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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:

What not to do:

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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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD