Ultraviolet keratitis: Difference between revisions
 
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== Background ==
==Background==
 
*Also known as photokeratitis, 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
*May not be initially apparent with latent period (6-12 hours) before onset


 
===Causes===
== Causes ==
 
*Lack of proper eye protection  
*Lack of proper eye protection  
*UV exposure from  
*UV exposure from:
**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>]]
*Symptoms occur typically 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)
 
**Surrounding eyelid and face may appear mildly erythematous and edematous (consistent with sunburn)
== Work-Up  ==
**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
*History of recent UV exposure
*Symptoms resolve spontaneously as cornea re-epithelializes over 48-72 hrs
*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<br>
 
 
== DDx  ==


*Viral conjunctivitis  
==Differential Diagnosis==
*Other causes of [[keratoconjunctivitis]]
*Viral [[conjunctivitis]]
*Thygeson's Superficial Punctate Keratitis  
*Thygeson's Superficial Punctate Keratitis  
*Dry eyes
*Dry eyes


{{High altitude DDX}}


== Treatment  ==
==Evaluation==
 
*Generally clinical diagnosis
*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
==Management==
*Most do not need ophtho f/u given limited course
*[[Analgesia]] (very painful condition) - PO [[NSAIDS]], [[opioids]].
*Emphasize proper eye protection with future exposure
**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)
*± [[Cycloplegic]]s


== See Other  ==
==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


[[High_Altitude_Medicine]]
==See Also==
*[[High Altitude Medicine]]
*[[Eye Algorithms (Main)]]
*[[Keratoconjunctivitis]]


== Source  ==
==References==
UptoDate, Emedicine, Rosen's, Harwood and Nuss
<References/>


[[Category:Ophtho]]
[[Category:Environmental]]
[[Category:Ophthalmology]]

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

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
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