The patient had photic injury from a laser. The initial OCT showed cystoid edema, disruption of the outer retinal layers, and a small amount of sub-neurosensory fluid. The retinal edema had resolved by the next visit 16 days later, leaving a deep scar and persistent damage to the outer retinal layers. The visual acuity had not changed 2 ½ weeks after the initial injury.
Laser injuries to the eye have become more common, because powerful lasers can be easily purchased over the Internet. Lasers with power in excess of 5mW are much more likely to cause retinal damage. There is evidence that shorter-wave light at the blue end of the spectrum might be more hazardous than longer-wave light toward the red end of the spectrum. Some cases involve manufacturer mislabeling of the laser power. Interestingly, approximately 65% of cases are unilateral, as in our patient. Most cases are accidental, though self-induced injury has been reported. As is the case for many kinds of accidental trauma, young men are at greatest risk.
The patient was offered retrobulbar Kenalog injection to reduce the inflammatory component of the injury, with the understanding that this treatment would not likely change the final visual outcome substantially. He declined this treatment.
References
Bhavsar KV, Wilson D, Margolis R, et al. Multimodal imaging in handheld laser-induced maculopathy. American Journal of Ophthalmology 2015;159(2):227-231.
Bhavsar KV, Michel Z, Greenwald M, Cunningham ET, Freund KB. Retinal injury from handheld lasers: a review. Survey of Ophthalmology 2021;66(2):231-260.
