WAIKOLOA, HAWAII Dr. Roy G. Geronemus warned against the cavalier approach of not using eye shields during laser surgery.
"The eyelid is very thin," he observed at the annual Hawaii dermatology seminar sponsored by Skin Disease Education Foundation. When using a device that works at 1.5 mm, "you damned well better" protect the patient's eyelids.
"With the CO2 lasers, I think you should put a shield underneath the eyelids if you're treating the lids." Because it is possible that plastic shields will melt, said Dr. Geronemus of the New York University Medical Center, he prefers to use metal eye shields.
In a subsequent presentation, Dr. R. Rox Anderson, professor of dermatology at Harvard Medical School, Boston, and director of the Wellman Center for Photomedicine at Massachusetts General Hospital, also advocated for routine use of an eye shield, "especially if you're going to be treating inside the bony orbit."
Both lasers and intense pulsed lights used for hair removal in this area can be extremely damaging to the patient's eyes, he noted. "These devices are made to kill melanin-containing structures at great depth in the tissue, and the greatest amount of melanin in the body is in the uveal tract and the retina," Dr. Anderson said. "They're retinal killers."
Eye shields can also protect against possible injury from cryogen spray, he said. "There are cases of cryogen spray freezing the cornea and hurting it."
Dr. Anderson cautioned not to let anesthetics get under the eye shields when inserting them. "Most of our anesthetics, particularly EMLA [combination lidocaine and prilocaine cream], are really quite irritating," Dr. Anderson said, and can cause corneal burns.
Dr. Anderson disclosed that he had no relevant conflicts.
Dr. Geronemus disclosed that he is a shareholder in Thermage Inc., Reliant Technologies Inc., and Light BioScience LLC.
He is on the medical advisory boards of PhotoMedex Inc., Lumenis Ltd., Rhytec Inc., Candela Corp., Zeltiq Aesthetics, and Skin Cancer Company, and is an investigator for Reliant Technologies, Medicis Pharmaceutical Corp., Rhytec, DUSA Pharmaceuticals Inc., L'Oreal, Cutera Inc., Allergan Inc., and DermTech International. SDEF and SKIN & ALLERGY NEWS are wholly owned subsidiaries of Elsevier.