Photokeratitis

Specialty: Ophthalmology.

• actinic keratopathy
• snow blindness
• welder's ophthalmia
• UV radiation keratitis

Why it occurs

• Direct exposure to electric welding without the use of a protective mask with an actinic filter
• Prolonged intense sun exposure reflected in the snow without approved sunglasses with ultraviolet filter
• Unprotected exposure to radiation from ultraviolet germicidal lamps for industrial or domestic use
• Use of tanning booths without suitable eye protectors

Initial workup

Previous instillation of a drop of topical anesthetic eye drops (tetracaine with oxybuprocaine) strictly to enable eyelid opening and diagnostic examination (this eye drop should never be given to the patient for home use due to the risk of corneal necrosis); Staining of the ocular surface with 1% sodium fluorescein eye drops will reveal under cobalt blue light a characteristic pattern of bilateral diffuse and confluent superficial punctate keratitis in the palpebral fissure area.

Standard management

• Ciclopentolate — 1% eye drops, 1 drop every 8 hours to temporarily paralyze the ciliary muscle and thus abolish pain due to ciliary spasm secondary to keratitis
• Tobramycin in ophthalmic ointment — or 0.5% erythromycin, apply to the conjunctival sac every 6 hours to act as a viscous lubricant and ensure broad-spectrum bacterial prophylaxis in the cornea devoid of epithelium
• Sodium hyaluronate 0.15% or 0.4% without preservatives (eye drops, apply every hour to promote rapid corneal biological re-epithelialization).