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

Primary Management of Photosensitivity with Burning Eyes

For a patient with no pre-existing eye conditions experiencing photosensitivity and burning eyes from sunlight, immediately implement comprehensive sun protection measures including broad-spectrum SPF ≥30 sunscreen, protective clothing with broad-brimmed hat, and strict avoidance of sun exposure between 10 AM-4 PM, while simultaneously reviewing and discontinuing any photosensitizing medications. 1, 2

Immediate Actions

Medication Review and Discontinuation

• Immediately discontinue all potentially photosensitizing medications including tetracyclines, fluoroquinolones, NSAIDs, thiazide diuretics, cardiovascular medications, and antidepressants if drug-induced photosensitivity is suspected 1
• Avoid psoralen-containing plants and foods for at least 2 hours before any sun exposure 1

Sun Protection Protocol

• Apply broad-spectrum sunscreen with SPF ≥30 to all exposed skin areas, including hands and face, reapplying every 2-3 hours during prolonged outdoor exposure 3, 1, 2
• Wear protective clothing: long-sleeved shirts, long pants, and broad-brimmed hats 1, 2
• Strictly avoid sun exposure between 10 AM and 4 PM when UV radiation is most intense 1, 2
• Use UV-blocking window films in vehicles if driving during peak hours 1

Eye-Specific Protection

While the guidelines primarily address PUVA-related eye protection, the principles apply to general photosensitivity with ocular symptoms:

• Wear UVA-protective eyewear with side shields when outdoors or near windows, as UVA penetrates window glass 3
• Protect eyes from ultraviolet light exposure to prevent potential long-term complications 3

Diagnostic Workup

Clinical Assessment

• Document timing and pattern of reactions, specific triggers, distribution of affected areas, and associated symptoms 2
• Evaluate ocular involvement including photophobia and conjunctival injection 2
• Perform detailed medication review as many drugs cause photosensitivity 2

Laboratory and Specialized Testing

• Obtain basic laboratory studies: complete blood count with differential and comprehensive metabolic panel 2
• Refer to dermatology for phototesting including minimal erythema dose determination for UVA and UVB 2
• Consider ophthalmology referral for comprehensive eye examination if ocular symptoms persist 2

Common Pitfalls to Avoid

• Do not underestimate delayed photosensitivity reactions, which may not manifest immediately after sun exposure 4, 5
• Avoid assuming all sunscreens provide adequate UVA protection; ensure "broad-spectrum" labeling 3, 1
• Do not overlook indoor fluorescent lighting as a potential trigger, particularly for UVA-sensitive patients 6
• Do not use topical calcineurin inhibitors concurrently with phototherapy if this treatment becomes necessary 3, 1

Monitoring and Follow-Up

• Encourage patient self-examination for new or changing skin lesions 1
• Annual full-body skin examinations by a dermatologist are recommended for all patients with chronic photosensitivity 1
• Monthly skin examinations during any active phototherapy if this treatment modality is eventually required 1

When Conservative Measures Fail

If photoprotection and medication discontinuation are insufficient:

• Consider prophylactic phototherapy with narrowband UVB (preferred first-line) or PUVA for several weeks during spring 7
• For solar urticaria specifically, non-sedating antihistamines such as fexofenadine or cetirizine may be beneficial 7
• Specialized management in a dermatology unit experienced with photodermatoses may be necessary 3