What is the treatment for welder's flash (photokeratitis)?

Treatment for Welder's Flash (Photokeratitis)

The treatment for welder's flash (photokeratitis) includes lubricating eye drops, topical antibiotics to prevent secondary infection, pain management, and discontinuation of contact lens use until the cornea returns to normal. 1

Understanding Welder's Flash

Welder's flash, also known as "arc eye," is a form of photokeratitis caused by exposure to intense ultraviolet radiation from welding arcs. This condition is particularly common among electric arc welders, where inadvertent exposure occurs frequently enough that the terms "arc eye" or "welders flash" are commonly used to describe the resulting photokeratitis 2.

Treatment Protocol

Immediate Management

• Apply lubricating eye drops to soothe the irritated corneal surface 3
• Administer topical broad-spectrum antibiotics to prevent secondary bacterial infection, particularly if there is any corneal epithelial damage 3, 1
• Prescribe oral pain medications as needed for discomfort 3
• Avoid patching the eye, especially in contact lens wearers, as this increases the risk of secondary bacterial keratitis 3

Antibiotic Selection

• A 5-7 day course of a broad-spectrum topical antibiotic (such as ofloxacin) should be prescribed, particularly if treatment is started within 24 hours of the injury 1
• Prophylactic topical antibiotics following corneal injury have been shown to prevent ulceration when treatment is started promptly 3, 1

Additional Measures

• If the patient wears contact lenses, discontinue use until the cornea returns to normal 3
• Cold compresses may provide symptomatic relief 3
• Artificial tears can be used frequently to lubricate the eye 3
• For severe pain, cycloplegic agents may be considered to reduce ciliary spasm 3

Follow-Up Care

• Patients should have a follow-up visit within one week of treatment, consisting of an interval history, visual acuity measurement, and slit-lamp biomicroscopy 3
• Most cases resolve within 24-72 hours without permanent damage 4

Prevention

• Proper eye protection with appropriate UV-filtering lenses or face shields should be worn during welding activities 2, 5
• Eye protection should be worn constantly while working with metal pieces, not just during active welding 6
• Education about the risks of UV exposure during welding is essential 5

Important Considerations and Pitfalls

• Do not confuse photokeratitis with infectious keratitis, which would require more aggressive antibiotic treatment 3
• Avoid using corticosteroids for simple photokeratitis as they may delay healing and increase the risk of infection 3
• If symptoms persist beyond 72 hours or worsen despite treatment, re-evaluate for possible complications or misdiagnosis 3
• While rare, repeated UV exposure from welding can potentially contribute to long-term ocular surface damage 5
• If moderate or severe pain persists, consider other diagnoses such as microbial keratitis 3