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July 2012

 
What Is This Month's Mystery Condition?
Written by Seema Garg, MD, PhD, and Matej Polomsky?, MD, University of North Carolina at Chapel Hill. Edited by Michael P. Kelly, FOPS.

Photo by Debra Cantrell, COA, University of North Carolina at Chapel Hill.
 
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July 2012 Blink

Ultraviolet Keratitis

A 66-year-old man presented with sudden bilateral eye pain and decreased vision 12 hours after repairing a defective ultraviolet light box at work. He had decided not to use protective eyewear because the estimated time of exposure was less than one minute. Visual acuity had decreased to 20/60 in both eyes.

Slit-lamp examinations (1A and 1B) of the left eye demonstrated bilateral conjunctival injection in the interpalpebral fissure and diffuse punctate epithelial erosions. The patient was treated conservatively with topical lubricating ointment.  

By the following day, the pain had completely resolved, and the visual acuity improved to 20/30 in both eyes. Repeat examination (2A and 2B) was consistent with almost complete resolution of the bilateral conjunctival injection and punctate epithelial erosions.

The diagnosis was ultraviolet keratitis. The brief exposure to ultraviolet light caused significant conjunctival and corneal epithelial cell loss in the interpalpebral fissure, leading to symptoms of severe pain and decreased vision. Notably, the portions of the conjunctiva and cornea under the eyelids were unaffected because they were protected from direct exposure. Fortunately, ultraviolet keratitis is usually self-limiting, and the corneal epithelium responds well to supportive therapy. 

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