| Photokeratitis | |
|---|---|
| Classification and external resources | |
| ICD-10 | H16.1 |
| ICD-9 | 370.24 |
| DiseasesDB | 31147 |
| eMedicine | emerg/759 |
Photokeratitis or ultraviolet keratitis is a painful eye condition caused by exposure of insufficiently protected eyes to the ultraviolet (UV) rays from either natural or artificial sources. Photokeratitis is akin to a sunburn of the cornea and conjunctiva, and is not usually noticed until several hours after exposure. Symptoms include increased tears and a feeling of pain, likened to having sand in the eyes.
The injury may be prevented by wearing eye protection that blocks most of the ultraviolet radiation, such as welding goggles with the proper filters, a welder's helmet, sunglasses rated for sufficient UV protection, or appropriate snow goggles. The condition is usually managed by removal from the source of ultraviolet, covering the corneas, and administration of pain relief. Photokeratitis is known by a number of different terms including: snow blindness, arc eye, welder's flash, bake eyes, corneal flash burns, flash burns, niphablepsia, or keratoconjunctivitis photoelectrica.
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Common symptoms include pain, intense tears, eyelid twitching, discomfort from bright light,[1] and constricted pupils.
Symptoms tend to occur a number of hours after exposure, and typically resolve spontaneously within 36 hours, although constriction of the pupils may last as long as 96 to 128 hours in some cases.
Any intense exposure to UV light can lead to photokeratitis. Common causes include welders who have failed to use adequate eye protection such as an appropriate welding helmet or welding goggles. This is termed arc eye, while photokeratitis caused by exposure to sunlight reflected from ice and snow, particularly at elevation, is commonly called snow blindness. It can also occur due to using tanning beds without proper eyewear. Natural sources include bright sunlight reflected from snow or ice or, less commonly, from sea or sand.[2] Fresh snow reflects about 80% of the UV radiation compared to a dry, sandy beach (15%) or sea foam (25%). This is especially a problem in polar regions and at high altitudes,[3] as with every thousand feet (approximately 305 meters) of elevation (above sea level), the intensity of UV rays increases by four percent.[4]
Fluorescein dye staining will reveal punctate areas of uptake under blue light.
Photokeratitis can be prevented by using sunglasses or eye protection that transmits 5–10 % of visible light and absorbs almost all UV rays. Additionally, these glasses should have large lenses and side shields to avoid incidental light exposure. Sunglasses should always be worn, even when the sky is overcast, as UV rays can pass through clouds.[5]
In the event of lost or damaged sunglasses, emergency goggles can be made by cutting slits in dark fabric or tape folded back onto itself. The SAS Survival Guide and Ancient Egyptians recommend blackening the skin underneath the eyes with charcoal to avoid any further reflection.[6][7]
The pain may be temporarily alleviated with anaesthetic eye drops for the examination, however it is not used for continued treatment as anaesthesia of the eye interferes with corneal healing, and may lead to corneal ulceration and even loss of the eye. Cool, wet compresses over the eyes and artificial tears may help local symptoms when the feeling returns. Nonsteroidal anti-inflammatory drug (NSAID) eyedrops are widely used to lessen inflammation and eye pain, but have not been proven in rigorous trials. Systemic (oral) pain medication is given if discomfort is severe. Healing is usually rapid (24–72 hours) if the injury source is removed. Further injury should be avoided by isolation in a dark room, removing contact lenses, not rubbing the eyes, and wearing sunglasses until the symptoms improve.[3]
The Inuit carved snow goggles from caribou antlers to help prevent snow blindness. The goggles were curved to fit the user's face, and had a large groove cut in the back to allow for the nose. A long thin slit was cut through the goggles to allow in a small amount of light, diminishing the amount of UV rays that get through. The goggles were held to the head by a cord made of caribou sinew.[8]