Ultraviolet keratitis: Difference between revisions
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== Background | ==Background== | ||
*Also known as photoconjunctivitis, welder's flash, snow blindness | *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 | *Prolonged/excessive UV exposure to eyes leads to inflammatory response and subsequent desquamation of corneal epithelium leaving exposed nerve endings of cornea | ||
=== Causes | ===Causes=== | ||
*Lack of proper eye protection | *Lack of proper eye protection | ||
*UV exposure from | *UV exposure from | ||
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**Artificial sources: Welder's arc, tanning beds, damaged metal halide lamps/lights | **Artificial sources: Welder's arc, tanning beds, damaged metal halide lamps/lights | ||
== Clinical Features | ==Clinical Features== | ||
*Symptoms occur typically 6-12 hrs after exposure (will present late night/early AM) | *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 | *Symptoms include bilateral eye pain, foreign body sensation, lacrimation, blepharospasm, photophobia, chemosis, temporary decreased visual acuity | ||
*Self resolution as cornea re-epithelializes in 48-72 hrs | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{High altitude DDX}} | {{High altitude DDX}} | ||
== | ==Diagnosis== | ||
* | *History of recent UV exposure | ||
* | *Full [[Eye exam]] (including slit lamp) | ||
*Eye rest- | **Surrounding eyelid and face may appear mildly erythematous and edematous (consistent with sunburn) | ||
*Lacrilube | **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 | ||
==Management== | |||
*Analgesia (very painful condition) - PO NSAIDS, Opiates. | |||
**If elderly consider topical anesthetics (e.g. tetracaine) if unable to tolerate opiates (Ensure good follow up and reliable social situation to avoid further corneal injury) | |||
*Eye rest (avoid re-exposure) | |||
*Lacrilube (saline eye drops) | |||
*± Antibiotic ointment (erythromycin ophthalmic or gentamycin ophthalmic) | |||
*± Cycloplegics | |||
== Disposition == | ==Disposition== | ||
*F/U with PMD in 1-2 days to ensure improvement of symptoms | *Discharge | ||
* | **F/U with PMD in 1-2 days to ensure improvement of symptoms | ||
*Emphasize proper eye protection with future exposure | **Generally do not need ophtho follow-up given limited course | ||
**Emphasize proper eye protection with future exposure | |||
==See Also== | ==See Also== | ||
[[High Altitude Medicine]] | [[High Altitude Medicine]] | ||
== | ==References== | ||
<References/> | |||
[[Category:Environ]] | [[Category:Environ]] | ||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 05:51, 11 August 2015
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
- Self resolution as cornea re-epithelializes in 48-72 hrs
Differential Diagnosis
- 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
Diagnosis
- History of recent UV exposure
- Full Eye exam (including slit lamp)
- Surrounding eyelid and face may appear mildly erythematous and edematous (consistent with sunburn)
- 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
Management
- Analgesia (very painful condition) - PO NSAIDS, Opiates.
- If elderly consider topical anesthetics (e.g. tetracaine) if unable to tolerate opiates (Ensure good follow up and reliable social situation to avoid further corneal injury)
- Eye rest (avoid re-exposure)
- Lacrilube (saline eye drops)
- ± Antibiotic ointment (erythromycin ophthalmic or gentamycin ophthalmic)
- ± Cycloplegics
Disposition
- Discharge
- F/U with PMD 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