Ever think you could get a nasty sunburn -- severe enough to peel -- by attending an indoor event? Seems improbable, but it can happen. And it has -- three times recently in Middle Tennessee.
Not ony can your skin be affected, your eyes could also be injured. This can occur if someone spends an extended period of time in a gymnasium that has one or more damaged metal halide lamps.
If the protective glass that covers the bulb in that particular type of lighting is broken, UV light can filter out. Even one damaged bulb could cause injuries similar to welders' arc burns or snow blindness and can also lead to a peeling sunburn on the face and/or eyelids.
Three outbreaks of injuries from damaged metal halide lamps in Middle Tennessee were reported to the Tennessee Department of Health in the past year.
One outbreak at a fund-raising event in a youth center gym caused eight people to report photokeratis (severe eye symptoms); another occurred at a three-day wrestling tournament in a gym; and the third was among volleyball players at a municipal gym.
Through a collaborative effort among Vanderbilt University Medical Center, the Tennessee Department of Health and the Centers for Disease Control and Prevention, these outbreaks were studied and a report was published in the April issue of the journal Archives of Pediatrics and Adolescent Medicine.
"Who would have 'thunk' it…that you could go to a gym and aside from a twisted ankle, just by turning a switch expose yourself to a severe health hazard," said co-author William Schaffner, M.D., professor of Preventive Medicine and chair of the department.
"We're supposed to be limiting ourselves to UV light."
The lights can be damaged, Schaffner hypothesizes, when an object like an errant basketball hits them, cracking the protective outer shield.
The collaborators contacted 119 of the approximately 600 people that attended the three-hour fund-raiser. Those contacted represented one or more people seated at each of the 62 tables at the event. Every person contacted responded to the questionnaire; 18 people met the researcher's case definition of photokeratitis. Among those, 13 also had UVR burns on their faces, mostly on their foreheads or eyelids. And two people who wore UVR-protective eyeglasses had no eye symptoms but had UVR burns on their faces.
The shortest amount of time a patient with symptoms spent in one of the gyms was one hour; the average was three hours.
Patients experienced a variety of symptoms including: conjunctival infection, burning or itching, photophobia, foreign-body sensation, tearing, blurry vision, periorbital edema and skin erythema (lesions). Some patients felt it necessary to visit the emergency room, others sought treatment from their doctor or ophthalmologist. Symptoms ceased after 24 to 48 hours after treatment.
But how big a problem is this?
"Across the United States it probably happens in a sporadic fashion. And unless a large group came for treatment at the same medical center, it would probably go unnoticed," Schaffner said.
He added that, in addition to the fact that it's widely known that one should avoid getting a sunburn, there is some debate that the eye injuries could also be associated with subsequent cataract development.
Schaffner said that to prevent these injuries from occurring, cages should be put over the bulb or bulbs that automatically switch off once the glass is cracked should be used. But both solutions are costly, and the latter is not as readily available as the standard lights, he said.
And once a light is damaged, no one may readily notice, said Schaffner, since the bulbs are typically inspected or replaced once or twice a year.
"If you can't see the crack, you can't tell the light is damaged," he said.
The authors of the report chose not to recommend that new industry regulations be created. What they do hope in publishing the article is that it will bring the instances of outbreak to the physicians' attention, so that when treating a patient with these symptoms and under the similar conditions, the doctors would notify their local health department.
The lead author of the report was David L. Kirschke, M.D., a former CDC trainee at the Tennessee Department of Health. Other study authors were Timothy F. Jones, M.D., assistant clinical professor of Preventive Medicine and deputy state epidemiologist at the Tennessee Department of Health and Nicole M. Smith, Ph.D., of the CDC.
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