A 13-year-old male with attention deficit disorder (ADD) presented to the Emergency Medicine Department accompanied by his mother complaining of visual disturbance after staring into the beam from a toy laser for a few hours earlier that day. The patient stated that the toy laser belonged to a friend but the injuries were self-inflicted. The BCVA was 6/60 in the right eye improving to 6/36 with pinhole, and 6/12 in the left eye. SD-OCT images on presentation showed full-thickness hyper-reflective damage involving both fovea (Fig. ). The patient was on methylphenidate 57 mg daily treatment for ADD and was known to Child and Adolescent Mental Health Services (CAMHS). He attended mainstream school with additional classroom support but was not classified as having special educational needs, with no statement of educational needs undertaken previously. Six weeks later, his BCVA had improved to 6/12 right and 6/9 left. An improvement in SD-OCT images was observed, notably an improvement in inner retinal layers. However, the centre involving outer lamellar layer defects on OCT and fundus changes persisted throughout 24 months of follow-up but decreased.
A 12-year-old boy was referred with a several month history of reduced vision in both eyes. He had a history of expressive and receptive language impairment and was attending a specialist school for children with cognitive impairment and disturbed behaviour. He was under CAMHS for anger and behavioural problems. There was no relevant past ocular or family history. The presenting BCVA were 6/30 right eye and 6/75 left eye. Colour vision was reduced, with only 4/17 Ishihara plates correctly identified in the right eye and 9/17 in the left eye. Bilateral multifocal macular pigmentary changes were noted (Fig. ). To investigate abnormal visual function, electrodiagnostic tests and magnetic resonance imaging (MRI) of the brain and orbits were performed, both of which were normal.\nAt subsequent follow-up and on direct questioning, the boy revealed he had been playing with laser pointers at school, particularly in games involving looking directly into the beam of the laser pointer. His BCVA at 12 months follow-up was 6/19 right eye and 6/48 left eye. Fundus examination showed irregular pigmentation at the right macular and a scar at the left macular. OCT scan showed small, round, punched-out lesions more frequent in the left than the right macula.