Ultraviolet keratitis

(Redirected from UV Keratitis)

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

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

High Altitude Illnesses

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

  1. 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