5.16 Photokeratitis (Ultraviolet Burn, Arc Eye, Snow Blindness)

eyes.nhs.scot/
Eyecare Guidelines/
Section 5 - Corneal/
5.16 Photokeratitis (Ultraviolet Burn, Arc Eye, Snow Blindness)

Date of last review:

29/4/2026

Date of next review:

29/4/2028

Date of publication:

6/7/2026

Differential Diagnosis ⁽¹⁾

A detailed history usually clarifies UV exposure as the cause. Consider alternative diagnoses such as:

Acute viral keratoconjunctivitis
Contact or toxic keratitis
Contact lens overwear
Dry eye
Corneal or subtarsal foreign body

Possible management by optometrist

Advice ⁽¹⁾

Avoid further UV exposure
Reassure the patient that photokeratitis is self-limiting and symptoms usually resolve within 24–48 hours, though mild blurring/photophobia may continue for up to a week or longer
Encourage cold compresses, sunglasses, and rest with eyes closed for comfort
Advise no contact lens wear until full epithelial healing
Monitor closely: the corneal epithelium should be mostly healed by the next day
Advise patient to return if symptoms persist
Counsel on future UV eye protection

Examination ⁽¹⁾

Topical anaesthetic (oxybuprocaine or proxymetacaine) may be used solely to aid examination, not for analgesia

Treatment

Symptomatic Relief
- Recommend simple over the counter pain relief with advice from pharmacist if needed^(1,7)
- Ocular lubricants (ideally unpreserved) for symptomatic relief as required ⁽¹⁾ (drops/gel for use during the day ± unmedicated ointment for use at bedtime)⁽⁷⁾. Refer to local formularies for suitable options⁽⁶⁾   
- For severe pain due to ciliary spasm, consider a short acting cycloplegic (e.g. cyclopentolate 1%) ⁽¹⁾
Consider topical antibiotic prophylaxis (e.g. chloramphenicol) if there is a large epithelial defect or risk of infection ⁽¹⁾

Typical adult dosage/duration

(Blue text = IP, black text = non-IP)

Chloramphenicol 0.5% eye drops ^(1,5) (POM, off-label): One drop every 2 waking hours for 48 hours. After this period, treatment should be every 4 hours during waking hours. Eye drops may be supplemented by 1% ointment at night. The course of treatment should be 5 days (even if symptoms improve)^(2,3)

Chloramphenicol 1% eye ointment ^(1,5) (POM, off-label): Apply at night (if eye drops used during the day), alternatively apply 3–4 times daily, if ointment used alone. The course of treatment should be 5 days (even if symptoms improve)^(2,3)

Cyclopentolate hydrochloride 1% eye drops ^(1,5) (POM): One drop up to 3 times daily, consider reducing (or stopping) as condition improves ^(6,7) (consult local guidance as they may vary on timescales⁽⁷⁾)

NB. Chloramphenicol 0.5% eye drops and 1% eye ointment are available via the NHS Pharmacy First service for the treatment of infected eye conditions only and not for prophylactic use in this condition. Where prophylactic antibiotic treatment is clinically indicated, chloramphenicol must be supplied on prescription by an independent prescribing (IP) optometrist, or requested from the patient’s GP where the optometrist is not IP‑qualified ⁽⁷⁾

Regimens should be adjusted according to severity and patient factors (e.g. age, weight, pregnancy, renal function). Prescribing should follow local formulary and national guidance where available ⁽⁷⁾.

In cases of known sensitivities, please consult local formularies for alternative options ⁽⁷⁾.

Further management options

Treatment may be provided within available locally enhanced schemes, or by community IP optometrists/OMPs, as appropriate ⁽⁷⁾
Management to resolution by Optometrist, usually without referral ⁽¹⁾

Possible management in secondary care or local/community pathways where available

See Further management options^(1,7)
Not normally required ⁽¹⁾unless further guidance is indicated locally⁽⁷⁾

College of Optometrists Clinical Management Guideline⁽¹⁾ 

Photokeratitis (ultraviolet [UV] burn, arc eye, snow blindness) - College of Optometrists*

* With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines

Guidance is informed by the following sources

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists
Advisory alignment with the BNF BNF (British National Formulary) | NICE
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above
Advisory alignment with expert consensus (CEGG)
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

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