Bilateral macular injury from a green laser pointer
A 13-year-old boy presented to our clinic complaining of decreased vision in both eyes 1 day after having intentionally gazed directly into the beam of a green laser pointing device (wavelength 532 nm), that had a maximum power rating of 5 mW (US Food and Drug Administration class 3A or IEC class 3R) stated on its labeling. He held the laser 5 cm away from his eyes for an estimated 30–60 seconds. Prior to this incident, the boy had reported no visual complaints. His last ocular examination had revealed visual acuity of 20/20 in both eyes.\nCurrent examination revealed best-corrected visual acuity of 20/50 in the right eye and 20/30 in the left eye. Anterior segments were normal in both eyes. Fundus examination showed bilateral, yellowish, oval-shaped, drusenoid-like lesions with attenuation of the foveal reflex ( and ).\nImaging studies were done on presentation to our practice 18 hours after exposure to the laser device. Optical coherence tomography (3D OCT; Topcon, Tokyo, Japan) of both eyes showed disruption of the outer retinal layer with nonspecific retinal thickening ( and ); red-free photographs demonstrated hypopigmented foveal dots bilaterally ( and ); fluorescein angiography showed early foveal hyperfluorescence in both eyes with late ill-defined leakage ( and ); and autofluorescence images showed heterogeneous hyperfluorescence in the macula of both eyes ( and ). Finally, a computerized 10–2 visual field threshold test (Humphrey Automated Perimeter; Humphrey Instruments, San Leandro, CA, USA), showed small pericentral scotomata in the right eye and a normal field in the left eye.\nThe patient was treated with an oral steroid (Prednisone; H.J. Harkins Company, Inc., Grover Beach, CA, USA) 1 mg/kg for 4 weeks then tapered over 2 months. At 3 months, visual acuity remained impaired but improved to 20/30 in the right eye and 20/25 in the left eye.\nAt 3 months, optical coherence tomography showed improvement of the retinal thickening in both eyes. The hyperreflective line representing the inner segment/outer segment junction was disrupted in the right eye and the left eye ( and ). The visual field improved and no scotoma was detected in the right eye.