Ultraviolet Keratoconjunctivitis, commonly known as welder's eye or tanning bed burn, causes eye pain and inflammation beginning 6-8 hours after unprotected exposure to intense UV light. Examination may show conjunctival redness and corneal staining. Treatment involves applying topical anesthetic for examination, antibiotic ointment with patching or cold compresses for 12 hours, along with oral pain medications. Prolonged use of topical anesthetics can slow healing and risks further injury, so pain medications should be provided instead of frequent anesthetic instillation. Symptoms usually resolve within 24 hours but an ophthalmologist should be consulted if pain persists.

1. Ultraviolet Keratoconjunctivitis (Welder's or
Tanning Bed Burn)
Presentation
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:
• 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:
• 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
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 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.