What is the treatment for photo conjunctivitis?

Treatment for Photokeratitis/Photoconjunctivitis

The primary treatment for photoconjunctivitis (UV-induced conjunctivitis) involves immediate removal from UV exposure, cool compresses, preservative-free lubricating eye drops, and pain management, with most cases resolving within 24-48 hours without permanent damage. 1

Pathophysiology and Clinical Presentation

Photokeratitis/photoconjunctivitis occurs when the cornea and conjunctiva are exposed to excessive ultraviolet radiation, most commonly from:

• Solar exposure (snow blindness)
• Artificial UV sources (welding arcs, tanning beds, laboratory UV lights)
• Reflected UV radiation from snow, water, or sand

Symptoms typically appear 6-12 hours after exposure and include:

• Severe eye pain and foreign body sensation
• Photophobia
• Excessive tearing
• Conjunctival injection (redness)
• Eyelid swelling
• Blurred vision
• Blepharospasm (eyelid spasm)

Treatment Algorithm

First-Line Management

1. Remove from UV exposure immediately
2. Cool compresses to reduce inflammation and provide symptomatic relief
3. Preservative-free lubricating eye drops (artificial tears) every 1-2 hours to soothe the ocular surface and dilute inflammatory mediators 2
4. Pain management:
   • Oral analgesics (acetaminophen or NSAIDs)
   • Topical NSAIDs may be considered for severe pain

Additional Treatments for Moderate to Severe Cases

1. Cycloplegic agents (e.g., cyclopentolate) for ciliary spasm and pain relief in severe cases
2. Antibiotic ointment may be used prophylactically if epithelial defects are present to prevent secondary infection 3
3. Autologous serum eye drops (20% concentration) can be considered for cases with significant corneal nerve damage to promote neuroregeneration 3
4. Short-term topical steroids (e.g., loteprednol 0.5%) may be used in severe cases with significant inflammation, but only under close ophthalmologic supervision 3

Contraindicated Treatments

• Topical anesthetics for prolonged use (can delay healing and mask worsening symptoms)
• Long-term steroid use without ophthalmologic supervision (risk of increased intraocular pressure, cataract formation, or delayed healing)

Follow-up and Monitoring

• Most cases resolve within 24-48 hours without permanent damage
• Follow-up within 24-48 hours for severe cases or if symptoms worsen
• Monitor for:
  • Corneal epithelial healing
  • Development of secondary infection
  • Persistent visual disturbances

Special Considerations

Contact Lens Wearers

• Discontinue contact lens wear until complete resolution of symptoms and signs
• Consider new lenses after recovery to prevent contamination
• Review contact lens fit, type, and care regimen before resuming wear 2

Prevention Strategies

• Proper eye protection when exposed to UV sources (welding, tanning, snow activities)
• UV-blocking sunglasses with side shields
• Wide-brimmed hats for additional protection
• Awareness of high-risk environments (high altitude, snow, water)

Long-term Complications

Chronic UV exposure may contribute to:

• Pterygium
• Climatic droplet keratopathy
• Increased risk of ocular surface squamous neoplasia 4

When to Refer to Ophthalmology

• Visual acuity does not return to baseline within 48-72 hours
• Persistent corneal epithelial defects
• Signs of corneal infection
• Severe pain unresponsive to conventional treatment
• History of recurrent episodes

Photoconjunctivitis is typically self-limiting with appropriate supportive care, and most patients recover completely without long-term visual impairment when properly managed.