What is the management for a patient with no pre-existing eye conditions or medications, experiencing a burning sensation in the eyes when exposed to sunlight?

Management of Burning Sensation in Eyes When Under the Sun

Immediate Sun Protection Measures

For a patient with no pre-existing eye conditions experiencing burning eyes in sunlight, the primary management is comprehensive UV protection through sunglasses, artificial tears, and behavioral modifications.

Essential Eye Protection

• Wear UV-blocking sunglasses with specific features: large eye size with side protection, less than 1% UV-B transmittance, less than 1% UV-A transmittance, gray or near-neutral colored lenses, and good optical quality 1
• Use a wide-brimmed hat or cap in addition to sunglasses for maximum protection from ultraviolet radiation 1
• Avoid sun exposure between 10 AM and 4 PM when UV radiation is most intense 2
• Apply UV-blocking window films in vehicles if driving during peak hours to prevent exposure through glass 2

The burning sensation is caused by acute UV radiation damage to the ocular surface, which can lead to photokeratitis and contribute to long-term conditions like cataracts and macular degeneration 3, 4. Dark lenses with category 2 protection rating are specifically recommended in areas with high sun exposure 5.

Symptomatic Relief

• Use artificial tears (ocular lubricants) for temporary relief of burning, irritation, and discomfort due to sun exposure 6
• Apply refrigerated artificial tears for additional cooling sensation and symptomatic relief 7
• Use cold compresses to reduce acute discomfort 7

Artificial tears are FDA-approved specifically for burning and irritation due to sun exposure and can be used as a protectant against further irritation 6.

When to Seek Ophthalmology Evaluation

While simple burning with sun exposure typically responds to the above measures, certain red flags require immediate ophthalmology referral:

• Severe photophobia with vision changes 8
• Mid-dilated or poorly reactive pupil 8
• Persistent symptoms despite adequate UV protection 8
• Development of corneal epithelial defects (would show with fluorescein staining) 7

Common Pitfalls to Avoid

• Do not underestimate the importance of side protection on sunglasses - UV radiation enters from peripheral angles, not just directly 1
• Do not assume all sunglasses provide adequate UV protection - consult with an eye care specialist to verify UV-blocking specifications 1
• Do not ignore chronic symptoms - long-term sunlight exposure contributes to pterygium, cataracts, and macular degeneration even if acute symptoms seem minor 3, 4
• Do not use only sunscreen without physical barriers - eyes require specific UV-blocking eyewear, not just facial sunscreen 2

Special Considerations

• Young children and aphakic patients (those without natural lens) are at highest risk for UV damage as their lenses readily transmit ultraviolet light 3
• Patients on photosensitizing medications (tetracyclines, fluoroquinolones, NSAIDs, thiazide diuretics) may experience exaggerated symptoms and should be especially vigilant about sun protection 2
• Incremental sun exposure of 5-30 minutes per day (depending on individual factors) with eyes closed or protected is recommended to balance vitamin D benefits while minimizing UV damage 9