Sir,

We read with interest the article by Raoof et al1 and would like to share our experience of paediatric laser eye injuries in Northern Ireland since setting up at a rapid access Paediatric Ophthalmology Priority Consultation Clinic in September 2013 in the Royal Victoria Hospital, Belfast.

To date, we have assessed 10 children with macular laser burns that have been either inadvertently self-inflicted or allegedly caused by a laser being shone into the child’s eye by another child (Table 1). In the seven ‘self-inflicted’ cases, the toy laser in question was bought abroad or over the internet. Not all children volunteered a history of laser exposure on initial questioning, but after some discussion, it became evident that they had access to toy lasers either at school or through friends.

Table 1 Characteristics of children with laser eye burns in Northern Ireland
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Interestingly, all of our 10 cases to date have presented in autumn (n=8) or winter (n=2). We speculate that this apparent ‘seasonal’ preponderance correlates with children bringing their ‘toy lasers’ to school after the summer holidays and inadvertently causing laser eye injuries; alternatively, children may only become aware of the visual deficits as they struggle to concentrate on their school work after the summer break.

Four cases were referred after optometric assessment identified asymptomatic macular changes when parents brought their children for routine eye testing. It is highly likely that there are many more asymptomatic children with macular laser burns who have not yet been identified.

It is reassuring that even the most severely affected patient in our cohort with presenting vision of 6/60 regained vision to a best-corrected Snellen acuity of 6/9 (Figure 1). However, all 10 cases demonstrated persistent retinal pigment epithelium disturbance on OCT that may infer a life-long increased risk for the development of choroidal neovascular membranes. Furthermore, more serious presentations with full-thickness macular holes and premacular subhyaloid haemorrhages have previously been described.2

Figure 1
figure 1

Images for Case 1. (a) Right macula showing central yellowish vitelliform-like lesion at initial presentation. (b) OCT of right fovea at initial presentation when vision was 6/60 revealing a full-thickness hyper-reflective column at the fovea extending to the retinal pigment epithelium (RPE). (c) OCT of right fovea 12 months following presentation when vision had improved to 6/9 revealing focal disruption of the photoreceptor layer and RPE. (d) Causative laser bought while on holidays in Puerto Rico.

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Following concerns regarding the emerging trend of children with laser-induced eye injuries, we alerted the Public Health Authority in Northern Ireland and the issue was highlighted in the local media in December 2014.3 We support the call by Raoof et al for a UK-wide public health campaign to educate children and parents on the dangers of so-called unregulated ‘toy lasers’ sold abroad and online. We would also suggest that this campaign could optimally be timed for the start of the school year.