Ultraviolet keratitis: Difference between revisions
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*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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***'''Superficial Punctate Keratitis'''-Small, pinpoint areas of increased uptake on cornea<br> | ***'''Superficial Punctate Keratitis'''-Small, pinpoint areas of increased uptake on cornea<br> | ||
== | ==Differential Diagnosis== | ||
*Viral conjunctivitis | *Viral [[conjunctivitis[[ | ||
*Thygeson's Superficial Punctate Keratitis | *Thygeson's Superficial Punctate Keratitis | ||
*Dry eyes | *Dry eyes | ||
{{High altitude DDX}} | |||
== Treatment == | == Treatment == | ||
Revision as of 21:09, 11 January 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
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
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
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