Macular hole from a laser pointer

Abstract

A 9-year-old boy was brought by his parents to our ophthalmology clinic for evaluation of decreased vision in his left eye. Visual acuity in the left eye was 20/100, as compared with 20/20 in the right eye. Funduscopic examination of the left eye revealed a large macular hole with a hypopigmented atrophic area inferiorly (Panel A). Optical coherence tomography confirmed the full-thickness macular hole. Fundus autofluorescence imaging highlighted two spots inferior to the macular hole that corresponded to additional areas of injury (Panel B). The child reported playing with a green laser pointer and repeatedly gazing into the laser beam. Although many national health agencies have warned about the potential eye hazards associated with handheld laser pointers, and the sale of devices with greater than 1 mW of power is restricted in many areas, more powerful laser devices remain accessible, especially through the Internet. Because of the large diameter of the macular hole and the accompanying atrophy in this patient, we favored conservative management rather than surgery. The patient's vision has remained unchanged during 18 months of follow-up. Copyright © 2018 Massachusetts Medical Society.