Treatment of Conjunctivitis Secondary to Welding Burns
For conjunctivitis secondary to welding burns, treatment should focus on artificial tears, topical antibiotics to prevent secondary infection, and pain management with cold compresses and oral analgesics. 1
Initial Management
- Immediate irrigation: The first step in treating a welding burn (ultraviolet keratitis/photokeratitis) is thorough irrigation of the eyes with cool water, saline, Ringer's lactate solution, or balanced salt solution to remove any potential chemical contaminants 1
- Cold compresses: Apply to reduce inflammation and provide symptomatic relief 2
- Artificial tears: Frequent application of preservative-free artificial tears helps lubricate the ocular surface and dilute inflammatory mediators 2
- Pain management: Oral analgesics such as acetaminophen or NSAIDs can help manage pain 2
Medication Management
Topical Antibiotics
- Apply topical antibiotic ointment such as bacitracin or erythromycin to prevent secondary bacterial infection of the damaged ocular surface 3, 4
- These antibiotics are indicated for "treatment of superficial ocular infections involving the conjunctiva and/or cornea" 3, 4
Topical Corticosteroids
- In severe cases with marked chemosis, lid swelling, or membranous conjunctivitis, a short course of topical corticosteroids may be beneficial 2, 5
- Use corticosteroids with poor ocular penetration (fluorometholone, rimexolone, or loteprednol) to minimize risk of elevated intraocular pressure or cataract formation 2
- Monitor patients on topical corticosteroids by periodically measuring intraocular pressure and pupillary dilation 2
- Taper corticosteroids once inflammation is controlled 2
Follow-up Care
- Patients with severe disease who have corneal epithelial ulceration or membranous conjunctivitis should be re-evaluated within 1 week 2
- Patients not treated with topical corticosteroids should return for follow-up if symptoms of red eye, pain, or decreased vision persist after 2-3 weeks 2
- Follow-up visits should include interval history, measurement of visual acuity, and slit-lamp biomicroscopy 2
Referral to Ophthalmologist
Refer patients to an ophthalmologist in the following circumstances:
- Visual loss
- Moderate or severe pain
- Severe purulent discharge
- Corneal involvement
- Conjunctival scarring
- Lack of response to therapy
- Recurrent episodes 2
Important Considerations and Pitfalls
- Avoid indiscriminate use of antibiotics: Only use when necessary to prevent secondary infection, as they can induce toxicity 2
- Monitor for corneal complications: Welding burns can lead to corneal epithelial defects that require close monitoring 2
- Rule out deeper ocular damage: Ensure the injury is limited to the conjunctiva and does not involve deeper ocular structures 1
- Patient education: Advise on proper eye protection for future welding activities to prevent recurrence 1
- Distinguish from other causes: Ensure symptoms are consistent with UV exposure (typically bilateral, delayed onset of symptoms after exposure) rather than chemical or thermal burns which may require different management 1
Most cases of welding flash burns heal within a few days with appropriate supportive care and prevention of secondary infection 1, 6.