Ultraviolet Keratitis Treatment & Management

Updated: Apr 06, 2017
  • Author: Alex Koyfman, MD; Chief Editor: Robert E O'Connor, MD, MPH  more...
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Treatment

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 help 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. [9] 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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