Supplementary Material for: Laser Iris Depigmentation Resulting in Markedly Elevated Intraocular Pressure and Herpes Simplex Keratitis with Corneal Scarring - Case Report

Introduction: Laser Iris Depigmentation (LID) is a cosmetic procedure designed to alter eye color by reducing iris pigment using an Nd:YAG laser. While this procedure is increasingly popular, it carries risk of serious, sight-threatening complications. This report highlights two cases that emphasize these potential complications. Case Presentation: Two patients presented after undergoing multiple sessions of LID performed abroad. They exhibited similar symptoms, including blurry vision, nausea, and eye pain. Case 1 had intraocular pressure (IOP) of 34 mmHg in both eyes and later developed herpes simplex keratitis, which resulted in corneal scarring. Case 2 presented with IOP of 60 mmHg in one eye. Both patients were admitted for topical IOP-lowering treatment and received systemic administration of acetazolamide and mannitol, resulting in normalized IOP levels. However, in the first patient, corneal scarring led to a marked decline in visual acuity. Conclusions: LID may be associated with serious, sight-threatening complications, including significant increases in IOP and corneal scarring. It is crucial for both patients and healthcare providers to be fully aware of these potential risks, which may outweigh the potential aesthetic benefits of the procedure, and to actively monitor postoperatively for any signs of these adverse effects.