Welder's Burn to the Eye (Photokeratitis)
Welder's burn to the eye, also known as photokeratitis or ultraviolet keratitis, is a painful corneal condition caused by exposure to ultraviolet (UV) radiation that damages the corneal epithelium, typically from welding arcs without proper eye protection. 1
Pathophysiology
Photokeratitis occurs when unprotected eyes are exposed to intense UV radiation, which causes photochemical injury to the corneal epithelium. The UV rays emitted during welding processes (particularly from electric arcs) are absorbed by the cornea, resulting in:
- Damage to the superficial corneal epithelial cells
- Inflammation of the conjunctiva
- Punctate epithelial erosions typically limited to the palpebral fissure 2
Clinical Presentation
Symptoms typically develop several hours after exposure and include:
- Intense ocular pain and burning sensation
- Excessive tearing (lacrimation)
- Photophobia (light sensitivity)
- Blepharospasm (eyelid spasm)
- Foreign body sensation
- Conjunctival hyperemia (redness)
- Decreased visual acuity 2, 3
The delay between exposure and symptom onset (typically 6-12 hours) is characteristic of photokeratitis and often leads patients to seek care at night or early morning after welding exposure during the day.
Diagnosis
Diagnosis is primarily clinical, based on:
- History of recent UV exposure (welding without proper eye protection)
- Characteristic symptom onset several hours after exposure
- Bilateral involvement in most cases
- Fluorescein staining revealing punctate corneal erosions 2
Treatment
Treatment is supportive as the condition is typically self-limiting and resolves within 24-72 hours 3. Management includes:
- Topical antibiotics to prevent secondary infection
- Lubricating eye drops to provide comfort and promote healing
- Cycloplegic agents may be used for pain relief in severe cases
- Cold compresses for symptomatic relief
- Oral analgesics for pain management
- Patching is generally not recommended as it may delay healing 2
Prognosis
Photokeratitis is usually self-limiting with complete resolution within 24-72 hours without permanent visual impairment 3. Visual acuity typically returns to normal once the corneal epithelium has healed.
Prevention
Prevention is crucial and includes:
- Proper eye protection with appropriate welding helmets/goggles with UV-filtering lenses
- Education about the risks of UV exposure during welding
- Ensuring proper functioning of protective equipment
- Avoiding looking directly at welding arcs, even briefly 2, 4
Complications
While most cases resolve without sequelae, potential complications include:
- Secondary bacterial infection
- Recurrent corneal erosion syndrome in severe cases
- Rarely, deeper corneal damage with prolonged exposure
Important Distinctions
It's important to distinguish photokeratitis (affecting the cornea) from retinal burns, which can occur from visible and near-infrared radiation that penetrates deeper into the eye. Retinal burns, particularly from MIG (metal-arc inert gas) welders, can cause permanent vision damage and are a separate clinical entity 5.
When to Refer
Urgent ophthalmology referral is indicated if:
- Symptoms persist beyond 72 hours
- Visual acuity does not improve
- Signs of corneal infection develop
- Deep corneal involvement is suspected