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 | ||
**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 | ||
== 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 | ||
== Work-Up == | == Work-Up == | ||
*History of recent UV exposure | *History of recent UV exposure | ||
*Full eye exam/Slit Lamp | *Full eye exam/Slit Lamp | ||
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**Fluoroscein | **Fluoroscein | ||
***'''Superficial Punctate Keratitis'''-Small, pinpoint areas of increased uptake on cornea<br> | ***'''Superficial Punctate Keratitis'''-Small, pinpoint areas of increased uptake on cornea<br> | ||
== DDx == | == DDx == | ||
*Viral conjunctivitis | *Viral conjunctivitis | ||
*Thygeson's Superficial Punctate Keratitis | *Thygeson's Superficial Punctate Keratitis | ||
*Dry eyes | *Dry eyes | ||
== Treatment == | == Treatment == | ||
*Self resolution as cornea re-epithelializes in 48-72 hrs | *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) | *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) | ||
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*+/- Antibiotic ointment (erythromycin ophthalmic or gentamycin ophthalmic) | *+/- Antibiotic ointment (erythromycin ophthalmic or gentamycin ophthalmic) | ||
*+/- Cycloplegics | *+/- Cycloplegics | ||
== Disposition == | == Disposition == | ||
*F/U with PMD in 1-2 days to ensure improvement of symptoms and possible ophtho if no improvement | *F/U with PMD in 1-2 days to ensure improvement of symptoms and possible ophtho if no improvement | ||
*Most do not need ophtho f/u given limited course | *Most do not need ophtho f/u given limited course | ||
*Emphasize proper eye protection with future exposure | *Emphasize proper eye protection with future exposure | ||
== See | ==See Also== | ||
[[High Altitude Medicine]] | [[High Altitude Medicine]] | ||
== Source == | == Source == | ||
UptoDate, Emedicine, Rosen's, Harwood and Nuss | UptoDate, Emedicine, Rosen's, Harwood and Nuss, Tintinalli | ||
[[Category:Environ]] | |||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 03:40, 13 June 2012
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
Work-Up
- History of recent UV exposure
- 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
- Superficial Punctate Keratitis-Small, pinpoint areas of increased uptake on cornea
DDx
- Viral conjunctivitis
- Thygeson's Superficial Punctate Keratitis
- Dry eyes
Treatment
- 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
- Most do not need ophtho f/u given limited course
- Emphasize proper eye protection with future exposure
See Also
Source
UptoDate, Emedicine, Rosen's, Harwood and Nuss, Tintinalli