What is the management for welding light exposure to the eyes with noted swelling?

Management of Welding Light Exposure to Eyes with Swelling

Immediately irrigate the eyes with copious amounts of tap water for at least 15 minutes, then seek urgent ophthalmologic evaluation for this photokeratitis (arc eye) injury. 1

Immediate First Aid Management

Decontamination by irrigation should be performed immediately after any ocular exposure. 1 While welding light exposure is not a chemical injury, the immediate cooling and flushing effect helps reduce inflammation and removes any particulate matter.

• Irrigate with copious tap water for 15 minutes minimum 1
• Normal saline, Ringer's lactate, or commercial eye wash solutions are reasonable alternatives if immediately available 1
• Avoid contaminating the unaffected eye during irrigation 1
• Some patients may need assistance maintaining open eyelids during irrigation 1

Clinical Recognition and Assessment

Welding light exposure causes photokeratitis (arc eye), a painful keratitis from ultraviolet radiation exposure to insufficiently protected eyes. 2 The condition presents with:

• Bilateral burning pain, lacrimation, photophobia, and blepharospasm 2
• Conjunctival hyperemia with punctate erosive keratitis limited to the palpebral fissure 2
• Symptoms typically appear several hours after exposure 3
• Corneal edema and swelling are expected findings 1

Arc welding is particularly dangerous - welders' average ocular exposures are 4-5 times the maximum permissible exposure limit even with helmets, and ambient UV levels in welding environments exceed safe limits by 5.5 times. 4

Definitive Medical Treatment

Once the patient reaches medical care, treatment consists of:

• Topical antibiotics to prevent secondary infection 2
• Wetting agents (artificial tears) for lubrication 2
• Agents with healing properties (such as topical NSAIDs or cycloplegics for pain relief) 2
• Topical 0.01% dexamethasone paste and 0.1% chlorhexidine gargling solution to reduce inflammation 1

For severe pain:

• Compound benzocaine gel can be applied topically 1
• Oral analgesics (acetaminophen or NSAIDs) 5

Expected Outcome and Follow-up

Total resolution with restoration of normal visual acuity is expected within 24-48 hours with appropriate treatment. 2 The prognosis for acute photokeratitis is excellent, though chronic exposure without protection causes permanent ocular disorders including cataracts, corneal opacity, and pterygium. 3

Critical Pitfalls to Avoid

• Do not delay irrigation - immediate decontamination is essential even though this is radiation rather than chemical injury 1
• Do not assume mild symptoms mean no injury - UV damage may not manifest fully for several hours after exposure 3
• Ensure ophthalmologic follow-up to assess for corneal abrasions, ulceration, or deeper injury that may not be apparent initially 1
• Screen for concurrent thermal or metallic foreign body injury - high-speed molten metal droplets are a principal hazard in welding 6

Prevention Counseling

Conventional welding helmets alone are insufficient - welders require additional ocular protection to supplement helmets, and any exposed skin should be protected. 4 Arc welding produces significantly more ocular hazards than carbide welding. 3