What are the treatments for photokeratitis?

Treatment of Photokeratitis

Photokeratitis is a self-limited condition that should be treated with topical antibiotics and lubricating agents, with complete resolution typically occurring within 48 hours. 1, 2

Immediate Management

Core Treatment Regimen

• Topical broad-spectrum antibiotics are the primary treatment to prevent secondary bacterial infection while the corneal epithelium heals 1, 2

  • Fluoroquinolones such as ofloxacin or moxifloxacin are appropriate choices given their broad coverage 3, 4
  • Treatment should be initiated promptly, ideally within 24 hours of injury, as this timing has been shown to prevent corneal ulceration 3, 4

• Lubricating agents (artificial tears) provide symptomatic relief and support epithelial healing 1

• Agents with healing properties may accelerate corneal epithelial recovery 1

Important Treatment Considerations

Avoid eye patching or bandage contact lenses in photokeratitis cases, as these interventions increase the risk of secondary bacterial keratitis 5, 3

The rationale for antibiotic prophylaxis is clear: photokeratitis creates punctate epithelial erosions that represent breaks in the corneal barrier, similar to traumatic corneal abrasions 1, 2. The American Academy of Ophthalmology specifically recommends prophylactic topical antibiotics for corneal abrasions to prevent progression to bacterial keratitis 3, 4.

Clinical Course and Follow-up

Expected Timeline

• Symptoms typically appear 4-6 hours after UV exposure 2
• Complete resolution of corneal epithelial defects occurs within 2 days with appropriate treatment 1, 2
• Visual acuity returns to baseline (10/10) once epithelial healing is complete 1

Monitoring Parameters

• Follow-up examination at 48 hours to confirm complete epithelial healing 1, 2
• Patients should be instructed to return immediately if symptoms worsen, as this could indicate secondary bacterial infection 5

Prevention Counseling

Patient education about UV protection is essential to prevent recurrence 1. This includes:

• Use of appropriate UV-protective eyewear during high-risk activities (welding, high-altitude activities, snow sports, theatrical lighting exposure) 1, 2
• Recognition that photokeratitis can occur from various UV sources including arc welding, high-power theatrical lamps, and natural sunlight reflection 1, 2

Key Clinical Pitfalls

While topical corticosteroids are sometimes used in corneal disease, there is inadequate evidence supporting their use in photokeratitis 6. The condition is self-limited and responds well to conservative management without steroids 1, 2.

The distinction between photokeratitis and bacterial keratitis is critical: photokeratitis presents with bilateral punctate epithelial erosions limited to the palpebral fissure zone after known UV exposure, whereas bacterial keratitis typically presents with unilateral infiltrate and suppuration 5, 1.