Photoretinitis: an underestimated occupational injury?

Abstract

Non-ionizing radiation, which is produced in large amounts by welding arcs, may induce photophthalmia, keratoconjunctivitis and cataracts. Retinal injuries resulting from exposure to electric welding arcs have been reported, but such injuries are not commonly seen and may be misdiagnosed. A case is described of bilateral maculopathy in a millwright exposed to metal arc inert gas-shielded welding and oxygen lance light. Insurance adjudicators denied his claim, as they did not acknowledge the cause-and-effect relationship between welding and retinopathy. Welding emits a wide spectrum of radiation, ranging from IR to UV and beyond. UV and far-IR radiation are adsorbed by the cornea and the lens, whereas visible light and near-IR radiation penetrate to the retina. According to the intensity and time of exposure, they may cause thermal or photochemical retinal damage, which may be permanent and sight-threatening. Workers covered by compulsory collective insurance should be eligible for compensation in every case of welding light-induced retinal damage.

Macular Degeneration in an Arc Welder

“…It rarely occurs before age 55, but is more common at age 75 and older 1) . Even though the primary ocular damage to electric arc welders has been reported as photophthalmia, keratoconjunctivitis and cataracts due to ultraviolet radiation (UV) 2,3) damage to the retinas of welders is frequently reported, especially when the welder's eye is accidentally exposed to the welding arc. Retinal damage among welders has been described as maculopathy or photoretinitis and basically has pathology and clinical characteristics similar to macular degeneration such as drusen, retinal pigment epithelial (RPE) changes, geographic atrophy, and changes in central vision [4][5][6][7][8][9][10] .…”

“…Thus, distinguishing AMD from welder's maculopathy depends not only on clinical symptoms and ophthalmologic examination, but also on the work history of the welder. The difficulty distinguishing between these two diagnoses can create controversy when a claim is made for welder's macular injury 2) . The possible theories for the mechanism underlying welder's retinal damage include a phototoxic reaction between visible light and the phospholipids of retinal pigments which generates reactive oxygen intermediates 11) .…”

Reversible structural disruption of the outer retina in acute welding maculopathy

“…Only one previous case of bilateral NA-AION after sildenafil is documented. 3 To our knowledge, this is the first report of sildenafil-related NA-AION and cilioretinal artery and central retinal vein occlusions.…”

“…2,3 In aphakia, as in our case, wider spectrum of waves, and in particular damaging short wavelength radiation, may gain access to the retina and exacerbate the damage.…”

“…[2][3][4] Anyway, as suggested by Dr Shah et al, we reanalysed the data by collapsing the data into individuals and analysed using Wilcoxon's test (a nonparametric test). The differences of visual field indexes between OSA and control arms were still found to be statistically significant (P ¼ 0.021 for the difference between mean deviation in the two arms, and P ¼ 0.001 for the difference between pattern standard deviation in the two arms, respectively).…”