This 13YO girl presented with immediate vision loss in her left eye after looking at a laser pointer one week earlier. Vision was 20/20 in her normal right eye and 20/70 in her left eye.
Triton color photography shows an oblique, slightly linear area of foveal pigment loss. Swept-source OCT scans through this lesion show focal hyperreflectivity with variable loss of the ellipsoid zone and outer segments.
Learning Points:
Sun gazing is thought to cause acute damage to the RPE and photoreceptors via photochemical mechanisms involving reactive oxygen species. Similar photochemical damage can follow laser pointer exposure, although the clinical findings can be different (Bloom and Singal, Retinal Cases 2022;16:
89-91).
Sun gazing acutely produces bilateral, symmetric, pinpoint subfoveal yellow-white lesions in the outer retina, followed by variable clinical depigmented foveal RPE and focal photoreceptor OCT defects extending from the external limiting membrane to the RPE.
Laser pointer maculopathy can cause a similar lesion, but presumed more prolonged viewing, saccades, and laser pointer movement can also lead to larger areas of macular damage.
Outer foveal microdefects (Cohen et al, Ophthalmology Retina 2021;5:553-561) have been described in numerous conditions, including macular telangiectasia, tamoxifen use, ABCA4 disorders (cone-rod dystrophies, Stargardt disease and fundus flavimaculatus), phototoxicity, trauma, and vitreomacular traction disorders.
