Ultraviolet keratitis

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

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

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

Analgesia (very painful condition) - PO NSAIDS, opioids.
- If elderly consider topical anesthetics (e.g. tetracaine) if unable to tolerate opioids (Ensure good follow up and reliable social situation to avoid further corneal injury)
Eye rest (avoid re-exposure)
Lacrilube (saline eye drops)
± Antibiotic ointment (erythromycin ophthalmic or gentamycin ophthalmic)
± Cycloplegics

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