Urgent Ophthalmology Referral Required
This patient requires immediate evaluation by an ophthalmologist, not an optometrist, due to suspected corneal injury (arc eye/welder's flash) that has not responded to initial treatment. 1
Why Ophthalmology, Not Optometry
Ophthalmologists possess the comprehensive medical training, diagnostic skills, and treatment capabilities necessary to manage potentially serious corneal injuries and their complications. 2 The American Academy of Ophthalmology guidelines explicitly state that ophthalmologists combine thorough understanding of ocular pathology, familiarity with systemic disorders, and clinical experience in diagnosis and treatment that makes them "the most qualified professional" for comprehensive medical eye evaluations. 2
Specific Red Flags in This Case
This patient meets multiple criteria requiring ophthalmology evaluation:
- Moderate or severe pain - welding-related injuries typically cause significant discomfort 2, 1
- Lack of response to therapy - the patient has tried eye drops without relief, indicating either inadequate treatment or more serious pathology 2, 1
- Potential corneal involvement - welding exposure causes ultraviolet keratitis (corneal epithelial damage) that requires slit-lamp examination and may reveal corneal infiltration or ulceration 1
Any patient with suspected corneal involvement, lack of response to initial therapy, or moderate-to-severe pain should be evaluated by an ophthalmologist. 1
Clinical Reasoning
Why This Is Urgent
Welding-related eye injuries can cause:
- Ultraviolet keratitis (arc eye/welder's flash) - typically presents 6-12 hours after exposure with severe pain, photophobia, tearing, and foreign body sensation
- Corneal abrasions or foreign bodies - metallic particles can embed in the cornea
- Corneal ulceration - if infection develops, this requires daily follow-up 2
- Permanent corneal scarring - if inadequately treated
What the Ophthalmologist Will Do
The ophthalmologist will perform:
- Slit-lamp biomicroscopy - essential for detecting corneal epithelial defects, foreign bodies, infiltrates, or early ulceration 1
- Fluorescein staining - reveals corneal epithelial damage
- Eversion of upper eyelid - to check for retained foreign bodies
- Appropriate medical management - may include topical antibiotics (if abrasion present), cycloplegics for pain relief, and close follow-up 1
Common Pitfall to Avoid
Do not assume "lubricating eye drops" are adequate treatment for post-welding eye pain. 1 While the patient may have been using over-the-counter artificial tears, welding injuries often require:
- Topical antibiotics to prevent infection in corneal abrasions
- Cycloplegic agents for pain control
- Possible removal of corneal foreign bodies
- Close monitoring for complications
Starting treatment without proper examination can delay diagnosis of serious conditions and worsen outcomes. 2, 1
Timeframe for Referral
This patient should be seen within 24 hours, ideally same-day. 1 While not requiring emergency department evaluation unless vision loss is present, welding injuries with persistent pain warrant urgent ophthalmology assessment to prevent complications. 1
The distinction between optometry and ophthalmology is critical here: optometrists can identify many eye conditions, but ophthalmologists have the medical training to manage corneal injuries, prescribe appropriate medications, and perform procedures if needed (such as foreign body removal). 2