Intense pulsed light therapy can cause ocular complications

The authors of this correspondence from the United Kingdom present a case of anterior uveitis and iris photoablation secondary to intense pulsed light (IPL) therapy. To their knowledge, this is one of only a small number of cases to be described regarding ocular IPL complications.

IPL is a noninvasive photorejuvenation treatment used to improve skin texture and treat areas of skin dyspigmentation or telangiectasia. It is frequently performed by nonmedically trained staff in beauty salons around the world. In my opinion, these kinds of scope-of-practice issues in which nonmedical people perform dangerous procedures with little knowledge illustrate the need for "house of medicine"- driven regulation of "surgical procedures."

The patient, a 31-year-old woman, presented with unilateral pain and photophobia two days after IPL to remove freckles. She reported that she was given eye protection initially but it was removed by the treating technician to treat the eyelid skin over the right eye. During the procedure, she complained of discomfort in her right eye and afterward noticed that the conjunctiva was injected and her pupil was irregular.

She had anterior chamber cell and flare, iris stromal hemorrhages, and diffuse transillumination defects. It was thought that the pigmented tissues on the iris were directly photoablated.

She was treated with topical corticosteroids and cycloplegics. Her condition improved and iritis resolved, but she was left with sequelae of anisocoria and severe glare.

The authors note that IPL uses polychromatic 500- to 1300-nm wavelength light to achieve photothermolysis of pigmented cutaneous tissues. The iris, with its richly pigmented structure, absorbs light within this spectrum and consequently renders it vulnerable to damage by IPL. Its potential effect on pigmented structures, such as the retinal pigment epithelium, remains of concern.

The popularity of IPL is increasing, and it needs to be included in the causes of unilateral iridocyclitis. The authors note that patients undergoing IPL should be offered eye protection and instructed not to remove it. Better training of and awareness by treating technicians regarding potential side effects will help prevent similar cases in the future.