Photothermal foveal injury secondary to accidental alexandrite-laser exposure: a case report and literature review

Purpose To report a case of alexandrite laser-induced foveal injury complicated by acute anterior uveitis, which showed a significant clinical improvement over serial follow-up. Observations We report the case of a 23-year-old female, a laser hair removal technician, who presented with sudden central visual loss in her left eye (LE) after an accidental exposure to an alexandrite laser beam while cleaning the probe. At the initial presentation, visual acuity (VA) of the LE was 0.1. Optical coherence tomography (OCT) demonstrated a loss of the foveal depression with a vertical hyperreflective column extending from the inner retinal layers to the retinal pigment epithelium (RPE), with focal disruption of the ellipsoid zone (EZ) and the external limiting membrane (ELM) at the fovea. Over 5 months with regular follow-up, VA improved to 1.0. OCT demonstrated residual central foveal disruption with localized attenuation of the EZ and RPE, confined to a smaller area compared with baseline. Conclusions and importance This case demonstrates the importance of safety protocols when handling laser devices to prevent accidental eye injuries, and demonstrates the potential for good clinical outcomes with regular evaluation and follow-ups.