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
- 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
- Fluoroscein 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
- 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
- Generally clinical diagnosis
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