2.09 Ultraviolet Keratoconjunctivitis (Welder's or Tanning Bed Burn)
Presentation
The patient arrives with burning eye pain, usually bilateral, beginning 6 to 8 hours after a brief exposure without eye protection to a high intensity ultraviolet light source such as a sunlamp or welder's arc. The eye exam shows conjunctival injection; fluorescein staining may be negative or show diffuse superficial uptake (discerned as a punctate keratopathy under slit lamp examination). The patient may also have first-degree skin burns.
What to do:
Apply topical anesthetic ophthalmic drops (once, to permit exam).
Perform a complete eye exam (visual acuity, funduscopic, anterior chamber bright light, fluorescein, inspection of conjunctival sacs).
Instill an antibiotic ointment and patch eyes for approximately 12 hours. Cold compresses, rest, and analgesics (oxycodone, codeine, ibuprofen, naproxen) should be prescribed to control pain. The first dose can be given in the ED.
Warn the patient that pain will return when the local anesthetic wears off, but that the pills prescribed should help to relieve it.
What not to do:
Do not give the patient a topical anesthetic for continued instillation. It can slow healing and increases the risk of eye injury.
Do not be stingy with pain medications. This is a painful, albeit short-lived injury.
Discussion
The history of a brief exposure may be difficult to elicit after the long asymptomatic interval. Longer exposures to lower intensity UV sources may resemble a sunburn. Some physicians find it quite acceptable to substitute for the antibiotic ointment a one-time instillation of an ophthalmic anesthetic ointment (Tetracaine), which allows longer-lasting topical anesthesia. Some patients do not tolerate bilateral patching (they may have to get home alone). Cold compresses may be substituted for patches. Healing should be complete in 12-24 hours. If the patient continues to have discomfort, an ophthalmologist should be consulted.
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