Accidental retinal laser injuries are easily diagnosed when there are known laser sources, typical macular injuries, and visual deficits consistent with retinal findings. Decisions are more difficult when retinal findings are subtle or absent, despite reported visual problems and somatic complaints. Inaccurate diagnosis of an ocular laser injury can precipitate a costly, lengthy sequence of medical and legal problems. Analysis of laser-tissue interactions and the characteristics of unambiguous retinal laser injuries provide 6 key questions to facilitate difficult diagnoses. Case reports demonstrate the usefulness of answering these questions before making diagnostic decisions. Retinal laser lesions that cause serious visual problems are readily apparent ophthalmoscopically and angiographically. Accidental, intentional, or clinical retinal laser lesions do not cause chronic eye, face, or head pains. Diagnosis of a retinal laser injury should be evidence based, not a matter of conjecture or speculation.