History
Document information regarding the nature and duration of the ultraviolet (UV) exposure in patients with UV keratitis.
Patients experience the onset of a foreign-body sensation, irritation, pain, photophobia, tearing, blepharospasm, and decreased visual acuity 6-12 hours after the exposure.
Obtain the pertinent history, including contact lens use, past ocular trauma or surgery, current medications, and allergies to medications. Inquire concerning the risk of foreign body.
Physical
Prior to examination or treatment, assess visual acuity, with corrective lenses if relevant. Perform a full examination of the eyes, including inspection of all external structures together with funduscopic and slit lamp examinations.
Examination of the lids and conjunctiva may reveal varying lid edema and conjunctival hyperemia. Tearing may be present.
A diffuse corneal haze may be seen in severe cases.
Perform a standard slit lamp examination with prior application of tetracaine 0.5% (Pontocaine) or proparacaine 0.5% (Alcaine, Ophthetic).
Fluorescein staining reveals superficial punctate epithelial surface irregularities, which usually cover the entire surface of the cornea. This condition usually is referred to as superficial punctate keratitis (SPK). If the patient's eyelid was partially closed during the exposure, a well-demarcated line separates normal from damaged corneal epithelium. Involvement of the lens is rare and occurs only after intense exposure.
The remainder of the ocular examination findings usually are unremarkable, including intraocular pressure.
Causes
Radiation injury to the eye may be caused by unprotected or long exposures to the sun, particularly at high altitude; exposure to UV radiation reflected off snow, ice, or water; and viewing of solar eclipses. In addition to the sun, sources of UV radiation include the following:
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Welder's arcs
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Carbon arcs
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Sun tanning beds [7]
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Photographic flood lamps
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Lightning
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Electric sparks
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Halogen desk lamps
Complications
Potential complications of ultraviolet keratitis include the following:
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Superinfection, rarely
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Vision loss, rarely
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Pterygium (rare, most commonly with chronic repeated exposures)
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Corneal degeneration (rare, with repeated exposures) [8]
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Diffuse uptake of fluorescein stain as seen in ultraviolet keratitis.
