Photokeratitis, commonly known as arc eye or welder’s flash, is a temporary but intensely painful condition resulting from unprotected exposure to ultraviolet (UV) radiation, such as a welding arc or reflected sunlight off snow. This UV damage creates a superficial burn on the cornea and conjunctiva, leading to severe discomfort often described as a foreign body sensation or having sand in the eyes. The accompanying photophobia, or extreme light sensitivity, makes falling asleep nearly impossible. Managing this acute pain and light sensitivity is the primary goal to facilitate the necessary rest for the eyes to heal.
Immediate Steps for Pain Relief
Applying a cold compress to the closed eyelids is the most direct step toward relieving the burning pain. A clean cloth soaked in cold water or a chilled, damp washcloth helps constrict superficial blood vessels and reduce the inflammation of the cornea and surrounding tissues. This external application temporarily numbs the nerve endings, providing a brief window of comfort. It is important to resist the strong urge to rub the eyes, as this action can worsen damage to the compromised corneal surface.
To manage the systemic pain and headache that often accompany photokeratitis, over-the-counter (OTC) oral pain relievers are highly recommended. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or acetaminophen can effectively reduce both pain and any associated inflammation. Following the recommended dosage instructions is necessary for safe use, as these medications treat the underlying discomfort that prevents relaxation.
While the eyes are irritated, applying lubricating eye drops, also known as artificial tears, can soothe the corneal surface. Preservative-free formulations are generally preferred to minimize the introduction of additional chemical irritants to the injured eye. Medicated drops intended to “get the red out” should be strictly avoided because the chemical vasoconstrictors they contain can cause rebound irritation and potentially interfere with the natural healing process.
Optimizing the Sleep Environment
The extreme light sensitivity that defines photokeratitis demands a completely dark sleeping environment to minimize discomfort. Light, even dim ambient light, can stimulate the exposed corneal nerves and trigger intense pain. Using blackout curtains or covering windows is highly effective, and a soft, non-compressive sleep mask may be used if it can be worn without applying any direct pressure to the irritated eyeballs.
The physical position assumed during sleep can also influence comfort levels and the healing process. Sleeping on one’s back is the best recommendation, as it ensures that no physical pressure from a pillow or hand is placed directly onto the sensitive cornea. If side sleeping is the only comfortable option, positioning the head so the less affected eye is facing upward can help reduce irritation.
Dry air can exacerbate the feeling of grittiness and dryness on the ocular surface, potentially delaying comfort. Running a cool-mist humidifier in the bedroom can help increase the air’s moisture content, supporting the eye’s natural tear film stability while resting. Conversely, positioning the bed away from direct air sources, such as air conditioning vents or oscillating fans, is advised to prevent air currents from drying out the eyes further.
Before attempting to sleep, all sources of visual stimulation should be eliminated to allow the eyes to remain closed and rested. The effort required to focus on screens, such as phones, tablets, or televisions, can strain the eye muscles and increase light exposure, worsening symptoms like photophobia. Avoiding these activities for at least an hour before bed promotes ocular rest and prepares the body for sleep.
Understanding Recovery and When to Seek Medical Help
Photokeratitis is a condition characterized by a rapid self-healing process once the UV exposure has ceased. Symptoms typically manifest about six to twelve hours after the initial exposure and often peak in intensity during the night or early morning. Most mild to moderate cases resolve completely within twenty-four to forty-eight hours, with the corneal surface regenerating its damaged cells.
While the condition is temporary, certain signs indicate the need for immediate professional medical attention. If the severe pain does not begin to subside after forty-eight hours, or if it noticeably worsens despite the use of OTC pain relievers, a doctor should be consulted. Any significant or persistent vision changes, such as blurring or a noticeable decrease in clarity, also warrant an urgent eye examination.
Signs of a potential secondary infection must be addressed immediately by an eye care professional. These signs include the presence of thick, colored discharge, such as green or yellow mucus, or increasing redness and swelling that spreads beyond the eyelids. A doctor can perform a detailed eye exam and may prescribe topical antibiotic drops or ointments to prevent or treat an infection during the recovery period.