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Review
. 2019 Mar;33(3):492-504.
doi: 10.1038/s41433-018-0276-z. Epub 2018 Dec 13.

Retinal burns from laser pointers: a risk in children with behavioural problems

E Linton  1 , A Walkden  2 , L R Steeples  3 , A Bhargava  2 , C Williams  3 , C Bailey  3 , F M Quhill  4 , S P Kelly  5
Affiliations
Review

Retinal burns from laser pointers: a risk in children with behavioural problems

E Linton et al. Eye (Lond). 2019 Mar.

Abstract

Objective: To explore self-inflicted retinal burns from laser pointers in children.

Methods: Literature review of laser pointer retinal injuries in childhood and online survey of UK Consultant Ophthalmologists. A cohort of local children with self-inflicted injury is described. The matter is topical. We review progress in recent legislation and policy change in the UK.

Results: Four of 77 case reports of laser burns in childhood analysed reported psychological or behavioural issues. Three of four children in our cohort had such issues. Delay in diagnosis occurred in two of our patients. Structural retinal damage persisted for over 12 months in all four children (seven eyes). Our survey of UK ophthalmologists found 159 cases of injury (85% male), 80% under 20 years of age. The majority of the laser pointers were purchased online. Many patients (36%) suffered moderate vision loss (6/18 to 6/60 Snellen), while 17% (at least 11 patients) suffered severe vision loss (<6/60 Snellen).

Conclusion: We highlight the risk of macular damage and vision loss from handheld lasers specifically in children with behavioural, learning or mental health issues. The diagnosis may be difficult or delayed in such children. In children with uncertain macular changes, ophthalmologists should explore the history for possible instances of exposure to handheld lasers pointers. Regulatory authorities and manufacturers of handheld lasers need to be aware of the risk to children. Furthermore, there is a need to better inform parents, carers and teachers of the risk of ocular self-injury from such lasers pointers.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Patient 1: right eye. Baseline visit. Top panel: OCT image with outer lamellar layer defect. Colour fundus image lower left panel and multicolor image lower right panel.
Fig. 2
Fig. 2
Patient 2. Baseline Visit. Top panel; Colour fundus photography showing yellow streak like lesions involving both fovea. Lower panel; OCT images both maculae show full-thickness hyper-reflective damage involving both fovea.
Fig. 3
Fig. 3
Patient 3. Right eye. Baseline Visit. (A) Multicolour fundus image and (B) infrared image showing discrete burns. (C) OCT image: outer lamellar layer defects seen.
Fig. 4
Fig. 4
Patient 4. Top panels; Linked infrared and OCT images with outer lamellar layer. Lower panels; Bilateral multifocal macular pigmentary changes.
See this image and copyright information in PMC

References

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