Welder's Burn or Ultraviolet Keratitis
The picture below show a fluasceine stained eye under ultraviolet light from a woods lamp. The light green color over the entire eye is the haze of stain put in by the examiner. The stain selectively binds to areas of the eye that are damaged. The bright green dots are superficial punctate keratitis (SPK) and can be a sign of welder's burn.
Ultraviolet keratitis is damage caused to the cornea of the eye from exposure to ultraviolet radiation. It is the number one injury to the eye caused by radiation in the united states. It can be caused from exposure to the sun, tanning beds, carbon arc lighting, arc welding, photographic flood lamps, lightning , reflected sunlight from snow or water, electric sparks, and halogen desk lamps. It can also be called actinic keratitis, snow blindness, flash burn, welder's flash, arc eye, or welder's burn.
Below is a picture of a very nice welder's helmet with auto-darkening lens...daddy like!
Ultraviolet keratitis is damage caused to the cornea of the eye from exposure to ultraviolet radiation. It is the number one injury to the eye caused by radiation in the united states. It can be caused from exposure to the sun, tanning beds, carbon arc lighting, arc welding, photographic flood lamps, lightning , reflected sunlight from snow or water, electric sparks, and halogen desk lamps. It can also be called actinic keratitis, snow blindness, flash burn, welder's flash, arc eye, or welder's burn.
Below is a picture of a very nice welder's helmet with auto-darkening lens...daddy like!
This disease is characterized by a latent onset of pain and decreased vision starting from 6 to 12 hours after the exposure. The very short wave ultraviolet radiation is completely absorbed by the cornea and rarely causes injury to deeper structures. However it is cumulative in nature so continued reexposure can lead to pterygium, climatic droplet keratopathy, and even squamous metaplasia and carcinoma. The lag time between exposure and symptoms can often lead to misdiagnosis as a chemical rather than radiation injury. The radiation causes injury to the squamus epilthelial cells, inhibiting mitosis and reproduction. As these cells die and then slough off, they leave the sensitive nerve ends exposed causing intense pain, photosensitivity, foreign body sensation, irritation, tearing and blepharospasm.
Under flourciene stained slit lamp examination, the cornea reveals a superficial punctate keritinopathy (called SPK). If the patient's eyes were partially closed during exposure, a well demarcated line will be present between areas exposed and areas protected by the eye lids. Varying amounts of lid edema and conjunctival hyperemia may be present as well as sunburn to the face, hands, and arms.
A throrough history will reveal exposure to one of the above sources of radiation.
Prehospital care includes flushing with NS for several minutes.
Hospital care includes appication of a short acting cycoplegic drop to relieve the pain of reflex ciliary spasm. Topical anesthetic drops should be used during examination but should not go home with the patient due to the risk of further injury to the anesthetized eye. Topical antibiotic ointment is used but patching is becoming controversial since it can lead to further damage to the eye if there should be a trapped FB under the patch. If a patch is used, antibiotic drops should be used after the patch is removed. Do not allow the patient to change the patch due to the danger of putting it on too tight, causing further damage.
An opthamological consult is not usually nescessary but is up to the clinician as the cornea is reepithelialized within 24 to 72 hours. Because of the severely painful nature of the condition, oral NSAID and narcotics are prescribed. Topical NSAID use is off label but common practice.
Please see http://www.emedicine.com/emerg/TOPIC759.HTM for further, more detailed information regarding this condition.
As you may know, I have been learning how to weld. I made a short peek at my work unprotected by the welders shield since I couldn't really see too good through the dark glass. Bad idea. Only my left eye was significantly affected but my eyelid was swollen and my eyeball was red and painful for several hours starting early in the morning, well after the exposure. This brought to mind a more serious exposure that I had several years ago. I'd like to share it with you since it's a bit funny.
I always have some hobby or project going to occupy my feeble mind. If I don't keep busy my idle hands become the tools of the devil...ha ha.
About five years ago I had several saltwater fish tanks and enjoyed the hobby immensly. The fish were relaxing and traquil however I had an outbreak of a condition called Ich, caused by a parasite. Several fish died and several more were infected. The ich parasite has a free swimming stage during which the microscopic organisim seeks out a host to feed on. The disease is characterized by white patches on the fish and it looks like somone has sprinkled salt on them. Unfortunatly it can also infect the gills and that usually kills the fish. A sure sign of ich is when the fish "flash" across the bottom of the tank or rocks or other stuctures trying to scratch the irriating patches on their flanks. It's very disheartening to see your loved pets so uncomfortable.
I read that using an ultraviolet sterilizer can kill the parasite during the free swimming stage. I found the largest one I could and ordered it from ebay. The package arrived one afternoon and I set about installing it into the water flow of the tank. The unit consist of a large black tube about two feet long and six inches across with a 36 watt ultraviolet bulb encased in a quartz inner tube surrounded by the water flow, thus exposing the moving water stream to the radiation.
Before installing it I decided to take the bulb out of the protective sheath to make sure it was working before I plumbed it into the complex system of waterflow through the tank. I was worried that my Flea-Bay purchase might be a dud. Now, let me tell you, anytime you purposely disable a safety feature of a device or product,you are probably making a mistake. This is true with table saws and nail guns and if you've ever worked at a trauma center, you know this is true firsthand. Of course, being an ER nurse, I'm usually exempt from such prohibitions, as you probably know. I am a walking testament to safety...just look at me. Who needs ten fingers anyway?
After disabling the safety device holding the bulb securely away from prying eyes, I turned it on and gazed at it...nothing. No light, no heat, no flame is visable, just a barely noticable flickering around the base that soon went away. I'm looking closely at the long, thin bulb, rubbing it across my left arm to see if it reflects any light...nothing. Soon I notice that the white dust on the box it came in was glowing a very bright blue, like in the blacklight room at Spencer's Gifts. Ah ha! It's working. The whole procedure took less then two minutes. I buttoned up the device and installed it, sure in the confidence that it was working. Then I set about doing some other chores involving the tank, cleaning and moving animals around and so forth.
Well, at about 6 AM I am awaked by a slight itching in my eyes. It quickly blossomed into a full sensation of someone playing a flamethrower across my face and eyes. I went to the sink and began flushing my eyes out with water but that just made it worse. I couldn't image what I had done. I thought that maybe I was exposed to some chemical in the water as some of the organisms can release toxins when irritated. Ahhhhh, I'm on fire! My eyes are streaming tears and my nose is running snot and my whole face and my left arm are all on fire. My face is swollen to the point of unrecognition. My eyelids look like wet red candies.
Jimmy took me to the ER and we arrived at 7 AM...shift change. I don't really know any of the morning nurses since by the time I wake up, they are gone. Besides, I had only been there for a few months. I entered through the ambulance bay and made a bee line toward the refigerator by the pyxis...dear god let there be some proparacain! I'm on fire. I am rummaging through the fridge in my sleeping clothing, my face is red and swollen, unshaved, tears are streaming down my cheeks...I hear "Excuse me, sir, sir...EXCUSE ME!" The day nurses have no idea who this crazy person is in the nursing station going through the medicines! Ha ha ha...good times.
So I finally find the drops and quickly instill them into my fiery eyeballs...aaaaahhh
After things got calmed down I'm escorted to an open room and my eyes are flushed. No one has any idea what to make of me. I kept thinking I was exposed to something in the water. The UV steriizer never came to mind! The ER doc didn't know what to make of it either. I wasn't going to let anyone pry that proparacain out of my grasp!
I went across the street for an opthamologic consult and the first question was...what time did your eyes, start bothering you? I told him about six in the morning. He immediatly asked me if I was a welder. Er...no. I don't even know how to weld. "Any other sources of ULTRAVIOLET radiation?", he asks, the word 'ultraviolet' ringing through my mind like a bell...aaaahhh...a light goes off in my brain. Mystery solved.
So that is basically the end of that rather embarassing story. I went home with an rx for antibiotic ointment and pain pills and by the next day it was completely pain free. My face and left hand and arm, that had been swollen and painful stopped hurting at about the same time. I was amazed that so little an amount, less than two minutes of exposure to just 36 watts of ultraviolet could cause so much pain!
I hope this little lesson has been as enjoyable for you to read as it was for me to experience... The take away is to never disable a safety device and to take a thourough history of eye pain...Welder's burns start hurting from 6 to 12 hours after the insult.
P.S. The Ich cleared up within a week and I never had another outbreak.
Thats some good research!
I wish I had a welders helmet like that. The thing looks like it could weld for you !
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