Unilateral decreased vision and macular lesions in a boy

A child was found to have noticeably decreased vision in his left eye during a routine optometry examination after showing normal vision six months previously. He did not self-report any eye symptoms (such as redness, pain, or tearing), headache, or dizziness, and had no personal or family history of eye diseases or other medical conditions. His parents reported that a green laser pointer (wavelength 532 ±10 nm, maximum output power <50mW, Class III) had been purchased six months previously and the patient had been playing with it frequently. The patient reported looking directly at the laser pointer light on several occasions. He did not report that anyone else had shone the laser into his eyes. There was no history of trauma to either eye.

On examination, his best corrected visual acuity was 20/32 in the left eye and 20/20 in the right eye. Fundus colour photography showed multifocal, yellowish, faceted lesions involving the fovea and juxtafoveal area in the left eye (fig 1). Optical coherence tomography angiography revealed multifocal, spotted lesions corresponding to the lesions seen on fundus colour photography and disruption of the external outer photoreceptor ellipsoid, external limiting membrane, and retinal pigment epithelium.