TREATMENT & DISPOSITION

Treatment

Initial treatment guidance for suspected ocular injury from laser exposure is limited. Readily identifiable injuries such as corneal abrasions, hyphema or vitreous hemorrhage should be treated using current standards in coordination with an eye care provider. These guidelines can be found in the Eye Trauma: Initial Care, 28 Aug 2019 and Ocular Injuries and Vision-threatening Conditions in Prolonged Field, 01 Dec 2017. In the context of visual dysfunction, available literature suggests early treatment with non-steroidal anti-inflammatory drugs (NSAIDS) and/or systemic corticosteroid therapy.4,5,6 Treatment of SMs with suspected ocular injury should be considered as follows (if not otherwise contraindicated):

1. Vision 20/40 or better but not at baseline, visual interference effects lasting more than 2-4 hours: start NSAID (indomethacin by mouth 25mg three times/day can be used if available, or ibuprofen 800mg by mouth three times/day
2. Vision worse than 20/40, any Amsler grid abnormalities: Consider addition of oral prednisone (0.5 to 1 mg/kg); teleconsultation with eye care provider recommended.

Evaluation by an eye care provider in theater should be obtained if operationally feasible. This decision is best made after discussion with the eye care provider. Teleconsultation for specific treatment decisions when no eye care providers is available.

Teleconsultation Services

- ADVISOR 833-238-7756; DSN 312-429-9089 (select emergency department and callers will be connected to ophthalmology) ADVISOR covers all Combatant Commands
- U.S. Air Force School of Aerospace Medicine Ophthalmology: 937-938-2675
- Naval Aerospace Medical Institute Ophthalmology: 850-452-2933; usn.pensacola.navmedotcnamefl.list.nami-ophthal@mail.mil

Asynchronous Consultation Services:

- INDOPACOM: Pacific Asychronous TeleHealth (PATH): https://gtp.health.mil/
- EUCOM, CENTCOM, AFRICOM, SOUTHCOM: Health Experts onLine Portal (HELP): https://gtp.health.mil/

NOTE: PATH and HELP links require establishment of an account

Service members (SM) reporting worsening visual acuity or visual symptoms, or a change in exam findings should be considered for priority evacuation to allow for evaluation and care by an eye care provider. SMs with any visual symptoms that persist beyond 24 hours despite initial treatment should be considered for priority evacuation.

All SMs with symptomatic exposures, even those that return to baseline function, should have comprehensive evaluation by an eye care provider in theater or upon redeployment if resources are not available in theater. This post-exposure evaluation should be documented in the electronic medical record.

SMs with repeated exposures (multiple exposures over several days), should be evaluated for symptoms after each incident, and each evaluation documented and treated as an additional exposure.

DISPOSITION

Flight Surgeons

Follow Service-specific guidelines for aviation personnel; full references at end of CPG.

- United States Air Force School of Aerospace Medicine Laser Injury Guidebook
- OPNAV Instruction 5100.27B Marine Corps Order 5104.1C, Navy Laser Hazards Control Program7
- Army personnel should follow above guidance

NOTE: Aviation personnel are only to be returned to duty in accordance with Service-specific aviation guidelines from the above references and local SOPs.

Other Forward Providers

SMs with exposures that return baseline visual function (with no new or persistent defects on Amsler grid testing, see Appendix C) within 2-4 hours may be returned to full duty without restrictions as long as the SM meets current service-specific standards. Full documentation and incident reporting is required for incidents with transient visual interference effects as well as suspected ocular injuries. Non-aviation personnel may return to duty when visual function returns to baseline and allows for effective execution of MOS-specific duties and operational requirements.

Eye care providers

1. Whenever feasible and operationally viable, obtain ultrastructural image of the retina as near to point of exposure as possible in SMs with persistent visual complaints. This will serve to further define the severity of injuries, serve as a baseline for visual recovery, and inform ongoing understanding of the spectrum of directed energy injuries as an evolving operational concern.
2. Service Members with suspected ocular injuries from laser exposure are eligible for enrollment in the DVEIVR https://vce.health.mil/Defense-and-Veterans-Eye-Injury-Vision-Registry. The registry is populated using medical encounter documentation. Only unclassified details of the event should be entered into the medical record. Coding recommendations to facilitate tracking and analysis are listed below.
3. Service Members with documented retinal involvement should be referred to a vitreoretinal specialist for further evaluation.

Medical Coding

The following ICD-10 coding guidance is recommended for laser exposures. Proper documentation and coding of these events allows for optimal tracking and analysis inform and evaluate treatment recommendations. Uniform and consistent medical documentation and coding is essential to proper surveillance and research efforts. This guidance is designed to standardize coding across the MHS.