Photophthalmia

Photophthalmia is produced due to exposure to short wavelength ultraviolet (UV) rays (especially in wavelength range of 311- 290 nanometer). The cornea absorbs ultraviolet radiation. This may be associated with

  • Exposure of naked eye to arc light: This may be seen in cases exposed to industrial welding. It is also seen in cinema operators.
  • Snow blindness: It is produced by reflected ultraviolet rays from snow surface.
  • Short circuiting: This is due to exposure to bright light being produced on short circuiting.

The essential change is the desquamation of corneal epithelium resulting in multiple erosions.

 

References

Nema HV, Nema Nitin. Textbook of Ophthalmology Sixth Edition. Jaypee Brothers Medical Publishers (P) Ltd 2012. P 157.

Sihota Ramanjit, Tandon Radhika. Parson’s Diseases of the Eye Twenty-second Edition. Reed Elsevier India Private Limited 2015. P 220.

Kunnamo Ilkka. Evidence-Based Medicine Guidelines. John Wiley & Sons Ltd 2005. P 1211.

Ahmed E. Comprehensive Manual of Ophthalmology. Jaypee Brothers Medical Publishers (P) Ltd 2011. P 326.

Khurana AK. Comprehensive Ophthalmology Sixth Edition. Jaypee Brothers Medical Publishers (P) Ltd 2015. P 28.

Symptoms of photophthalmia usually manifest with a latent period of about 4- 5 hours after exposure to ultraviolet rays. It includes

  • Extreme burning pain.
  • Intense foreign body sensation.
  • Lacrimation or watering.
  • Redness.
  • Marked photophobia (aversion to light).
  • Blepharospasm (abnormal contraction of eyelid muscles).
  • Swelling of palpebral conjunctiva.


The symptoms disappear in about 1- 2 days following healing of corneal desquamation.

Photophthalmia may be caused due to exposure to short wavelength

  • Exposure of naked eye to exposed arc light: This may be seen in cases exposed to industrial welding. It is also seen in cinema studios. It is rarely due to exposure to enclosed arc light since the glass globe absorbs the most deleterious light rays.
  • Snow blindness: It is produced by reflected ultraviolet rays from snow surface. In snow blindness, the cause is similar, since the ultraviolet rays are reflected from snow surfaces. Snow reflects 85% of ultraviolet radiations, increasing the radiation exposure of cornea. The higher the altitude, more ultraviolet radiation is absorbed because the radiation traverses the thin air easily.
  • Short circuiting: This is due to exposure to bright light being produced on short circuiting.

The essential pathology is the desquamation of corneal epithelium resulting in multiple erosions.

Diagnosis depends upon the clinical history and signs observed on examination.

The symptoms in eye appear characteristically after a latent period of 4- 5 hours of exposure to ultra-violet light. There is intense burning pain, foreign body sensation, and watering of eyes. There is associated marked photophobia and blepharospasm.

On slit-lamp examination, corneal epithelium shows breach in continuity of epithelium which takes up fluorescein sodium stain. In severe cases, the epithelium of the cornea is detached, which may result in corneal erosion. There is conjunctival erythema (redness). There may be presence of retro-tarsal folds.

Management should be carried out under medical supervision.

General prophylactic therapy:

Prophylactic therapy consists of wearing dark glasses when exposure is anticipated. Material such as Crookes glass may be used, since it cuts off nearly all the ultraviolet and infrared rays.

 

Medical therapy:

It comprises of

  • Cold compresses.
  • Lubricant eye drops.
  • Bandaging both eyes for 24 hours after putting antibiotic eye ointment and cycloplegic (which puts ciliary muscle to rest) eye drops may provide relief from the severe pain.  It also allows epithelium to regenerate/grow over the eroded areas.

Local surface topical anaesthesia to the eye should be avoided.

  • PUBLISHED DATE : Apr 27, 2017
  • PUBLISHED BY : DEEPAK CHANDRA
  • CREATED / VALIDATED BY : Dr. S. C. Gupta
  • LAST UPDATED ON : Apr 27, 2017

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