Ultraviolet keratitis

Background

• Also known as photoconjunctivitis, welder's flash, snow blindness
• Prolonged/excessive UV exposure to eyes leads to inflammatory response and subsequent desquamation of corneal epithelium leaving exposed nerve endings of cornea

Causes

• Lack of proper eye protection
• UV exposure from
  • Natural sources : snow, water, high altitudes (less protective ozone), eclipses
  • Artificial sources: Welder's arc, tanning beds, damaged metal halide lamps/lights

Clinical Features

• Symptoms occur typically 6-12 hrs after exposure (will present late night/early AM)
• Symptoms include bilateral eye pain, foreign body sensation, lacrimation, blepharospasm, photophobia, chemosis, temporary decreased visual acuity

Work-Up

• History of recent UV exposure
• Full eye exam/Slit Lamp
  • Surrounding eyelid skin and face may appear mildly erythematous, edematous consistent with sunburn
  • Pt. with obvious tearing, discomfort, blepharospasm throughout exam with relief of symptoms upon instilling topical anesthetic
  • Fluoroscein
    • Superficial Punctate Keratitis-Small, pinpoint areas of increased uptake on cornea
      

DDx

• Viral conjunctivitis
• Thygeson's Superficial Punctate Keratitis
• Dry eyes

Treatment

• Self resolution as cornea re-epithelializes in 48-72 hrs
• Very painful-Provide PO NSAIDS, Opiates. If elderly consider topical anesthetics (ie tetracaine if unable to tolerate opiates. Ensure good follow up and pt/family is reliable as to avoid further corneal injury)
• Eye rest-avoid reexposure
• Lacrilube, Saline eye gtts
• +/- Antibiotic ointment (erythromycin ophthalmic or gentamycin ophthalmic)
• +/- Cycloplegics

Disposition

• F/U with PMD in 1-2 days to ensure improvement of symptoms and possible ophtho if no improvement
• Most do not need ophtho f/u given limited course
• Emphasize proper eye protection with future exposure

See Other

High Altitude Medicine

Source

UptoDate, Emedicine, Rosen's, Harwood and Nuss

Background

1. High UV exposure can lead to corneal burns w/in 1hr
   1. May also see with arc welders, tanning beds

Diagnosis

1. Symptoms develop after delay of up to 6-12hr
   1. Ocular pain, foreign-body sensation, photophobia, tearing, conj erythema, chemosis

See Also

High Altitude Medicine

Source

Tintinalli