Management of Welding Flash Burns (Photokeratitis)
For welding flash burns causing blurred vision and foreign body sensation, immediately irrigate the eyes with sterile saline or commercial eyewash solution, apply topical antibiotics, provide pain management with NSAIDs, and avoid rubbing the eyes. 1, 2
Initial Management
- Do not allow the patient to rub their eyes as this can cause further damage by potentially causing corneal abrasion 1
- Irrigate the eyes with sterile saline or commercial eyewash solution to flush out any potential loose foreign material 2
- Apply a broad-spectrum topical antibiotic (e.g., moxifloxacin drops four times daily) as prophylaxis to prevent secondary infection 2
- Consider using a topical NSAID such as ketorolac tromethamine ophthalmic solution for pain relief, which can significantly decrease pain, photophobia, and foreign body sensation 2
- Oral analgesics such as acetaminophen or NSAIDs can be used for additional pain relief 2
- Apply a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent unintentional touching or rubbing 1
Understanding Welding Flash Burns (Photokeratitis)
- Welding flash burns are caused by exposure to ultraviolet radiation emitted by welding arcs, resulting in photokeratitis or "arc eye" 3, 4
- Symptoms typically include blurred vision, foreign body sensation, pain, lacrimation, photophobia, and blepharospasm 4
- The condition is characterized by punctate erosive keratitis limited to the palpebral fissure, which can be visualized using fluorescein staining 4
- The ultraviolet radiation primarily affects the corneal epithelium, causing temporary but painful damage 5
Advanced Management Options
- For severe pain from ciliary spasm, consider cycloplegic agents (e.g., cyclopentolate) to decrease anterior segment inflammation 2
- For persistent symptoms or severe cases, a bandage contact lens may be considered, though this requires antibiotic prophylaxis and close monitoring 6
- When using a bandage contact lens, patients should be informed of the risk of infectious keratitis and instructed to contact their ophthalmologist if redness, pain, or increased photophobia develops 6
- For temporary relief of corneal edema, the hyperosmotic effect of topical sodium chloride 5% drops or ointment may be helpful 6
When to Seek Immediate Ophthalmological Referral
- Persistent symptoms despite initial treatment 1
- Suspicion of corneal penetration or intraocular foreign body 2
- Irregular pupil, eye bleeding, or significant vision loss after the injury 1
- Signs of infection such as increasing pain, redness, or purulent discharge 6
- Concern for potential retinal damage, which can occur from visible and near-infrared radiation that penetrates to the retina 3, 7, 8
Prevention of Future Incidents
- Always use appropriate eye protection when welding, even for brief periods 8
- Proper eye protection should include welding helmets with appropriate filtering lenses 3
- Educate patients about the risks of UV exposure during welding and the importance of protective equipment 4
Common Pitfalls to Avoid
- Rubbing the eyes can cause further damage by potentially causing corneal abrasion 1
- Ignoring persistent symptoms, which may indicate more serious damage or secondary infection 1
- Failure to consider potential retinal damage in addition to corneal injury, especially with MIG welding which may pose a greater threat to sight 3, 8
- Using eye patches, which are no longer recommended for corneal abrasions 2