Can laser treatment for trichoepithelioma cause macular edema (ME) or central serous retinopathy (CSR) in patients, especially those with a history of eye problems?

Laser Treatment for Trichoepithelioma Does Not Cause Macular Edema or Central Serous Retinopathy

Laser treatment for trichoepithelioma (a benign skin tumor) does not cause macular edema (ME) or central serous retinopathy (CSR), as these are dermatologic procedures performed on facial skin, not intraocular interventions. The confusion may arise from the term "laser," but the mechanisms, targets, and risks are entirely different between dermatologic and ophthalmic laser procedures.

Understanding the Distinction

Dermatologic Laser for Trichoepithelioma

• Argon laser treatment for trichoepitheliomas targets superficial skin lesions through thermocoagulation and epidermal atrophic effects, performed as an outpatient procedure under local anesthesia 1.
• The laser energy is directed at skin chromophores (melanin, hemoglobin) in facial tumors, not at ocular structures 1.

Ocular Complications from Dermatologic Lasers

The primary eye-related risk from facial dermatologic laser procedures is direct ocular injury from inadequate eye protection, not macular edema or CSR:

• Most eye injuries from dermatologic lasers occur due to improper eye protection (73% of cases), particularly during laser hair removal of the face 2.
• These injuries typically affect anterior structures or cause wavelength-specific damage to ocular chromophores when the laser directly enters the eye 2.
• Persistent ocular symptoms occurred in 52% of cases with direct eye injury, but these represent corneal burns, iris damage, or lens opacities—not macular edema or CSR 2.

Macular Edema and CSR: Distinct Etiologies

Macular Edema Causes

Macular edema results from:

• Retinal vascular occlusions (branch or central retinal vein occlusion) treated with anti-VEGF agents as first-line therapy 3.
• Diabetic retinopathy requiring focal laser photocoagulation for clinically significant macular edema 3.
• Inflammatory conditions, post-cataract surgery, or age-related macular degeneration 4.
• Intraocular procedures such as intravitreal injections or vitrectomy 3.

Central Serous Retinopathy Causes

CSR involves:

• Choroidal vascular abnormalities with subretinal fluid accumulation, often associated with corticosteroid use or stress 3, 5.
• Treatment options include subthreshold micropulse laser, photodynamic therapy, or selective retina therapy directed at the choroid and retinal pigment epithelium 3.
• CSR in a military pilot was treated with laser photocoagulation, but this was therapeutic laser applied to the retina, not a dermatologic procedure 5.

Critical Safety Consideration

The only way dermatologic laser treatment for trichoepithelioma could theoretically affect the macula is through direct, accidental laser exposure to the eye due to absent or inadequate eye protection. This would cause:

• Immediate retinal photocoagulation burns at the point of laser impact.
• Potential macular scarring if the fovea is directly hit.
• NOT macular edema or CSR, which have entirely different pathophysiologic mechanisms 2.

Clinical Recommendation

When performing laser treatment for facial trichoepitheliomas:

• Use appropriate laser-specific protective eyewear for both patient and operator (wavelength-appropriate optical density) 2.
• Apply metal eye shields directly on the patient's closed eyelids when treating periorbital lesions 2.
• Ensure the patient understands they must keep protective eyewear in place throughout the procedure 2.

If a patient with a history of CSR or macular edema requires trichoepithelioma treatment, proceed with the dermatologic laser using proper eye protection—the pre-existing retinal condition is unrelated to the dermatologic procedure and will not be affected by appropriately performed facial laser treatment.