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Photokeratits: A painful burn to the eye preventable with a few simple precautions

January 10, 2013

Hershel R Patel, BS MSa and Robert J. Applebaum, MD MBAb


a University of South Florida College of Medicine Tampa, FL
b University of South Florida Department of Ophthalmology Tampa, FL
In early December 2012, on his talk show Anderson Live, Anderson Cooper informed his viewing audience of an episode of "eye burn" that he suffered during a recent trip to Portugal. While filming an episode of 60 minutes on the water, Mr. Cooper exposed his eyes to the sun for a prolonged period of time without wearing protective eyewear. The damage to his eyes that resulted from this exposure caused temporary blindness for a period of 36 hours. He described the episode as waking up in the middle of the night feeling as if his eyes were on fire causing him to douse his eyes with water.

This "eye burn" Mr. Cooper experienced is known to ophthalmologists and other health professionals by several names, including photokeratitis, photoconjunctivitis, arc eye, welders flash, corneal flash burns, and keratoconjunctivitis photoelectrica. Prolonged exposure to ultraviolet light, whether natural or artificial, causes damage to the outer layer of cells, known as epithelial cells, on the central, clear part of the front of the eye, known as the cornea. Commonly, a 6-12 hour latency period exists between exposure and symptom onset. However, this latency period can be as short as one hour. Acute UVB exposure causes inflammation and apoptosis (basically, cellular suicide) in the cornea. When these processes occur, people commonly report sensitivity to bright light, pain, and excessive tearing. This problem is so painful because when the epithelial cells that cover and protect the cornea are damaged, raw nerve cells, known as sub-epithelial axons, are exposed. These unprotected nerve endings constantly transmit pain signals to the brain until the corneal epithelial cells are able to repopulate and once again cover them.

Anesthetic eye drops do provide relief from the pain while an ophthalmologist or optometrist is examining a patient. However, these drops cannot be prescribed to patients because they are damaging to cornea epithelial cells and prolonged use will interfere with the corneal healing process. Avoidance of contact lenses, cold/wet compresses over the eyes, artificial tears, and eye rest are often recommended to patients for pain relief. NSAID (Non Steroidal Anti Inflammatory Drug) eye drops can also be used to decrease inflammation and pain. Another obvious recommendation is to avoid ultraviolet light, the source of the "eye burn." The patient should also be told to take precautions to protect his or her eyes from UV light once healing is complete.

Corneal healing is usually rapid and takes 24-72 hours; however, some people experience light sensitivity (photophobia) and mild blurring of light for up to a week. Although the human eye is resilient, multiple episodes of photo keratitis and/or long-term exposure to UV light with or without symptoms may increase the risk of developing other eye issues. These issues include cataracts, various cancers of the lids or of the eye itself, and benign (non-cancerous) growths on the surface of the eye with potential to block vision known as pterygia.

At first glance, an "eye burn" may seem like an extremely unusual occurrence. It is important for the reader to keep in mind that there is no such thing as a sunscreen eye drop. While in the sun, individuals do not have anything other than protective eyewear to shield them from harmful UV rays (even though scientists have tried antioxidant/chromophore eye applications in mice/rabbits). Therefore, it is essential that everyone, especially individuals with a fair complexion and lightly colored eyes, wear appropriately protective eyewear that blocks both UVA and UVB radiation. Individuals should also wear a hat with a generous brim to protect the eyes from UV rays entering from the side. Those individuals hitting the slopes this winter should also be sure to wear UV protective goggles to prevent another form of "eye burn" known as snow blindness.

Most importantly, if you think you have an "eye burn," be sure to schedule an appointment with your ophthalmologist or optometrist as soon as possible for evaluation and possible treatment as necessary.

References

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Walsh JE, Bergmanson JP, Wallace D, Saldana G, Dempsey H, McEvoy H, Collum LM. Quantification of the ultraviolet radiation (UVR) field in the human eye in vivo using novel instrumentation and the potential benefits of UVR blocking hydrogel contact lens. Br J Ophthalmol. 2001 Sep;85(9):1080-5.

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