Vol:.(1234567890) Canadian Journal of Emergency Medicine (2021) 23:726–727 https://doi.org/10.1007/s43678-021-00151-6 Vol.:(0123456789) 1 3 LETTER Minimally symptomatic facial laser-induced retinal burn Duoduo Wu 1  · Tina Yu Ting Shen 2  · Blanche Xiao Hong Lim 1,2  · Dawn Ka‑Ann Lim 1,2  · Chris Hong Long Lim 1,2,3,4 Received: 2 May 2021 / Accepted: 11 May 2021 / Published online: 22 May 2021 © The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d’Urgence (ACMU) 2021 Keywords Floater · Facial laser · Retinal burn · Photic retinopathy Dear Editor, We would like to bring to attention a case of a patient with a laser-induced retinal burn who presented with minimal symptoms. A 34-year-old lady presented for evaluation of her right eye. She reported a solitary foater in her visual feld present for approximately a day which shifted with eye movements. She did not volunteer any further information. Relevant reported negatives include the lack of physical trauma, pain, blurring of vision, photopsia or metamorphopsia. On examination, bilateral visual acuities were 20/20 and intraocular pressures were within normal limits. There were no pupillary abnormalities identifed. Slit lamp examination with pupillary dilatation demonstrated the presence of vit- reous haemorrhage arising from the superotemporal retina with associated retinal oedema of approximately 4-disc diameters in size, sparing the macula. A further pursuit of her history later revealed her occupa- tion as a beautician and had accidentally looked at the laser whilst performing a facial laser procedure on herself. She was subsequently diagnosed with a laser-induced reti- nal burn that was associated with a vitreous haemorrhage, in view of inadvertent burn to the vessels and was advised to return for regular review until resolution of the haemor- rhage to facilitate identifcation of further retinal pathology. She was also provided with advice to seek prompt evalua- tion should she experience symptoms suggestive of a retinal detachment. Laser-induced retinal burns have been associated with foaters, acute blurring of vision, scotomas and metamor- phopsia [1, 2]. However, our patient presented without these symptoms due to the extramacular location of the afected area. This highlights the importance of a thorough history in achieving an accurate diagnosis. The type of laser should also be ascertained. Longer wavelength lasers, such as 795 nm alexandrite and 1064 nm Nd:YAG lasers, have increased propensity to cause severe injuries by penetrating deeper into the retina [3]. These lasers are also weakly visible to the naked eye, further pos- ing potential hazards as the user may experience ocular dam- age without visualising the laser beam. Although no specifc treatment exists for retinal burns, patients should receive prompt evaluation from an ophthal- mologist for the presence of associated injuries and compli- cations including corneal damage, uveitis, photic retinopa- thy, retinal breaks or detachments, and vitreous haemorrhage [2, 3]. Patient education regarding safe handling of lasers and donning of protective eyewear should also be provided. In summary, this case calls to attention the integral role of an accurate history in prompt identifcation and management of patients with laser-induced ocular injuries. Funding This research did not receive any specifc grant from funding agencies in the public, commercial, or not-for-proft sectors. Declarations Conflict of interest The authors declare that they have no conficts of interest. * Chris Hong Long Lim chrislimmd@gmail.com 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore 2 Department of Ophthalmology (Eye), National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore 3 Singapore Eye Research Institute, Singapore, Singapore 4 School of Optometry and Vision Science, University of New South Wales, Sydney, Australia