What is included in emergency department (ED) care of ultraviolet keratitis?

Updated: Mar 14, 2019
  • Author: Alex Koyfman, MD; Chief Editor: Liudvikas Jagminas, MD, FACEP  more...
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Answer

Administration of a short-acting cycloplegic drop (eg, cyclopentolate 1%) may help relieve the pain of reflex ciliary spasm.

Use of a bland ointment (eg, Lacrilube) may help reduce pain. Ointments may interfere with healing in severe corneal injuries.

Many practitioners administer topical antibiotic ointment or drops (eg, erythromycin or gentamicin). However, no evidence supports this practice. If an eye patch is used with an antibiotic ointment, the patient should use antibiotic drops after the eye patch has been removed.

Application of a semipressure dressing with the eye well closed underneath was once the standard of care, but today this method of treatment is controversial. While these dressings may offer good pain relief, they may also delay reepithelialization. Moreover, some patients find the loss of sight and depth perception (in the case of single-eye patching) more traumatic than the pain itself. When used, the dressing is to be left on for 24 hours. The dressing should not be replaced by the patient without professional assistance because excessive pressure can cause further damage to the eye.

UV keratitis symptoms vary from extreme pain to a minor annoyance, depending on individual patient factors and the severity of the injury. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a reasonable first-choice analgesic. Narcotic/acetaminophen combinations are useful for breakthrough pain.

Topical anesthetic may be administered only in the ED; frequent use retards epithelial healing and may lead to corneal ulcer formation. To date, the only evidence showing that topical anesthetics causing more harm in uncomplicated corneal abrasions is from experimental animal studies, case reports, and case series. Based on available evidence, it is most likely reasonable to send patients home with dilute topical anesthetics for a period of no more than 24 hours without patients having complications, but larger studies will need to occur before this recommendation can be made. The relief provided by topical anesthetics is so immediate and dramatic that patients are highly motivated to take a bottle home with them. Be careful not to allow the patient to take the bottle surreptitiously.

Topical NSAIDs are not approved for this indication but are used for many other painful and allergic eye conditions. [9] Topical NSAIDs for UV keratitis and corneal abrasions is an off-label use but has become common practice in many places.


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