Ultraviolet Keratitis Treatment & Management

  • Author: Reed Brozen, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 15, 2011
 

Prehospital Care

  • If ultraviolet (UV) keratitis is suspected, flush eyes for several minutes with water or saline solution.
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Emergency Department Care

  • Administration of a short-acting cycloplegic drop (eg, cyclopentolate 1%) may help relieve the pain of reflex ciliary spasm.
  • Use of a bland ointment (eg, Lacrilube) may hep reduce pain. Ointments may interfere with healing in severe corneal injuries.
  • Many practitioners administer topical antibiotic ointment or drops (eg, erythromycin or gentamicin). However, no evidence supports this practice. If an eye patch is used with an antibiotic ointment, the patient should use antibiotic drops after the eye patch has been removed.
  • Application of a semipressure dressing with the eye well closed underneath was once the standard of care, but today this method of treatment is controversial. While these dressings may offer good pain relief, they may also delay reepithelialization. Moreover, some patients find the loss of sight and depth perception (in the case of single-eye patching) more traumatic than the pain itself. When used, the dressing is to be left on for 24 hours. The dressing should not be replaced by the patient without professional assistance because excessive pressure can cause further damage to the eye.
  • UV keratitis symptoms vary from extreme pain to a minor annoyance, depending on individual patient factors and the severity of the injury. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a reasonable first-choice analgesic. Narcotic/acetaminophen combinations are useful for breakthrough pain.
  • Topical anesthetic may be administered only in the ED; frequent use retards epithelial healing and may lead to corneal ulcer formation. The relief provided by topical anesthetics is so immediate and dramatic that patients are highly motivated to take a bottle home with them. Be careful not to allow the patient to take the bottle surreptitiously.
  • Topical NSAIDs are not approved for this indication but are used for many other painful and allergic eye conditions.[4] Topical NSAIDs for UV keratitis and corneal abrasions is an off-label use but has become common practice in many places.
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Consultations

  • Ophthalmologic consultation is not usually necessary for this condition but may be obtained at the discretion of the emergency physician in the ED or if substantial healing has not occurred within 24-48 hours.
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Contributor Information and Disclosures
Author

Reed Brozen, MD  Director of Air Transport, Associate Professor, Department of Emergency Medicine, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center

Reed Brozen, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, New Hampshire Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Christian Fromm, MD, FAAEM, FACEP  Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Director of Research, Attending Physician, Department of Emergency Medicine, Maimonides Medical Center

Christian Fromm, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric M Kardon, MD, FACEP  Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

James Steven Walker, DO, MS  Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Schein OD. Phototoxicity and the cornea. J Natl Med Assoc. Jul 1992;84(7):579-83. [Medline].

  2. Daxecker F, Blumthaler M, Ambach W. Ultraviolet exposure of cornea from sunbeds. Lancet. Sep 24 1994;344(8926):886. [Medline].

  3. [Guideline] Eye. Elk Grove Village: American College of Occupational and Environmental Medicine (ACOEM); 2004. 77 p. [Full Text].

  4. Brown MD, Cordell WH, Gee AS. Do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing?. Ann Emerg Med. Oct 1999;34(4 Pt 1):526-34. [Medline].

  5. Belin MW, Catalano RA, Scott JL. Burns of the eye. In: Catalano RA, ed. Ocular Emergencies. Philadelphia, Pa: WB Saunders Co; 1992:192-4.

  6. Brunette DD, Ghezzi K, Renner GS. Ophthalmologic disorders. In: Rosen P, Barkin R, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby Year Book; 1998:2704.

  7. Crumpton KL, Shockley LW. Ocular trauma: a quick illustrated guide to treatment, triage, and medicolegal implications. Emerg Med Rep. 1997;18:223-34.

  8. Spencer WH. The Cornea. Ophthalmic Pathology. 4th ed. Philadelphia, Pa: WB Saunders Co; 1996:233-35.

  9. Weaver CS, Terrell KM. Evidence-based emergency medicine. Update: do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing?. Ann Emerg Med. Jan 2003;41(1):134-40. [Medline].

  10. Wittenberg S. Solar radiation and the eye: a review of knowledge relevant to eye care. Am J Optom Physiol Opt. Aug 1986;63(8):676-89. [Medline].

  11. Yen YL, Lin HL, Lin HJ, et al. Photokeratoconjunctivitis caused by different light sources. Am J Emerg Med. Nov 2004;22(7):511-5. [Medline].

 
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Diffuse uptake of fluorescein stain as seen in ultraviolet keratitis.
 
 
 
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