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UV DAMAGE

Radiant UV Energy Damages Cells and Tissues

UV-Related Eye Conditions

Cataract, pterygium, pingueculum, macular degeneration and UV keratoconjunctivitis are all eye conditions for which UVR has been implicated. To read more about some of the most common UV-related eye conditions, click on the condition names:

Cataract
Pterygium
Pingueculum
Macular degeneration
UV keratoconjunctivitis

UV-Related Eye Conditions

UV exposure has been implicated as a risk factor or cause in the pathogenesis of a large number of ocular conditions.a-d These ocular conditions include UV keratoconjunctivitis, pterygium, pingueculum, cataract, squamous cell carcinoma, ocular melanoma, climatic droplet keratopathy and macular degeneration.

UV-related eye conditions have a negative impact on both quality of life and health care costs. For example, the depletion of the ozone layer is estimated to result in 830,000 more cataract surgeries over the next 10 to 20 years at an approximate cost of $2.8 billion.e

Cataractb, f-i

Cataract is the leading cause of blindness in the world. In many societies, cataract removal is one of the most commonly performed surgical procedures. In the U.S., this surgery is responsible for 60% of all Medicare costs related to vision.

Cataract
Cataract development is very complex.
  • Age and heredity are the most important risk factors for the development of all types of cataracts.
  • UV exposure is considered a major risk factor for cataract development, and has been linked to early onset of cortical cataract. Although the correlation between UV and cataract has experimentally been well established, the exact role of UV in the natural development of the condition is not well understood.
There are many ways UV can affect the lens and potentially induce cataract.
Some postulated mechanisms include:
  • Changes to photosensitive amino acids in lens proteins
  • Covalent binding of UV filter compounds to lens proteins
  • Formation of reactive toxic oxidants
  • Direct damage of DNA within corneal epithelium

Pterygiumj-m

UV exposure appears to be the most significant factor in development of pterygium. There is a higher incidence in people who live near the equator and/or spend much of their time outdoors.

Pterygium
Pterygium pathogenesis:
  • The conjunctival stroma degenerates and is replaced by thick fibers. The corneal stroma also can be affected. In the case shown here, it appears the pterygium is just beginning to encroach on the cornea of the left eye.
  • The pterygium is typically a raised, wing-shaped patch of fibrous, fibrovascular or vascular tissue. It is also commonly nasal in location.
  • Patients are often asymptomatic, but may come to you because they are concerned about appearance.
  • Pterygium is difficult to treat; surgery is not always successful.

Pingueculum n, o

Pingueculum
  • A pingueculum is a nonmalignant elevated, yellow lesion that is localized, most commonly on the nasal limbus.
  • A pingueculum develops over several years.
  • These lesions occur as a result of conjunctival stroma degeneration.

Macular degenerationp–s

Macular Degeneration
  • In developing countries, age-related macular degeneration is a leading cause of irreversible central vision loss.
  • Age-related macular degeneration is a multifactorial disease.
  • The development of age-related macular degeneration may be associated with UV exposure.

UV keratoconjunctivitist

Acute overexposure to the sun can result in UV keratoconjunctivitis. The more general term for this condition, photokeratitis, doesn’t specify the light source responsible for the damage and doesn’t take involvement of the conjunctiva into account.

Keratoconjunctivitis
UV keratoconjunctivitis progresses as follows:
  • The epithelial layer becomes irritated and loosens. The ensuing inflammatory response results in edema, congestion and stippling of the cornea.
  • Epithelial cells may die and visual acuity may be compromised. Nerve fibers are spared however, so the related pain can be significant.
  • The conjunctiva also is involved. The trauma results in a “sand-in-the-eye” sensation.

a Coroneo M. Sun, eye, the ophthalmohelioses and the contact lens. Eye Health Advisor, a magazine of Johnson & Johnson Vision Care, January 2006.

b Young RW. The family of sunlight-related eye diseases. Optom Vis Sci. 1994;71(2):125–44.

c Taylor HR, West S, Munoz B, Rosenthal FS, Bressler SB, Bressler NM. The long-term effects of visible light on the eye. Arch Ophthalmol. 1992;110(1):99–104.

d Wittenberg S. Solar radiation and the eye: a review of knowledge relevant to eye care. Am J Optom Physiol Opt. 1986;63(8):676–89.

e West SK, Longstreth JD, Munoz BE, Pitcher HM, Duncan DD. Model of risk of cortical cataract in the U.S. population with exposure to increased ultraviolet radiation due to stratospheric ozone depletion. Am J Epidemiol. 2005;162(11):1080–8.

f McCarty CA, Nanjan MB, Taylor HR. Attributable risk estimates for cataract to prioritize medical and public health action. Invest Ophthalmol Vis Sci. 2000;41(12):3720-5.

g Bova LM, Sweeney MH, Jamie JF, Truscott RJ. Major changes in human ocular UV protection with age. Invest Ophthalmol Vis Sci. 2001;42(1):200-5.

h Taylor LM, Andrew Aquilina J, Jamie JF, Truscott RJ. UV filter instability: consequences for the human lens. Exp Eye Res. 2002;75(2):165-75.

i Ellwein LB, Urato CJ. Use of eye care and associated charges among the Medicare population. Arch Ophthalmol. 2002;120(6):804-11.

j Saw SM, Tan D. Pterygium: prevalence, demography and risk factors. Ophthalmic Epidemiol. 1999;6(3):219–28.

k Ang LP, Chua JL, Tan DT. Current concepts and techniques in pterygium treatment. Curr Opin Ophthalmol. 2007;18(4):308–13.

l Mackenzie FD, Hirst LW, Battistutta D, Green A. Risk analysis in the development of pterygia. Ophthalmology. 1992;99(7):1056–61.

m Nolan TM, DiGirolamo N, Sachdev NH, Hampartzoumian T, Coroneo MT, Wakefield D. The role of ultraviolet irradiation and heparin-binding epidermal growth factor-like growth factor in the pathogenesis of pterygium. Am J Pathol. 2003;162:567–74.

n Perkins ES. The association between pinguecula, sunlight and cataract. Ophthalmic Res. 1985;17(6):325–30.

o Lica L. Pinguecula and pterygium. Gale Encyclopedia of Medicine Web site, accessed via BNET Research Center Web site. Published 1999. Accessed December 7, 2007.

p Bialek-Szymanska A, Misiuk-Hojlo M, Witkowska D. Risk factor evaluation in age-related macular degeneration. Klin Oczna. 2007;109(4–6):127–30.

q Loeffler KU, Sastry SM, McLean IW. Is age-related macular degeneration associated with pinguecula or scleral plaque formation? Curr Eye Res. 2001;23(1):33–7.

r Cruickshanks KJ, Klein R, Klein BE, Nondahl DM. Sunlight and the 5-year incidence of early age-related maculopathy: the Beaver Dam Eye Study. Arch Ophthalmol. 2001;119(2):246–50.

s Taylor HR, Munoz B, West S, Bressler NM, Bressler NM, Bressler SB, Rosenthal FS. Visible light and risk of age-related macular degeneration. Trans Am Ophthalmol Soc. 1990;88:163–73; discussion 173–8.

t Bergmanson JP. Corneal damage in photokeratitis—why is it so painful? Optom Vis Sci. 1990;67(6):407–13.