Retinal Injury After Inadvertent Handheld Laser Exposure

In Brief Purpose: To evaluate acute and long-term clinical and spectral domain optical coherence tomography features after handheld laser exposure to the retina. Methods: Retrospective case series of three children with retinal injury secondary to inadvertent handheld laser exposure. All individuals underwent ophthalmologic examination and spectral domain optical coherence tomography at presentation and follow-up 11 months to 18 months after exposure. Results: Three male children aged 6 years to 10 years sustained bilateral macular injury after exposure to a handheld green or red laser. Two of the three handheld lasers were ordered from foreign internet retailers and were labeled as Class 3B devices. Acutely, flat yellow deep retinal lesions with pigment irregularity were apparent. Spectral domain optical coherence tomography demonstrated disruption of the external limiting membrane and outer photoreceptors, a hyperreflective mound extending from the external limiting membrane to the retinal pigment epithelium, and linear opacification in Henle's layer. Over time, there was partial restoration of the external limiting membrane and persistent irregularity of the outer photoreceptor layers. Two individuals with severe vision loss acutely had some improvement of Snellen acuity at a 1-year follow-up. Conclusion: Handheld lasers can produce permanent retinal damage with visual sequelae if improperly used. Spectral domain optical coherence tomography demonstrates chronic disruption, primarily in the retinal pigment epithelium/photoreceptor region. Handheld lasers are readily available on the internet and may pose a significant public health problem if incorrectly used. A series of three children with permanent retinal injury and vision loss after handheld laser exposure are presented. Sequential spectral domain optical coherence tomography imaging demonstrates acute outer retina injury and chronic photoreceptor alterations.