During certain laser or light-based procedures involving the periocular area (around the eyes), intraocular shields are used to protect the eyes from potential damage caused by laser energy. These shields are medical-grade devices placed directly on the surface of the eyes (over the cornea) after applying a numbing agent.

Procedure:

• Anesthetic eye drops will be applied to numb the eyes.
• Sterile intraocular shields will be gently placed over the eyes.
• The shields will remain in place for the duration of the procedure and will be removed immediately afterward.

Risks and Potential Complications:

Although the use of intraocular shields is generally safe, the following risks and complications are possible:

1. Mild discomfort or irritation during or after the procedure.
2. Temporary blurred vision due to the numbing drops or shield placement.
3. Corneal abrasion (scratches on the eye surface) or irritation.
4. Rare risk of infection or inflammation.
5. Allergic reaction to the numbing drops or materials used.

Patient Responsibilities:

• Inform your provider if you have a history of eye conditions such as dry eye, glaucoma, or recent eye surgeries.
• Follow all post-procedure care instructions provided by your provider.
• Notify the provider immediately if you experience persistent pain, redness, or vision changes after the procedure.

Acknowledgment and Consent:

By signing below, I acknowledge that:

• I have been informed about the purpose, procedure, and potential risks associated with the use of intraocular shields.
• I have had the opportunity to ask questions, and my questions have been answered to my satisfaction.
• I consent to the use of intraocular shields during my procedure.
• I understand that I may withdraw my consent at any time prior to the procedure.