2.09 Ultraviolet Keratoconjunctivitis 
(Welder's or Tanning Bed Burn)
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agk's Library of Common Simple Emergencies

Presentation
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The patient arrives with burning eye pain, 
usually bilateral, beginning 6 to 8 hours after 
a brief exposure without eye protection to a 
high intensity ultraviolet light source such as 
a sunlamp or welder's arc. The eye exam shows 
conjunctival injection; fluorescein staining 
may be negative or show diffuse superficial 
uptake (discerned as a punctate keratopathy 
under slit lamp examination). The patient may 
also have first-degree skin burns.

What to do:
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- Apply topical anesthetic ophthalmic drops 
   (once, to permit exam).
- Perform a complete eye exam (visual acuity, 
   funduscopic, anterior chamber bright light, 
   fluorescein, inspection of conjunctival 
   sacs).
- Instill an antibiotic ointment and patch eyes 
   for approximately 12 hours. Cold compresses, 
   rest, and analgesics (oxycodone, codeine, 
   ibuprofen, naproxen) should be prescribed to 
   control pain. The first dose can be given in 
   the ED.
- Warn the patient that pain will return when 
   the local anesthetic wears off, but that the 
   pills prescribed should help to relieve it.

What not to do:
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- Do not give the patient a topical anesthetic 
   for continued instillation. It can slow 
   healing and increases the risk of eye 
   injury.
- Do not be stingy with pain medications. This 
   is a painful, albeit short-lived injury.

Discussion
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The history of a brief exposure may be 
difficult to elicit after the long asymptomatic 
interval. Longer exposures to lower intensity 
UV sources may resemble a sunburn. Some 
physicians find it quite acceptable to 
substitute for the antibiotic ointment a 
one-time instillation of an ophthalmic 
anesthetic ointment (Tetracaine), which allows 
longer-lasting topical anesthesia. Some 
patients do not tolerate bilateral patching 
(they may have to get home alone). Cold 
compresses may be substituted for patches. 
Healing should be complete in 12-24 hours. If 
the patient continues to have discomfort, an 
ophthalmologist should be consulted.

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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