Handheld laser devices and laser-induced retinopathy (LIR) in children: an overview of the literature

Abstract

Handheld laser devices are easily available to purchase through the internet and unregulated marketplaces at a relatively low cost. They are particularly attractive to children as they are seen as 'high tech', brightly coloured, and known to be able to burn holes in objects such as balloons. There is a widespread lack of knowledge about the risks of viewing the beam emanating directly from handheld lasers, and particularly those with high-output powers. The number of reported laser induced retinopathy (LIR) injuries in children is on the increase in the United Kingdom and represents a major public health issue. The number of individuals affected by LIR is likely to be underestimated owing to lack of presentation to health professionals, general poor awareness and non-reporting by children after the incident. The presentation of LIR is highly variable and dependent on many factors including type of laser, length of exposure and how it is administered. In this article, we review the features of retinal damage associated with inadvertent or deliberate laser administration using a handheld laser device. We highlight the importance of educating the wider public about this increasing problem; children who play with these devices are usually completely unaware of the long-term consequences of laser damage to the eye. It is also important that the features of LIR are recognised by health professionals involved in eye care as they can be mistaken for retinal dystrophies, particularly if the history of laser exposure is not volunteered or elicited.

Fig. 1

Example of red and green handheld lasers, being scattered by liquid nitrogen

Fig. 2

Fundus photography and optical coherence tomography (OCT) of a 14-year old child with laser-induced retinopathy. a Fundus photography of the right eye at presentation revealing macular scarring. b OCT of the right eye at presentation showing inner segment–outer segment junction disruption. c and d Fundus photography and OCT of the right eye at 9 months follow-up showing subtle retinal remodelling