SIGNS AND SYMPTOMS 
- Patients will present with bilateral eye pain, photophobia, redness, and tearing.
- No purulent discharge will be present.
- Associated facial edema, lid edema, erythema, and blepharospasm may be present.
History
- Elicit history of exposure to UV light 6–12 hr prior to complaint of pain.
- In addition to pain, complaints may include:
- Photophobia
- Tearing
- Foreign-body sensation
Physical Exam
- Visual acuity may be mildly diminished.
- Eye exam reveals chemosis, injection, tearing.
- Slit-lamp exam with topical ophthalmic anesthetics and fluorescein:
- Multiple superficial punctate corneal lesions
- Otherwise unremarkable
ESSENTIAL WORKUP
- Accurate history including:
- Type, timing, and duration of exposure
- Visual acuity
- Complete ocular exam including:
- Extraocular movements
- Exam of conjunctiva/sclera/cornea with fluorescein
- Anterior chamber checking for cell and flare
- Eversion of lids to check for foreign bodies
DIAGNOSIS TESTS & INTERPRETATION
Lab
Blood testing will not be necessary unless widespread severe sunburn is present.
Imaging
A careful history should obviate need for orbital US/CT/MRI for foreign body.
DIFFERENTIAL DIAGNOSIS
[Outline]
PRE-HOSPITAL
When diagnosis is unambiguously established, pressure patching or applying mild pressure to eyes with closed lids may provide temporary relief.
ED TREATMENT/PROCEDURES
- Topical anesthetic to facilitate slit-lamp exam.
- Provide adequate oral analgesia as needed.
- Apply topical antibiotic ointment.
- Initiate short-acting cycloplegic agent.
- May apply eye patching for comfort (patching has not been shown to accelerate healing):
- Soft double patching with mild pressure
- If both eyes involved, either patch both eyes or patch the eye that is more severely affected.
MEDICATION
- Topical anesthetic agent (for ED only):
- Tetracaine hydrochloride ophthalmic solution 0.5%: 1–2 drops into affected eye:
- Do not prescribe for outpatient as this may impair healing and increase corneal ulcer formation.
- Oral analgesics:
- Topical antibiotic ointment:
- Erythromycin ophthalmic ointment 0.5%, apply to affected eye QID
- Cycloplegic agent:
- Scopolamine hydrobromide ophthalmic solution 0.25%: 1 or 2 drops into affected eye q6–8h
- Cyclopentolate hydrochloride ophthalmic solution 0.5%: 1 or 2 drops into affected eye q6–8h
[Outline]
DISPOSITION
Admission Criteria
Consider admission in cases of severe decreased visual acuity, bilateral patching, or in situations when self-care and follow-up are difficult.
Discharge Criteria
Nearly all patients may be discharged from the ED following treatment with oral analgesics, topical antibiotics, cycloplegics, and/or patching:
- Lesions should heal completely in 24–72 hr.
FOLLOW-UP RECOMMENDATIONS
- Follow up with ophthalmologist within 24–48 hr to monitor healing and symptom resolution.
- Long-term UV damage to eye may result in pterygium and some forms of corneal degeneration, though association with UV keratitis episodes has not been demonstrated.
[Outline]
- Jacobs DS. Photokeratitis. In: Basow DS, ed. UpToDate. Waltham, MA: UpToDate, 2013.
- Marx JA, Hockberger RS, Walls RM. Chapter 22. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier/Saunders, 2014.
- Yen YL, Lin HL, Lin HJ, et al. Photokeratoconjunctivitis caused by different light sources. Am J Emerg Med. 2004;22:511–515.
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