Retinal injury from laser pointers: case series

Abstract

Nowadays optical quantum generators of visible electromagnetic spectrum are widely adopted for non-professional use as portable devices, so called laser pointers. When safety regulations are abused by users, an accidental exposition of the laser beam to the eye, potentially resulting in injury, become possible. The most harmful effect is associated with laser sources of 400 to 1400 nm (visible and near infrared wavelengths) since these wavelengths are highly penetrative in optical media. Being focused by optical system of the eye, laser beam became increased in power density by factor 4 to 10 therefore even low – power devices are potentially dangerous. Severity of laser damage mostly depends on few laser-related variables including exposition, power density, wavelength, and operating mode (pulse or continuous). Additionally, individual variability in anatomy of the eye defines the resultant damage. Therefore, the spectrum of laser injuries of the eye varies significantly from subclinical damage with no functional loss to those resulting in profound visual deterioration. Еhere are two main acceptors for visible or near-infrared light within the eye fundus: melanin of the retinal pigment epithelium and the choroid and hemoglobin. From this point of view, short-wavelength (e.g. blue spectrum) lasers are more dangerous in terms of intraocular damage. On the other hand, compared to visible spectrum, near-infrared lasers can penetrate some non-transparent tissues such as sclera and also penetrates deep in the choroid. Moreover, this wavelength is invisible for the human eye and therefore potentially more dangerous. We presented two cases of leaser injury of the eye caused by green and blue laser pointers, based on multimodal approach (visualization of the posterior eye segment abnormalities using several methods). Multimodal approach, namely infrared scanning laser ophthalmoscopy and optic coherence tomography add precision in assessment of severity of retinal damage and can substantially improve diagnosis of laser injuries of posterior eye segment.

Keywords

laser photocoagulation / laser pointer / retina / retinal injury / visual acuity / scanning laser ophthalmoscope / optical coherence tomography

References

[1] Бойко, Э.В. Диодный лазер в офтальмологической операционной / Э.В. Бойко, М.М. Шишкин, Ю.Д. Березин. – СПб., 2000. – 30 с.

[2] Качерович, П.А. Использование оптической когерентной томографии в диагностике поражений глаз газовым оружием самообороны / П.А. Качерович [и др.] // Вестн. Росс. воен.- мед. акад. – 2017. – № 4 (60). – С. 91–94.

[3] Мальцев, Д.С. Оптическая когерентная томография в диагностике и лечении центральной серозной хориоретинопатии / Д.С. Мальцев [и др.] // Вестн. офтальмол. – 2018. – Т. 134, № 6. – С. 15–24.

[4] Санитарные нормы и правила устройства и эксплуатации лазеров (СанПин 5804-91). – М.: Минздрав РФ, 2018. – 48 с.

[5] Черепнин, А.И. Клинические случаи повреждения сетчатки в быту инфракрасным излучением лазерной указки / А.И. Черепнин [и др.] // Современные технологии в офтальмологии. – 2018. – № 2.– С. 280–282.

[6] Фисун, А.Я. Поражение лазерным излучением. Избранные лекции по профессиональной патологии у военнослужащих: учебное пособие / А.Я. Фисун. – СПб.: Фолиант, 2018. – С. 155–166.

[7] Boiko, E.V. Midinfrared laser pancorneal coagulation as a method of treatment for painful bullous keratopathy E.V. Boiko, D.S. Maltsev, A.V. Yan // Cornea. – 2013. – Vol. 32, № 10. – P. 1349–1353.

[8] Boiko, E.V. Retro-mode scanning laser ophthalmoscopy planning for navigated macular laser photocoagulation in macular edema // E.V. Boiko, D.S. Maltsev // J. Ophthalmol. – 2016; 2016:3726353

[9] Smalley, P.J. Laser safety: risks, hazards and control measure / P.J. Smalley // Laser Therapy – 2011. – № 20 (2). – Р. 95–106.

RIGHTS & PERMISSIONS

Kulikov A.N., Vlasenko A.N., Maltsev D.S., Kovalenko A.V., Kovalenko I.Yu.