Photokeratitis: 光角膜炎, 是由紫外線造成. ㄧ開始暴露於紫外線可能不會立即產生症狀, 一般是曬傷之後 6-12 小時開始疼痛, 通常會自然痊癒.
INTRODUCTION — Photokeratitis, also known as ultraviolet keratitis or UV keratitis, is an acute syndrome that occurs after UV irradiation of the eyes. The exposure may not be initially apparent to the patient, as there is a latent period (6 to 12 hours) between exposure and onset of symptoms. Although intensely painful, photokeratitis is generally a self-limited condition with complete resolution.
INTRODUCTION — Photokeratitis, also known as ultraviolet keratitis or UV keratitis, is an acute syndrome that occurs after UV irradiation of the eyes. The exposure may not be initially apparent to the patient, as there is a latent period (6 to 12 hours) between exposure and onset of symptoms. Although intensely painful, photokeratitis is generally a self-limited condition with complete resolution.
SOURCES OF ULTRAVIOLET EXPOSURE — 紫外線來源. 最常見是雪盲以及焊工使用電焊產生灼傷. 其他紫外線來源包括: 曬傷. 太陽燈. 高壓電電弧. 紫外線殺菌燈. 故障的鹵素燈(常用於體育場.禮堂). 水族殺菌燈.
Many recreational and occupational activities are associated with ultraviolet (UV) exposure and the potential for photokeratitis in unprotected eyes. Welder's arc burns and snowblindness are the best known examples of photokeratitis, but other exposures include:
●Other recreational solar exposure
●Sunlamps
●Short circuit in a high-voltage line
●Laboratory or germicidal UV lamps
●Damaged metal halide lamps, typically used in gymnasia and assembly halls [1-3]
●Aquaria disinfection lamps [4]
TREATMENT — 治療. 主要是症狀治療. 雪盲會導致嚴重疼痛. 初步治療包括止痛和給予抗生素藥膏.
Treatment of photokeratitis is supportive, with acknowledgment that the pain related to this syndrome is severe (anecdotally reported as comparable to childbirth or a kidney stone). There is no evidence from clinical trials on the efficacy of various treatment options. Initial treatment with oral analgesics and lubricant antibiotic ointments can be undertaken by the primary care or emergency clinician.
Supportive care includes: 支持性療法包括. 口服止痛藥. 潤滑性的抗生素藥膏. 例如 紅黴素. BACITRACIN. POLYMYXIN-BACITRACIN 等. 一天3-4 次. 連續使用 2-3 天.
●Oral analgesics – The pain from photokeratitis is typically severe, especially at the onset. Mild oral opioids are usually necessary for adequate pain relief. We suggest that patients are given oxycodone 5 to 10 mg every 4 to 6 hours as needed for the first 24 to 48 hours. Pain control permits sleep and helps recovery.
●Lubricant antibiotic ointments – Topical antibiotic ointments can improve comfort and may provide prophylaxis against superinfection [9]. We suggest treating patients with an antibiotic ointment (eg, erythromycin, bacitracin, or polymyxin-bacitracin), prescribed three to four times daily for two to three days.
通常在 1-2 天需回診檢查. 評估症狀是否緩解. 如果症狀持續. 或者有新的症狀. 建議轉眼科.
Patients should be re-examined in one to two days for resolution of signs and symptoms. They should be referred to an ophthalmologist for any new or persistent signs or symptoms.
畏光. 可以使用睫狀肌放鬆藥水. 但這些藥水可能導致瞳孔擴張數天. 讓病患不舒服. 因此不建議使用. 將眼睛加壓包紮可稍微緩解症狀. 但目前無證據顯示會加速角膜破皮的恢復. 對於紫外線輻射應該無效. 所以也不建議眼睛包紮.
Photophobia can be relieved with cycloplegic drops (cyclopentolate 1 percent, homatropine 2 to 5 percent, or scopolamine 0.25 percent). However, these agents can result in pupil dilation lasting days, which may be distressing to the patient. We suggest that patients not be treated with cycloplegics. Pressure patching of the worse eye may offer some relief. However, it has not been proven to speed healing after corneal abrasion [10] and is unlikely to improve healing after ultraviolet (UV) irradiation. We suggest that patients not be treated with eye patching.
除了一開始做檢查. 不建議給予局部止痛藥水(角膜麻醉藥水). 持續使用止痛藥水可產生依賴性. 角膜毒性. 持續性角膜上皮缺損. 角膜潰瘍. 失明。角膜麻醉之後, 不管是病理性的或藥理性的因素. 都可導致神經萎縮性潰瘍. 因喪失角膜傷害神經脈衝輸入(腦部), 導致角膜保護性反射降低(包括流淚和閉眼). 神經萎縮性角膜發炎與糖尿病神經退化造成的足底潰瘍相似.
We recommend that topical anesthetics not be dispensed or prescribed, although they may be used during the initial examination [11]. Continued use can lead to dependency, corneal toxicity, persistent corneal epithelial defects, corneal ulceration, and loss of the eye [11]. Corneal anesthesia, whether pathologic or pharmacologic, can lead to neurotrophic ulceration related to the absence of neural input that generates protective reflexes, including tearing and blinking. Neurotrophic keratitis is analogous to foot ulcers seen in diabetic neuropathy.
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