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      Case series of keratitis in poultry abattoir workers induced by exposure to the ultraviolet disinfection lamp

      case-report

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          Abstract

          Background

          An outbreak of eye diseases occurred among workers at a poultry abattoir in South Korea from December 2012 to June 2013. An epidemiological investigation of the causative agent was conducted. The workers were given a special health examination and workplace environmental monitoring was performed. Workers with ocular symptoms subsequently underwent an ophthalmic examination.

          Case Presentaion

          From a total of 41 workers, 26 (63.4 %) were diagnosed with keratoepitheliopathy by ophthalmic examination. Environmental monitoring of the workplace revealed that the ultraviolet (UV) apron-disinfection lamp had not been turning off at the set times, and so the workers’ faces had been exposed to UV radiation. Effective radiation dose measurement showed a UV-B exposure of 7-30 μW/cm 2, and a UV-C exposure of 40-200 μW/cm 2; both values exceed the occupational exposure limits. The outbreak ceased after the lamp was repaired.

          Conclusions

          This case shows that inappropriate use of the UV disinfection lamp can cause mass photokeratitis. In order to prevent this, the UV disinfection lamp must be checked regularly, workers must be educated on the health effects of UV radiation, and appropriate eye protection must be worn.

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          Most cited references14

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          Vernal keratoconjunctivitis: a major review.

          Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, at times asymmetrical, seasonally exacerbated, allergic inflammation of the ocular surface, involving tarsal and/or bulbar conjunctiva. Though the allergic nature of this entity has been accepted for a long time, the accumulation of a large amount of immunological data has proved that the pathogenesis of VKC is much more complex than a mere type 1 hypersensitivity reaction. In the past several years, many clinical and experimental studies about the cells and mediators involved in initiating and perpetuating the ocular allergic inflammation have shown that T helper type 2 cells and their cytokines, corneal fibroblasts and epithelium along with various growth factors play an important role in the pathogenesis of VKC. Based on this information about the pathogenesis of VKC newer, more selective drugs like anti-chemokine receptor antibodies and leukotriene receptor antagonists are under evaluation. Cyclosporine has been shown to be effective in the treatment of VKC but further randomized control trials are required to establish the minimum effective concentration.
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            Host defense at the ocular surface.

            Microbial infections of the cornea frequently cause painful, blinding and debilitating disease that is often difficult to treat and may require corneal transplantation. In addition, sterile corneal infiltrates that are associated with contact lens wear cause pain, visual impairment and photophobia. In this article, we review the role of Toll-Like Receptors (TLR) in bacterial keratitis and sterile corneal infiltrates, and describe the role of MD-2 regulation in LPS responsiveness by corneal epithelial cells. We conclude that both live bacteria and bacterial products activate Toll-Like Receptors in the cornea, which leads to chemokine production and neutrophil recruitment to the corneal stroma. While neutrophils are essential for bacterial killing, they also cause tissue damage that results in loss of corneal clarity. These disparate outcomes, therefore, represent a spectrum of disease severity based on this pathway, and further indicate that targeting the TLR pathway is a feasible approach to treating inflammation caused by live bacteria and microbial products. Further, as the P. aeruginosa type III secretion system (T3SS) also plays a critical role in disease pathogenesis by inducing neutrophil apoptosis and facilitating bacterial growth in the cornea, T3SS exotoxins are additional targets for therapy for P. aeruginosa keratitis.
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              Ocular effects of ultraviolet radiation from 295 to 365 nm.

              A 5,000 watt Xe-Hg source and a double monochromator were used to produce 6.6 nm. full band-pass ultraviolet (UV) radiation. Pigmented rabbit eyes were exposed to the 6.6 nm. band-pass UV radiant energy in 5 nm. steps from 295 to 320 nm. and at random intervals above 320 nm. Corneal and lenticular damage was assessed and classified with a biomicroscope. Corneal threshold radiant exposure (Hc) rose very rapidly from 0.022 Jcm.-2 at 300 nm. to 10.99 Jcm.-2 at 335 nm. Radiant exposures exceeding 2 x Hc resulted in irreversible corneal damage. Lenticular damage was limited to wavebands above 295 nm. The action spectrum for the lens began at 295 nm. and extended to about 315 nm. Permanent lenticular damage occurred at radiant exposure levels approximately twice the threshold for lenticular radiant exposure. The importance in establishing both corneal and lenticular damage criteria is emphasized.
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                Author and article information

                Contributors
                jdmoon@chol.com
                Journal
                Ann Occup Environ Med
                Ann Occup Environ Med
                Annals of Occupational and Environmental Medicine
                BioMed Central (London )
                2052-4374
                15 January 2016
                15 January 2016
                2016
                : 28
                : 3
                Affiliations
                Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, 519-763 Hwasun, Jeollanam-do Korea
                Author information
                http://orcid.org/0000-0002-1081-9840
                Article
                87
                10.1186/s40557-015-0087-7
                4714468
                26779342
                ec77135c-bdd9-4f7a-96d1-d9483ba27399
                © Kwon et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 September 2015
                : 28 December 2015
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2016

                photokeratitis,poultry abattoir,ultraviolet,south korea
                photokeratitis, poultry abattoir, ultraviolet, south korea

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