Ophthalmic manifestations of laser-induced eye injuries

The basis for almost all laser-induced eye injuries is the concentration of the radiation in the visible and near infra red range on the retina. The effect of this concentration is that the energy required to produce a visible retinal lesion is minuscule, about 50 microjoule for a Q- switched 532 nm laser. Even at lower energies the radiation can cause dazzle and flash blindness. At higher energies it can produce lesions which are ophthalmoscopically invisible, and at even higher energies, lesions that are visible and permanent. Higher energies still produce vitreous hemorrhage. The functional results of visible lesions depend not only on the energy impinging on the retina but mostly on the location of the injury. Foveal lesions will cause permanent reduction in visual functions, extrafoveal injuries will cause temporary visual incapacitation, and lesions further away from the macula may cause unnoticeable damage. Temporary incapacitation by intraocular hemorrhage can be engendered by a lesion anywhere in the eye. The latter is usually absorbed spontaneously or can be surgically removed by vitrectomy. An over-threshold injury anywhere on the posterior pole of the eye will lead to severance of the retinal nerve fiber layer, and thus to blind spots in parts of the retina unaffected by the original lesion. A common late, visually devastating, effect of laser lesions is retinal scarring which may lead to retinal holes, retinal detachment and delayed blindness.