Safety & sun

Laser pointers, gel blasters and toy guns: the eye injuries behind the gift

Lasers, gel blasters and toy guns are easy to give and easy to misuse. What the hospital reports show, what to do in the first minutes, and the signs that mean an eye check the same day.

by Dr Chan Li Yen · MBBS, MOphth (UM), Fellowship in Paediatric Ophthalmology & Strabismus

Dr Chan Li Yen, consultant paediatric ophthalmologist, MMC 43128, NSR 132980 · Eagle Eye Centre Kuala Lumpur, Petaling Jaya

11 min read · 2,050 words

Key takeaways

A hand-held laser can burn the macula, the centre of the retina, and the child may feel nothing at the time.
In a UK hospital series, 67 per cent of children with laser injury had no symptoms when first seen, yet the retinal scar stayed in every case.
Any laser beam into a child's eye, even briefly, means an eye examination the same day, even if your child says the eye feels fine.
Gel blasters and hard pellets can cause bleeding inside the front of the eye. Do not rub, press or remove anything stuck, and go to be examined.
Published Malaysian figures for these injuries are limited, so the numbers in this article come from hospitals in other countries.

A laser pointer or a toy blaster looks like a safe gift. A few of them are not. The injuries are uncommon, but the ones that are described in the medical papers can change how a child sees for life, and the first warning is often nothing at all.

This is not an article to frighten you off every toy. It is the short list of what hurts a child's eye, what to do in the first minutes, and the signs that mean you go to an eye doctor today. Published Malaysian figures for laser or gel-blaster eye injuries are limited, so everything below comes from hospital reports in other countries, and I say which.

Can a laser pointer really hurt my child's eye?

Yes. A hand-held laser beam can burn the macula, the small central part of the retina (the light-sensing layer at the back of the eye) that we use for reading and for seeing faces. A burn there can leave a permanent scar and a blind or blurred spot in the middle of what the child looks at.

Several hospital teams have reported this in children. A 2016 report in the journal Pediatrics described four boys aged 9 to 16 who hurt the macula in one or both eyes by mishandling laser pointers. They lost central vision, saw a blank spot in the middle of sight, or saw straight lines look bent. Three had damage that might not recover. A German university eye centre looked back over 909,150 patients seen between 2007 and 2020 and found eight children with laser pointer injury, aged 6 to 16, and five of the eight were hurt in 2019 and 2020. Its authors wrote that the number of injuries had increased over recent years.

These are small numbers, and the injury is not common. The reason to know about it is that it is avoidable and does not hurt when it happens.

Why would a child stare into a laser beam?

Because children do not do what adults do, which is look away. The Royal College of Surgeons of Edinburgh notes that children are less likely to look away from a bright light, and that babies cannot protect themselves or tell anyone something is wrong.

Power matters. The American Academy of Ophthalmology says that above five milliwatts (a measure of laser power) the time that is safe for the eye gets shorter, and it warns about labels such as "military grade" or "burn". A survey of UK eye doctors, published in the journal Eye in 2018, counted 159 cases of laser damage to the macula: 80 per cent were under 20 years old and 85 per cent were male, and the authors flagged children with impulsive or obsessive behaviour as a group to watch.

What are the signs after a laser hits the eye, and can there be none?

There can be none. In a UK hospital series of nine children with laser retinal injury, 67 per cent had no symptoms when they were first seen, yet the scar on the macula stayed in every case. One child had a fragile new blood vessel under the retina that needed injections, and the authors warn such complications can appear years later.

When there are symptoms, they are a dark or blurred spot in the centre of vision, lines that look wavy or bent, an after-image that will not fade, colours that look duller in one eye, or trouble reading that was not there before.

So the rule is about what happened, not how the eye feels. If a laser beam has been shone into your child's eye, even for a moment and even if your child says it is fine, arrange an eye examination the same day. The college says a same-day referral to ophthalmology is appropriate if damage to the macula is suspected. A scan of the retina (an optical coherence tomography, or OCT, which is a painless picture of the layers of the back of the eye) is what shows the answer.

What about gel blasters, foam-dart guns and toy guns?

They can bruise or burst the front of the eye. A 2019 case report from a children's hospital in Queensland described two children hit in the eye by gel-blaster pellets (hydrated gel beads). Both had a large amount of bleeding in the front chamber of the eye, called a hyphaema, which needs urgent examination. Their sight returned to normal, but the report says both keep a lifelong risk of eye complications, and it argued that gel blasters should not be treated as harmless toys.

The American Academy of Ophthalmology lists projectile toys among those to think twice about, and names scratches on the front of the eye (corneal abrasion) and bleeding inside it as common injuries, with retinal detachment and blindness as the rarer, worse outcomes. It also says that if a toy injures your child's eye, see an ophthalmologist. Its children's injury page says nine out of ten childhood eye injuries could be prevented, and it advises skipping toys or games with darts, pellets or other flying pieces, and avoiding any toy that shoots a projectile, even a soft one.

I have covered foam darts briefly with other home hazards in eye safety at home. But a foam dart at close range, a hard pellet, and a gel bead fired from a powered blaster are not the same thing. If your family plays with any of them, the eye protection goes on before the first shot, for everyone on the field.

What do I do in the first minutes after a toy or laser hurts the eye?

Keep your child calm, keep their hands away from the eye, and go to be examined. Do not rub, do not press and do not try to remove anything stuck in the eye. That is the whole first-aid list for a projectile, and it follows the American Academy of Ophthalmology's advice for eye injuries.

For a blunt hit from a pellet, ball or dart, the academy says a small cold compress can ease pain and swelling, and that no pressure should be put on the eye. I have set out what to look at in the first minute in a child poked in the eye. If something sharp has cut or pierced the eye, put a shield over it (the bottom of a paper cup taped to the bones around the eye works), do not rinse it with water, and do not pull out anything that is stuck.

A chemical is a different case: rinse first, at once, as described in the first sixty seconds of a chemical splash. After a cut or puncture, do not give aspirin, ibuprofen or similar tablets, since the academy says they thin the blood and may increase bleeding.

When is it a go-today situation, and when can it wait?

Go today, to an eye emergency department or the nearest place that can examine the eye, for any of these: any laser beam into the eye; blood visible in the front of the eye; a pupil that is not round or is a different size from the other; ongoing pain; a cut or torn eyelid; an eye that does not move as well as the other; something stuck in the eye; or any blur, missing spot, wavy lines or lingering after-image. The academy adds that you may not be able to tell if an injury is serious.

What can wait is a light tap with none of the signs above: the pupil is round, sight looks normal, there is no bruising and the pain settles within minutes. Even then, watch that eye for the next day or two, because a blunt hit can look fine at first and worsen later, as I explained in the article on the shuttlecock and your child's eye.

How do we keep the fun and lose the risk before the year-end gifts?

Choose gifts by age label, keep lasers out of the house, and put eye protection on for any toy that fires something. The academy says to check age labels and to keep toys made for older children away from younger ones.

For lasers, the Edinburgh college's advice is to get rid of them from homes with children, and never to buy an unmarked device from an unverified online seller. The American Academy of Ophthalmology, quoting the US regulator, is blunter: do not buy laser pointers for your children. For blasters, a snug pair of polycarbonate goggles (a tough clear plastic used in safety eyewear) with side cover is a fair rule for every player, adults included.

I did not confirm any Malaysian rule on the sale of laser pointers or gel blasters, so I have not stated one. If you are unsure whether something is safe to give, ask before you buy, and if a child has already been hit, do not wait for the weekend.

Go to an eye emergency department today if…

A laser beam has been shone into your child's eye, for any length of time.
There is a dark, blurred or missing spot in the middle of what your child looks at, wavy lines, or an after-image that will not fade.
There is blood visible in the front of the eye, or the pupil is not round or is a different size from the other.
The pain is ongoing, the eyelid is cut or torn, or one eye does not move as well as the other.
Something is stuck in or has cut the eye. Shield it, do not rinse and do not pull anything out.

Common questions

Can a laser pointer cause permanent damage to a child's eye?

Yes, it can. Hospital reports describe scarring of the macula, the centre of the retina, from consumer laser pointers in children. A German eye centre found that outer retinal damage persisted in eight of eleven affected eyes at the last follow-up. It is uncommon, but it is permanent when it happens.

My child looked into a laser for a second and says the eye is fine. Do we still need to go?

Yes, go the same day. In a UK series, two thirds of children with a laser retinal injury had no symptoms when first seen, and the scar still showed on the scan. The Royal College of Surgeons of Edinburgh says same-day referral to ophthalmology is appropriate when macular damage is suspected.

How strong is too strong for a laser pointer?

The true power is hard to know, because labels are often missing or wrong. The American Academy of Ophthalmology says that above five milliwatts the safe exposure time shrinks, and, relaying US FDA advice, says not to buy laser pointers for children. It also warns about labels that say things like military grade or burn.

Are gel blasters just harmless toys?

Not always. A 2019 report from a children's hospital in Queensland described two children hit by gel-blaster pellets who each had a large amount of blood in the front of the eye. Their sight recovered, but both keep a lifelong risk of eye complications. Eye protection is sensible for everyone in the game.

What should I do first if my child is hit in the eye by a toy pellet or dart?

Keep your child calm and stop them rubbing or pressing the eye. A small cold compress held near the eye can ease pain, with no pressure on it. Then have the eye examined, especially if there is any blood, a misshapen pupil, or a change in vision.

Should I rinse the eye with water after a hit?

Rinse only for a chemical splash or loose grit. For a hit from a pellet or dart, or anything sharp, do not rinse. If the eye has been cut or pierced, shield it with something like the bottom of a paper cup, and do not remove anything stuck in it.

Are Malaysian laws on laser pointers or gel blasters clear?

I did not confirm any Malaysian rule on their sale or use, so I will not state one. What holds anywhere is that a laser is not a toy, that a blaster needs eye protection, and that a child who has been hit should be examined.

References

Pediatrics 2016 · Retinal injury secondary to laser pointers in pediatric patients (Xu et al.) · pubmed.ncbi.nlm.nih.gov
International Ophthalmology 2023 · Incidence and long-term outcome of laser pointer maculopathy in children (Farassat et al.) · pubmed.ncbi.nlm.nih.gov
Journal of Pediatric Ophthalmology & Strabismus 2023 · The danger of laser pointer-induced retinal damage in children: a UK case series and survey · pubmed.ncbi.nlm.nih.gov
Eye 2018 · Retinal burns from laser pointers: a risk in children with behavioural problems (Linton et al.) · pmc.ncbi.nlm.nih.gov
Royal College of Surgeons of Edinburgh · Lasers aren't toys: preventing injuries and protecting children's eyes · www.rcsed.ac.uk
BMJ Case Reports 2019 · Ocular injuries from gel blasters: not just a harmless toy (Hayes and Dai) · pubmed.ncbi.nlm.nih.gov
American Academy of Ophthalmology · Holiday gift and toy safety checklist · www.aao.org
American Academy of Ophthalmology · Children's eye injuries, prevention and care · www.aao.org
American Academy of Ophthalmology · Recognizing and treating eye injuries · www.aao.org
American Academy of Ophthalmology · Is your laser pointer dangerous enough to cause eye injury? · www.aao.org

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.