EC Ophthalmology

To report a case of premacular hemorrhage without outer retinal damage in a child following accidental exposure to non-certified diode laser pointer.

A 9-year-old girl was referred to the retina clinic complaining of sudden onset visual loss in her left eye after accidental exposure to a handheld blue diode laser (450 nm wavelength, labeled as 50,000 mW output, class III laser).

On examination, best-corrected visual acuity of the left eye was 20/200. Fundus examination revealed a boat-shaped premacular hemorrhage. Optical coherence tomography (OCT) confirmed the presence of a sub-ILM hemorrhage without outer retinal damage. The patient was managed conservatively with short-term follow-up. Three months after the initial trauma, best corrected visual acuity of the left eye improved to 20/40, with spontaneous resolution of the premacular hemorrhage. This case highlights the potential for severe macular injury following the inappropriate use of handheld laser pointers. Strict regulation with limited access to the use of these lasers is essential to prevent ocular injury, particularly in children and adolescents.

 Keywords: Premacular Hemorrhage; Handheld Diode Laser Pointer; Optical Coherence Tomography (OCT)

1. Neffendorf JE., et al. “Handheld laser devices and laser-induced retinopathy (LIR) in children: an overview of the literature”. Eye (London)8 (2019): 1203-1214.
2. ANSI Z136.1-2000. Washington, DC: American National Standards Institute. American National Standard for the Safe Use of Lasers (2000).
3. Ajudua S and Mello MJ. “Shedding some light on laser pointer eye injuries”. Pediatric Emergency Care 9 (2007): 669-672.
4. Birtel J., et al. “Retinal injury following laser pointer exposure”. Deutsches Ärzteblatt International 49 (2017): 831-837.
5. Reidenbach H-D., et al. “First experimental results on eye protection by the blink reflex for laser class 2". Biomedical Engineering/Biomedizinische Techniks1 (2001): 428-429.
6. Hadler J., et al. “Random testing reveals excessive power in commercial laser pointers”. Journal of Laser Applications 25 (2013): 032007.
7. Mtanes K., et al. “Laser pointer-induced maculopathy: more than meets the eye”. Journal of Pediatric Ophthalmology and Strabismus 5 (2018): 312-318.
8. Barkana Y and Belkin M. “Laser eye injuries”. Survey of Ophthalmology 6 (2000): 459-478.
9. Glickman RD. “Phototoxicity to the retina: mechanisms of damage”. International Journal of Toxicology 6 (2002): 473-490.
10. Robertson DM., et al. “Laser pointers and the human eye: a clinicopathologic study”. Archives of Ophthalmology 12 (2000): 1686-1691.
11. Alsulaiman SM., et al. “High-power handheld blue laser-induced maculopathy: the results of the King Khaled Eye Specialist Hospital Collaborative Retina Study Group”. Ophthalmology2 (2014): 566-572.e1.
12. Ham WT., et al. “Retinal burn thresholds for the helium-neon laser in the rhesus monkey”. International Journal of Toxicology 6 (1970): 797-809.
13. Khair Allah A. “Spontaneous resolution of a high-power blue laser pointer- induced maculopathy: A case report”. Zagazig University Medical Journal (2024): 748-752.
14. Swatch P., et al. “Laser pointer retinopathy: a case report and review”. CRO Journal1 (2022).