Use of an at-home red light therapy mask may be associated with acute bilateral angle-closure glaucoma secondary to ciliochoroidal effusions in a patient whose vision returned to baseline following treatment.
Researchers described a 43-year-old patient with no previously diagnosed medical or ocular conditions who presented with acute bilateral vision loss, severe frontal headache, periocular discomfort, and progressive edema. She reported no medication, substance, vitamin, or supplement use and had begun using a red light therapy (RLT) mask for cosmetic purposes 2 weeks prior to presentation, including on the morning her symptoms developed. She had received a frontalis botulinum toxin injection 1 week earlier but had undergone similar treatments previously without complications.
At presentation, visual acuity was counting fingers in the right eye and 20/400 in the left eye at near, and intraocular pressure (IOP) ranged from 60 to 65 mmHg in both eyes. Slit-lamp examination showed 360-degree iridocorneal touch in the right eye and 180-degree iridocorneal touch in the left, with shallow anterior chambers bilaterally. Gonioscopy showed closed angles with no visible angle structures. Ultrasound biomicroscopy demonstrated significant anterior ciliochoroidal effusions in both eyes.
Initial treatment included intravenous acetazolamide, topical dorzolamide, timolol, brimonidine, and latanoprost, and manual angle decompression. IOP decreased to 28 mmHg in the right eye and 21 mmHg in the left, with substantial improvement in headache. Following identification of the ciliochoroidal effusions, the patient received cyclopentolate, prednisolone acetate, hypertonic sodium chloride for the more pronounced corneal edema in the right eye, and systemic methylprednisolone. She was instructed to stop using the RLT mask.
During close outpatient follow-up, IOP remained low as acetazolamide and topical therapies were gradually discontinued. Serial examinations showed progressive resolution of the choroidal effusions and improvement in visual acuity. At 2 months following presentation, visual acuity had returned to 20/20 in both eyes.
The researchers considered the presentation most consistent with secondary angle closure resulting from ciliochoroidal effusions and anterior rotation of the ciliary body. Recent RLT mask use was the only identified recent lifestyle change, and the patient had not used eye protection during treatment. The researchers noted that previous studies of repeated low-level red-light therapy in pediatric patients with myopia have demonstrated increased choroidal thickness, vessel volume, and perfusion. They proposed that red and near-infrared light could potentially promote uveal vasodilation, although the mechanism by which RLT might cause ciliochoroidal effusions remains unknown.
The researchers were unable to establish causality. The study involved a single patient, and they found no previous reports directly linking at-home RLT mask use with choroidal effusions. Although prior evidence suggests that red-light exposure can affect choroidal vascularity and thickness, whether those effects explain the effusions observed remains uncertain. Further investigation is needed to characterize the ocular safety profile of RLT devices.
“In the absence of any other risk factors in this patient, it is plausible that RLT contributed to the development of ciliochoroidal effusions,” wrote lead study author Margarita Labkovich, of the Department of Ophthalmology at Manhattan Eye, Ear and Throat Hospital at Northwell Health, and colleagues.
The study authors reported no conflicts of interest.