INTRODUCTION

This Clinical Practice Guideline provides information and instructions for medical providers responsible for Service members following a suspected directed energy (DE) exposure involving the visual system. (Consider: There is little experience in the general medical community with DE and having a high index of suspicious for this type of injury is important. If a DE exposure is suspected – early consultation with ocular care providers is important as is having a full understanding of the physiologic and anatomic effects of this type of injury. Ocular DE injury can result in mission compromise and pose safety hazards to the individual and the unit.) These suspected exposures, presumed caused by a laser or other intense bright light source, can compromise the ability to execute mission essential functions. For the purposes of this guideline, the term laser will also include any light source, visible or invisible, capable of resulting in potential injury. The intent of this guideline is to provide a better understanding of this type of injury and its effects and to establish a care algorithm for first-line providers and follow-on care by eye care providers. This CPG is based on expert consensus because there is little available data on this type of injury. Specifically, it includes the key elements of a Service member’s history, examination, disposition, and medical record coding following potential exposures. Service and unit-specific reporting procedures for exposures and possible injuries are also included. Early recognition and treatment of potential injuries is essential to maintain optimal visual performance. In addition, timely reporting is essential to assess the operational impact of these exposures/injuries.

Clinical Scenarios

1. An aircrew making a final approach is exposed to a laser source, leading to temporary flash blindness. Spatial awareness and situational awareness is effected, compromising actions during critical operations. The symptoms resolve without functional or anatomic evidence of damage.
2. A mounted service member employs an escalation of force visible laser during operations. The beam is reflected of the turret mirror resulting in close proximity exposure. Central vision is immediately compromised. Evaluation shows decreased vision and retinal edema. This results in a central retinal scar and loss of vision