The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Macular Hole from a Laser Pointer

A B

Sofia Androudi, M.D., Ph.D.
University of Thessaly
Larissa, Greece
androudi@​­otenet​.­gr
Eleni Papageorgiou, M.D., Ph.D.
University Hospital of Larissa
Larissa, Greece
A 
9-year-old boy was brought by his parents to our ophthalmol-
ogy 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. Fundu-
scopic examination of the left eye revealed a large macular hole with a hypopig-
mented 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.
DOI: 10.1056/NEJMicm1714488
Copyright © 2018 Massachusetts Medical Society.

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