Ultraviolet 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

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

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 gentamycin 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