Ver el código de «Laser injury»

==Background==
* Use of lasers in civilian and military applications is increasing
* Military use -  range finders, target designators, guidance systems, non-lethal denial, and now being used as directed energy weapons
* Civilian use - laser cutter/engraver, precision measurement, pointers, welding, entertainment
* Potential to cause injury is largely dependent upon irradiance and beam wavelength
* Irradiance
** Amount of energy that hits the eye/skin per unit area
** Dependent on output power, distance from source to target, and beam divergence
** Human eye can focus laser to a very small area on the retina increasing the irradiance by a factor of 100,000

===ANSI Classification of Laser===
: Class 1 - non-hazardous
: Class 2 - visible laser, aversion response will protect
: Class 3a - eye hazard with optical aids  that collect or focus beam
: Class 3b - eye hazard, some skin at high power
: Class 4 - eye hazard, skin hazard, fire hazard, diffuse reflection hazard

==Clinical Features==
===Eye===
''Main organ of concern; range of effects as below starting with the most severe to the least; damage from  thermal / photochemical / photomechanical process''
* Tissue vaporization
* [[Retinal hemorrhage]] / ocular holes
* Retinal burn / corneal burn / irreversible scotoma/minimal visible lesion
* Histological damage / irreversible scotoma / cataract
* Nominal ocular hazard distance (NOHD)
** Distance from laser source which the intensity of a single laser beam becomes safe by not exceeding the maximum permissible exposure
** Laser is dangerous if viewed from a closer distance than this
** Can be calculated if power (mW), divergence (mrad), and diameter at aperture (mm) is known
* Flash blindness / after images / reversible scotoma
** [[visual loss]] temporary
** lasts seconds to minutes
** similar to flashbulb effect
* Glare/dazzle
** no permanent damage results
** similar to driving into the setting sun
* Distraction

===Skin===
''Second organ of concern; effect more dependent on wavelength of laser''
* thermal [[burns]] - IR, visible, UV-A laser
* photosensitivity - Visible, UV-A laser
* darkening - UV-A laser
* accelerated skin aging - UV-B
* skin cancer/erythema - UV-C

==Differential Diagnosis==

==Evaluation==
* History 
** Obtain detailed information as to the nature and characteristic of the laser beam exposure
** Intensity, color, constant or flicker, duration of exposure, location, beam diameter estimate, range, source, location, type of laser, class of laser
* Examination
** External exam of skin and adenxa looking for burns or evidence of physical trauma
** Visual acuity near and far
** Amsler grid test
** Pupils
** Stereopsis
** Color vision
** [[Slit lamp examination]]
** Retinal (fundoscopic) examination

==Management==
* As appropriate per history and physical exam findings

==Disposition==
* Discharge home if normal exam and no persistent symptoms suggestive of laser eye injury
* Consult ophthalmologist if persistent symptoms or positive findings on examination suggesting laser eye injury such as retinal hemorrhage, corneal burn, ocular holes, etc.

==See Also==

==References==
<references/>

[[Category:Military]]
[[Category:Dermatology]]
[[Category:Ophthalmology]]