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You are seeing a 10-year-old boy with bilateral eye pain and redness. He spent the entire day at the beach yesterday, mostly in the ocean surfing. There is no history of known direct trauma. Yesterday evening he started to complain of eye pain, and this morning he refused to open his eyes. After instilling topical anesthetic, you are able to open his eyes enough to perform an exam: visual acuity normal to pictographs, conjunctival injection with perilimbic sparing, no discharge, no chemosis, fluorescein exam no large areas of uptake (difficult exam due to patient non-cooperation, even with anesthetic).
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August 13, 2025 at 11:30 pm
A) Sun
The patient is showing signs of UV keratitis aka photokeratitis. UV exposure from outdoor recreational activities such as water and snow activities are common causes. It may also occur after UV exposure from tanning beds and UV disinfection lamps. Symptoms include eye pain, foreign body sensation, red eye, photophobia, tearing, and sometimes mildly decreased visual acuity. Flourescein exam may show a punctate uptake pattern. Patients may also have an associated facial sunburn. Treatment is supportive with artificial tears eye lubricant, oral analgesics, and eye rest. Avoid use of contact lenses. Patients should receive close follow-up for resolution of symptoms and good return precautions.