View source for 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


== Causes  ==

*Lack of proper eye protection 
*UV exposure from 
**Natural sources&nbsp;: 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<br>


== 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 Other  ==
[[High Altitude Medicine]]

== Source  ==
UptoDate, Emedicine, Rosen's, Harwood and Nuss 

[[Category:Ophtho]]