with these procedures, including cosmetic procedures, such as filler injectables, laser hair removal, and skin resurfacing with laser and light-based devices. Topical anesthetics are now widely used in dermatologic procedures.
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