Cause / Mechanism

Ocular injury from medical/cosmetic lasers occurs when beams directly or indirectly enter the eye. Nd:YAG 1064 nm penetrates deeply and may cause retinal burns; 532 nm causes photocoagulation of retina; Er:YAG 2940 nm primarily absorbed in cornea. Causes include absent or incorrect eyewear, reflections from instruments/jewellery, patient eye shields displaced, or operator error. ^{1 2}

Risk Factors

• Patient: periocular treatments (eyelids, tear troughs), uncooperative movement, poor eye shield fit.
• Staff: inadequate or incorrect protective eyewear optical density (OD).
• Device: misaligned aiming beam, accidental discharge.
• Environment: reflective surfaces, poor signage/access control. ^{1 3}

Signs & Symptoms

• Corneal: pain, tearing, foreign body sensation, photophobia.
• Retinal: photopsia (flashes), scotoma (dark spot), blurred or lost vision.
• Eyelid/Periorbital: erythema, swelling, burns.
• All exposures are considered serious and vision-threatening until excluded. ^{4 5}

Prevention

• Mandatory wavelength-specific eyewear for all in the room (patient, operator, assistants). ¹
• For periocular treatment: use approved intraocular metal corneal shields or external goggles.
• Secure shields with lubricant; check fit before arming laser.
• Cover reflective surfaces; display Class 4 laser warning signage.
• Operator must confirm eyewear OD against laser wavelength before each use. ^{2 5}

Management Protocol

Immediate Actions:

• Cease laser firing immediately.
• Do NOT attempt to self-treat eye beyond irrigation for chemical contaminants.
• Keep eyewear/shield in place if protective (unless dislodged). ⁵

Acute Care:

• Arrange urgent same-day ophthalmology review for all suspected exposures.
• Document laser wavelength, pulse, fluence, distance, and exposure duration.
• If corneal burn suspected: cool compress only until reviewed (avoid further topical agents unless specialist-directed). ⁴

Serious Injury:

• Retinal burns: irreversible; urgent retinal specialist care may reduce sequelae.
• Corneal burns: require ophthalmic intervention; risk of scarring or vision loss. ⁵

Follow-up & Documentation

• Complete incident report with all laser parameters.
• Record patient consent status and discussions post-incident.
• Notify SafeWork NSW if significant injury.
• Review and re-train staff in eyewear protocols.
• Service device if malfunction contributed. ⁶

Sources

1. AS/NZS 4173:2018 Safe use of lasers and intense light sources in health care., viewed 7 October 2025, https://www.standards.org.au ↩︎
2. ARPANSA. Advice for providers: Lasers, IPL and LED for cosmetic purposes., viewed 7 October 2025, https://www.arpansa.gov.au ↩︎
3. SafeWork NSW. Information on lasers in workplaces., viewed 7 October 2025, https://www.safework.nsw.gov.au ↩︎
4. UNSW Safety. Laser safety hazards (ocular injuries)., viewed 7 October 2025, https://safety.unsw.edu.au ↩︎
5. RANZCO. Laser Safety Protocol and guidance on ocular exposures., viewed 7 October 2025, https://ranzco.edu ↩︎
6. Ahpra (2025). Guidelines for practitioners performing non-surgical cosmetic procedures., viewed 7 October 2025, https://www.ahpra.gov.au ↩︎