Central Serous Retinopathy Following Long Duration Laser Pointer Exposure. (Correspondence).

To the Editor: Laser pointers are inexpensive devices with low power and poor optical quality. Yet, their beams are very brilliant. Rare reports of retinal injury have been seen.

Case Report. A 36-year-old healthy man presented to my office 4 days after exposure of his right eye to a laser-pointing device. Three days previously, he had deliberately gazed directly into the beam of a laser-pointing device held 3 feet away from his right eye for an estimated 12 seconds. Eye pain and a headache developed immediately after exposure, and lasted approximately 4 hours. The patient denied eye rubbing after exposure. Three days after exposure, a central scotoma and decreased visual acuity developed in the right eye. The patient's medical and ocular histories were unremarkable.

Ocular examination disclosed corrected visual acuity of 20/40 in the right eye and 20/20 in the left eye. Ocular motility, confrontation visual field, pupillary responses, and anterior segment biomicroscopy were unremarkable. Amsler grid testing revealed a central scotoma. Fundus examination of the right eye revealed a 1.25-mm diameter central serous fluid with a retinal pigment epithelial defect at the superior temporal aspect of the central serous fluid. Fundus examination of the left eye was unremarkable. Intravenous fluorescein angiography of the right eye revealed a focal leak at the superior temporal aspect of the fovea and late leakage consistent with central serous retinopathy. The central serous lesion enlarged to 2.75 mm in diameter over the next 6 weeks, and retinal precipitates developed within the center of the central serous fluid. Subsequently, over a period of 7 months, the central serous fluid began to resolve and the patient's visual acuity returned to 20/20.

Discussion. The patient was exposed to a laser-pointing device, which had a maximum power rating of 5 milliwatts (US Food and Drug Administration class 3A laser) with a 630-670 nanometer wavelength (Alpec-Team, Inc, Livermore, Calif). Instructions and a label on the device stated, "laser light--avoid direct eye exposure." Most cases of retinal injury due to a laser occur from class 4 lasers with military, laboratory, or medical applications. (2) Laser pointers must be class 2 or 3A devices, which means that they must have <5 milliwatts of power. Therefore, reports of retinal injury due to these low energy devices are rare. It is well known that any defect in the retinal pigment epithelium can lead to central serous retinopathy. It has also been shown in a prior report that a laser pointer can cause a focal disturbance of the retinal pigment epithelium. (1,3) Although a causal relationship cannot be proven, we believe that central serous retinopathy may have developed in our patient as the result of a focal disturbance to the retinal pigment epithelium caused by a laser pointer. This finding emphasizes the importance of appropriate use of these class 2 or 3A devices. Deliberately staring at the laser beam may result in macular injury and possibly central serous retinopathy.

John O. Mason III, MD

Department of Ophthalmology and Vitreoretinal Surgery

University of Alabama at Birmingham School of Medicine

700 18th St 5, Suite 505

Birmingham, AL 35233

References

(1.) Luttrull JK, Hallisey J: Laser pointer-induced macular injury. Am J Ophthalmol 1999; 127:95-96

(2.) Wolfe JA: Laser retinal injury. Milit Med 1985; 150:177-185

(3.) Chen TL, Yang KR, Chen SM: Photic maculopathy by low energy laser beam: a case report. Chang Keng IHSUEH 1994; 14:273-277