The goal of the present study was to analyze the interaction between incident laser light and retinal tissue in confocal scanning laser ophthalmoscopy and tomography. We examined the change in axial intensity distribution during evaluation of the retinal surface topography in macular and optic nerve head evaluation in normal volunteers and patients with different retinal diseases. Additionally, we examined a model eye with a model cyst and human globes in an eye mounting chamber. We found that confocal scanning laser tomographs record specular reflected light originating from intraocular surfaces as well as light scattering from deeper retinal structures. Concave and convex retinal surfaces and eye movements may influence accurate topographic detection. Knowledge of the exact mechanism of image formation in confocal tomography is of great importance for the understanding of validity of these measurements. Proper identification of observed artifacts and preventive measures will increase the utility, reproducibility, and validity of this technology.