Ultraviolet keratitis: Difference between revisions
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==Background== | ==Background== | ||
*Also known as | *Also known as photokeratitis, 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 | *Prolonged/excessive UV exposure to eyes leads to inflammatory response and subsequent desquamation of corneal epithelium leaving exposed nerve endings of cornea | ||
*May not be initially apparent with latent period (6-12 hours) before onset | |||
===Causes=== | ===Causes=== | ||
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**Natural sources: snow, water, high altitudes (less protective ozone), eclipses | **Natural sources: snow, water, high altitudes (less protective ozone), eclipses | ||
**Artificial sources: Welder's arc, tanning beds, damaged metal halide lamps/lights | **Artificial sources: Welder's arc, tanning beds, damaged metal halide lamps/lights | ||
{{Keratoconjunctivitis Types}} | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:UVKeratitis.png|400px|thumb|Slit Lamp Exam of UV Keratitis<ref>Kwon DH, Moon JD, Park WJ, et al. Case series of keratitis in poultry abattoir workers induced by exposure to the ultraviolet disinfection lamp. Ann Occup Environ Med. 2016;28:3. Published 2016 Jan 15. doi:10.1186/s40557-015-0087-7</ref>]] | |||
*History of recent UV exposure - symptoms typically occur 6-12 hrs after exposure (will present late night/early AM) | *History of recent UV exposure - symptoms typically occur 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 | *Symptoms include bilateral [[eye pain]], foreign body sensation, lacrimation, blepharospasm, photophobia, chemosis, temporary decreased [[vision loss|visual acuity]] | ||
*[[Eye exam]] (including slit lamp) | *[[Eye exam]] (including slit lamp) | ||
**Surrounding eyelid and face may appear mildly erythematous and edematous (consistent with sunburn) | **Surrounding eyelid and face may appear mildly erythematous and edematous (consistent with sunburn) | ||
**Obvious tearing, discomfort, blepharospasm on exam with relief of symptoms after instilling topical anesthetic | **Obvious tearing, discomfort, blepharospasm on exam with relief of symptoms after instilling topical anesthetic | ||
** | **Fluorescein exam - '''Superficial Punctate Keratitis''' - small, pinpoint areas of increased uptake on cornea | ||
*Symptoms resolve spontaneously as cornea re-epithelializes over 48-72 hrs | *Symptoms resolve spontaneously as cornea re-epithelializes over 48-72 hrs | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Other causes of [[keratoconjunctivitis]] | |||
*Viral [[conjunctivitis]] | *Viral [[conjunctivitis]] | ||
*Thygeson's Superficial Punctate Keratitis | *Thygeson's Superficial Punctate Keratitis | ||
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{{High altitude DDX}} | {{High altitude DDX}} | ||
== | ==Evaluation== | ||
*Generally clinical diagnosis | *Generally clinical diagnosis | ||
==Management== | ==Management== | ||
*Analgesia (very painful condition) - PO [[NSAIDS]], [[opioids]]. | *[[Analgesia]] (very painful condition) - PO [[NSAIDS]], [[opioids]]. | ||
** | **Do not prescribe topical anesthetics (i.e. tetracaine) to be used at home, this can lead to poor corneal healing and corneal melt | ||
*Eye rest (avoid re-exposure) | *Eye rest (avoid re-exposure) | ||
*Lacrilube (saline eye drops) | *Lacrilube (saline eye drops) | ||
*± Antibiotic ointment (erythromycin ophthalmic or | *± Antibiotic ointment ([[erythromycin]] ophthalmic or [[gentamicin]] ophthalmic) | ||
*± | *± [[Cycloplegic]]s | ||
==Disposition== | ==Disposition== | ||
*Discharge | *Discharge | ||
** | **Follow up with primary care provider in 1-2 days to ensure improvement of symptoms | ||
**Generally do not need ophtho follow-up given limited course | **Generally do not need ophtho follow-up given limited course | ||
**Emphasize proper eye protection with future exposure | **Emphasize proper eye protection with future exposure | ||
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==See Also== | ==See Also== | ||
*[[High Altitude Medicine]] | *[[High Altitude Medicine]] | ||
*[[Eye Algorithms (Main)]] | |||
*[[Keratoconjunctivitis]] | |||
==References== | ==References== | ||
Latest revision as of 21:42, 28 March 2020
Background
- Also known as photokeratitis, 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
- May not be initially apparent with latent period (6-12 hours) before onset
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
Keratoconjunctivitis Types
- Atopic keratoconjunctivitis
- Caustic keratoconjunctivitis
- Secondary to chemical orbital exposure
- Epidemic keratoconjunctivitis
- Highly contagious viral (adenovirus) conjunctivitis, associated with watery discharge
- Ultraviolet keratitis
- Secondary to UV light exposure
- Keratoconjunctivitis sicca
- Associated with autoimmune disorders such as Sjögren syndrome, sarcoidosis, rheumatoid arthritis, and scleroderma
Clinical Features
Slit Lamp Exam of UV Keratitis[1]
- History of recent UV exposure - symptoms typically occur 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
- Eye exam (including slit lamp)
- Surrounding eyelid and face may appear mildly erythematous and edematous (consistent with sunburn)
- Obvious tearing, discomfort, blepharospasm on exam with relief of symptoms after instilling topical anesthetic
- Fluorescein exam - Superficial Punctate Keratitis - small, pinpoint areas of increased uptake on cornea
- Symptoms resolve spontaneously as cornea re-epithelializes over 48-72 hrs
Differential Diagnosis
- Other causes of keratoconjunctivitis
- Viral conjunctivitis
- Thygeson's Superficial Punctate Keratitis
- Dry eyes
High Altitude Illnesses
- Acute mountain sickness
- Chronic mountain sickness
- High altitude cerebral edema
- High altitude pulmonary edema
- High altitude peripheral edema
- High altitude retinopathy
- High altitude pharyngitis and bronchitis
- Ultraviolet keratitis
Evaluation
- Generally clinical diagnosis
Management
- Analgesia (very painful condition) - PO NSAIDS, opioids.
- Do not prescribe topical anesthetics (i.e. tetracaine) to be used at home, this can lead to poor corneal healing and corneal melt
- Eye rest (avoid re-exposure)
- Lacrilube (saline eye drops)
- ± Antibiotic ointment (erythromycin ophthalmic or gentamicin ophthalmic)
- ± Cycloplegics
Disposition
- Discharge
- Follow up with primary care provider in 1-2 days to ensure improvement of symptoms
- Generally do not need ophtho follow-up given limited course
- Emphasize proper eye protection with future exposure
See Also
References
- ↑ Kwon DH, Moon JD, Park WJ, et al. Case series of keratitis in poultry abattoir workers induced by exposure to the ultraviolet disinfection lamp. Ann Occup Environ Med. 2016;28:3. Published 2016 Jan 15. doi:10.1186/s40557-015-0087-7