Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXV: Laser Injury of the Eye

Medical Concerns

United States Department of Defense
Peer Review Status: Internally Peer Reviewed

1. Index of Suspicion. Reports by combatants of observing bright flashes of light, of experiencing sudden eye discomfort or poor vision, or of feeling focal heat should alert the medical officer to the possibility of laser exposure and injury. Obvious lesions such as corneal burns, retinal tears, and hemorrhage or skin burns confirm ones suspicions. Conceivably, one might confuse the use of invisible lasers with chemical agent exposure which also irritates the eyes and skin. Spontaneous fires and unexplained damage to optical instruments further corroborate laser exposure.
2. Physical Examination. Surface and deep bums of the cornea and the skin indicate that a high energy CO₂ laser has been used. Retinal hemorrhage probably implicates use of pulsed laser in the visible or near-infrared portion of the spectrum. Isolated retinal burns probably indicate exposure to a visible laser in the continuous wave mode.
3. Therapy. At the present time there is no definitive treatment for laser injury of the eye. Corneal burns are treated the same as ocular burns from other traumatic agents, specifically topical antibiotics, patches, and frequent examinations to monitor epithelial healing. It should also be borne in mind that the likelihood of an isolated corneal burn, especially of only one eye, is very small. Generally, there will be burns of both eyes as well as burns about the face and mouth. The general principles of treatment of facial burns and airway maintenance apply.
   1. Soldiers who sustain laser injuries of the retina only should not be treated the same as those with corneal burns of the eye Their injuries may range from small retinal spot burns to complete detachments and vitreous hemorrhages. Eye patches should be used sparingly in these cases, since eye patches only serve to magnify the soldier's visual impairment and increase his dependency for the basic needs of survival on others.
   2. Panic and hysteria may be the major difficulty encountered. The fear of blindness and the witnessing of blinding injuries in comrades can cause a major disruption of combat effectiveness. Although the longterm disability for these casualties is great, their near-term medical requirements are small. They do not require a large expenditure of resources and should not be allowed to overburden the medical evacuation system if other more critically wounded require those resources. The tactical situation and the availability of surface or aeromedical evacuation assets will determine when these patients are moved to the rear. Retinal bums and vitreous hemorrhage cases can be delayed. Corneal or other surface burns receive standard first aid measures and are evacuated. For those with lesser injuries, an assessment of visual function and the presence of pain will determine how useful a soldier can be to his unit and whether or not he should be evacuated.
4. Prevention. For CO₂ lasers, ordinary spectacle lenses will protect the eyes and ordinary visors will protect the face. When struck by the laser beam, one's spectacles and visors may become opaque or burned, thereby impeding vision. For visible laser protection, narrow-band filters for the elimination of lasers of specific or multiple wavelengths are currently undergoing development. The ideal protector will filter out only the deleterious wavelengths while allowing the remaining visible light to pass. Use of these wavelength filters may cause some tinting of one's vision. The use of several different wavelength filters may impair vision, particularly at night and during the hours of dusk and twilight due to their dark color.

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