Pictorial case study

Contributed by Dr Jean Watkins, a retired GP in Hampshire.

The case
This young man complained of watering, redness and pain in both eyes, blurred vision, photophobia and blepharospasm. The previous night he had been repairing a car using a welder, but he did not wear a protective mask. Some hours later, he was woken by these distressing symptoms.

Diagnosis and management
The symptoms were typical of arc eye following exposure to UVB, direct or reflected from snow, water or tanning lamps or UVC found in artificial sources such as mercury arc and germicidal lamps.

Symptoms can develop within six to 12 hours of exposure and normally settle within two days. Both eyes are usually affected, the pupils are constricted and, after staining with fluorescein, some corneal ulceration may be noted.

To examine the eye, it may be necessary to instil a topical anaesthetic such as oxybuprocaine into the eye. An oral analgesic such as ibuprofen may be helpful and, occasionally, an ophthalmologist may offer steroid eye drops to reduce inflammation and avoid potential scarring in severe cases.

Dark glasses or an eye patch should be used to reduce glare and further exposure. A topical antibiotic may be prescribed as a prophylactic measure against secondary infection. The patient must also be reminded of the importance of protecting the eyes where excess glare could cause problems.

Possible differential diagnoses

  • Bacterial conjunctivitis
  • Acute viral keratoconjunctivitis
  • Overuse of contact lenses
  • Foreign body in the eye
  • Dry eye

Differential diagnosis
Foreign body in the eye

  • Often just one eye affected.
  • Dust, sand or other matter may rest in the conjunctival sac and may easily be seen by pulling down the lower lid or everting the upper lid.
  • Objects that hit the eye at high speed may embed in the cornea or occasionally penetrate deeper in the eye.
  • Patients complain of pain and watering in the eyes.
  • Staining with fluorescein will indicate any corneal damage or ulceration.
  • Foreign bodies may be wiped off with a moist cotton wool bud or may need topical local anaesthetic before removal using a sterile needle under slit lamp control.
  • Refer to eye clinic if foreign body cannot be removed, if patient is in severe pain, if vision is affected or for chemicals in the eye.
  • After removal prescribe antibiotic eye drops.

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