Occupational Exposure to Solar Radiation and the Eye: A Call to Implement Health Surveillance of Outdoor Workers

Main Article Content

Alberto Modenese https://orcid.org/0000-0002-0850-5615
B. Ralph Chou
Balázs Ádám
Tom Loney
Marilia Silva Paulo
Thomas Tenkate
Fabriziomaria Gobba


solar radiation, adverse eye effects, occupational exposure, optical radiation, ultraviolet radiation, cataract, pterygium, macular degeneration, eye tumours, health surveillance, outdoor workers, outdoor work, ocular melanoma


Globally, hundreds of millions of outdoor workers are exposed to solar radiation (SR) for the majority of their working life. Such occupational exposure is known to induce various adverse health effects to the eyes, mainly related to its ultraviolet (UV) component. The present work is a call-to-action aimed at raising the awareness on the need of health surveillance for the prevention of the chronic ocular diseases in outdoor workers. Photo-chemical chronic damage can induce pterygium at the outer layer of the eye and cataract in the lens. Considering carcinogenic effects, rare squamous-cells tumors of the cornea and/or of the conjunctiva and the ocular melanomas are associated with UV radiation exposure. Solar UV-related eye diseases should be considered as "occupational diseases" when there is sufficient exposure in workers, but they are often not recognized, and/or frequently not reported to the national compensation authorities. Therefore, to prevent the burden of these work-related eye pathologies, an adequate risk assessment with identification of appropriate preventive measures, and a provision of periodic health surveillance to the exposed workers, in particular considering those at higher risk of exposure or with individual susceptibility, should be urgently implemented.

Abstract 558 | PDF Downloads 464


1. Cherrie JW, Cherrie MPC. Workplace exposure to UV radiation and strategies to minimize cancer risk. Br Med Bull. 2022;144(1):45-56. doi:10.1093/bmb/ldac019
2. World Health Organization. Environmental Burden of Disease Series, No. 13. Solar ultraviolet radiation: Global burden of disease from solar ultraviolet radiation. Available online: https://apps.who.int/iris/bitstream/handle/10665/43505/9241594403_eng.pdf?sequence=1&isAllowed=y (accessed on 27 April 2023).
3. Razzaque MS. Sunlight exposure: Do health benefits outweigh harm?. J Steroid Biochem Mol Biol. 2018;175:44-48. doi:10.1016/j.jsbmb.2016.09.004
4. International Commission on Non-Ionizing Radiation Protection; International Labour Organization; World Health Organization. Protecting, ICNIRP 14/2007. Protecting Workers from Ultraviolet Radiation. Available online: https://www.icnirp.org/cms/upload/publications/ICNIRPUVWorkers.pdf (accessed on 27 April 2023)
5. Internationals Standard Organization and Commision Internationale d’Eclairage ISO 17166:1999(E) CIE S 007/E-1998. Erythema reference action spectrum and standard erythema dose. Spectre d'action érythé-male de référence et dose érythémale normalisée. Available online: https://www.iso.org/obp/ui/fr/#iso:std:iso:17166:ed-1:v2:en:sec:A (accessed on 27 April 2023)
6. International Labour Office. Occupational Safety and Health Series n° 72. Technical and Ethical Guidelines for Workers’ Health Surveillance. Available online: https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---safework/documents/normativeinstrument/wcms_177384.pdf (accessed on 27 April 2023)
7. International Commission on Occupational Health. International Code of Ethics for Occupational Health Professionals. Available online: http://www.icohweb.org/site/multimedia/code_of_ethics/code-of-ethics-en.pdf (accessed on 27 April 2023)
8. International Commission on Non-Ionizing Radiation Protection (ICNIRP). ICNIRP Guidelines on Limits of Exposure to Incoherent Visible and Infrared Radiation. Health Phys. 2013;105(1):74-96. doi:10.1097/HP.0b013e318289a611
9. International Commission on Non-Ionizing Radiation Protection (ICNIRP). ICNIRP statement--Protection of workers against ultraviolet radiation. Health Phys. 2010;99(1):66-87. doi:10.1097/HP.0b013e3181d85908
10. Coroneo M. Ultraviolet radiation and the anterior eye. Eye Contact Lens. 2011;37(4):214-224. doi:10.1097/ICL.0b013e318223394e
11. Hohberger B, Bergua A. Selbst verursachte laserinduzierte Makulopathie im Jugendalter [Self-inflicted la-ser-induced maculopathy in adolescence]. Ophthalmologe. 2017;114(3):259-261. doi:10.1007/s00347-016-0293-x
12. Bachmeier I, Helbig H, Greslechner R. Retinopathia solaris : Eine Fallserie nach der Sonnenfinsternis am 20.3.2015 [Eclipse retinopathy : A case series after the partial solar eclipse on 20 March 2015]. Ophthalmologe. 2017;114(1):44-48. doi:10.1007/s00347-016-0286-9
13. International Commission on Non-Ionizing Radiation Protection (ICNIRP). Guidelines on limits of expo-sure to ultraviolet radiation of wavelengths between 180 nm and 400 nm (incoherent optical radia-tion). Health Phys. 2004;87(2):171-186. doi:10.1097/00004032-200408000-00006
14. Guly HR. Snow blindness and other eye problems during the heroic age of Antarctic explora-tion. Wilderness Environ Med. 2012;23(1):77-82. doi:10.1016/j.wem.2011.10.006
15. Sliney DH. Exposure geometry and spectral environment determine photobiological effects on the human eye. Photochem Photobiol. 2005;81(3):483-489. doi:10.1562/2005-02-14-RA-439
16. Bunsen RW, Roscoe HE. Photochemical researches – Part V. On the measurement of the chemical action of direct and diffuse sunlight. Proceedings of the Royal Society 1862;12:306.
17. Sengillo JD, Kunkler AL, Medert C, et al. UV-Photokeratitis Associated with Germicidal Lamps Purchased during the COVID-19 Pandemic. Ocul Immunol Inflamm. 2021;29(1):76-80
18. Asokan R, Venkatasubbu RS, Velumuri L, Lingam V, George R. Prevalence and associated factors for pter-ygium and pinguecula in a South Indian population. Ophthalmic Physiol Opt. 2012;32(1):39-44. doi:10.1111/j.1475-1313.2011.00882.x
19. Chui J, Di Girolamo N, Wakefield D, Coroneo MT. The pathogenesis of pterygium: current concepts and their therapeutic implications. Ocul Surf. 2008;6(1):24-43. doi:10.1016/s1542-0124(12)70103-9
20. Modenese A, Gobba F. Occupational Exposure to Solar Radiation at Different Latitudes and Pterygium: A Systematic Review of the Last 10 Years of Scientific Literature. Int J Environ Res Public Health. 2017;15(1):37. Published 2017 Dec 26. doi:10.3390/ijerph15010037
21. Malekifar P, Esfandiari H, Behnaz N, et al. Risk Factors for Pterygium in Ilam Province, Iran. J Ophthalmic Vis Res. 2017;12(3):270-274. doi:10.4103/jovr.jovr_85_16
22. Cullen AP, Chou BR, Hall MG, Jany SE. Ultraviolet-B damages corneal endothelium. Am J Optom Physiol Opt. 1984;61(7):473-478. doi:10.1097/00006324-198407000-00009
23. Taylor HR. Ocular effects of UV-B exposure. Doc Ophthalmol. 1994;88(3-4):285-293. doi:10.1007/BF01203682
24. Löfgren S. Solar ultraviolet radiation cataract. Exp Eye Res. 2017;156:112-116. doi:10.1016/j.exer.2016.05.026
25. Modenese A, Gobba F. Cataract frequency and subtypes involved in workers assessed for their solar radia-tion exposure: a systematic review. Acta Ophthalmol. 2018;96(8):779-788. doi:10.1111/aos.13734
26. Della Vecchia E, Modenese A, Loney T, et al. Risk of cataract in health care workers exposed to ionizing ra-diation: a systematic review. Med Lav. 2020;111(4):269-284. Published 2020 Aug 31. doi:10.23749/mdl.v111i4.9045
27. Tenkate T, Adam B, Al-Rifai RH, et al. WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of occupational exposure to solar ultraviolet radiation and of the effect of occupation-al exposure to solar ultraviolet radiation on cataract. Environ Int. 2019;125:542-553. doi:10.1016/j.envint.2018.10.001
28. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96(5):614-618. doi:10.1136/bjophthalmol-2011-300539
29. Nowak JZ. Age-related macular degeneration (AMD): pathogenesis and therapy. Pharmacol Rep. 2006;58(3):353-363
30. Fletcher AE, Bentham GC, Agnew M, et al. Sunlight exposure, antioxidants, and age-related macular degen-eration. Arch Ophthalmol. 2008;126(10):1396-1403. doi:10.1001/archopht.126.10.1396
31. Sliney DH. How light reaches the eye and its components. Int J Toxicol. 2002;21(6):501-509. doi:10.1080/10915810290169927
32. Modenese A, Gobba F. Macular degeneration and occupational risk factors: a systematic review. Int Arch Occup Environ Health. 2019;92(1):1-11. doi:10.1007/s00420-018-1355-y
33. International Agency for Research on Cancer (IARC). Radiation Volume 100 D. A review of human carcin-ogens. Lyon, WHO press 2012. Available online: http://monographs.iarc.fr/ENG/Monographs/vol100D/mono100D.pdf (accessed on 27 April 2023)
34. Yam JC, Kwok AK. Ultraviolet light and ocular diseases. Int Ophthalmol. 2014;34(2):383-400. doi:10.1007/s10792-013-9791-x
35. Lee GA, Williams G, Hirst LW, Green AC. Risk factors in the development of ocular surface epithelial dys-plasia. Ophthalmology. 1994;101(2):360-364. doi:10.1016/s0161-6420(94)31328-5
36. Guha N, Loomis D, Guyton KZ, et al. Carcinogenicity of welding, molybdenum trioxide, and indium tin ox-ide. Lancet Oncol. 2017;18(5):581-582. doi:10.1016/S1470-2045(17)30255-3
37. Chalada M, Ramlogan-Steel CA, Dhungel BP, Layton CJ, Steel JC. The Impact of Ultraviolet Radiation on the Aetiology and Development of Uveal Melanoma. Cancers (Basel). 2021;13(7):1700. Published 2021 Apr 3. doi:10.3390/cancers13071700
38. American Conference of Governmental Industrial Hygienists. Documentation of the Threshold Limit Val-ues and Biological Exposure Indices, 7th ed.; American Conference of Governmental Industrial Hygienists, Cincinnati, US, 2001
39. Peters CE, Pasko E, Strahlendorf P, Holness DL, Tenkate T. Solar Ultraviolet Radiation Exposure among Outdoor Workers in Three Canadian Provinces. Ann Work Expo Health. 2019;63(6):679-688. doi:10.1093/annweh/wxz044
40. Moehrle M, Dennenmoser B, Garbe C. Continuous long-term monitoring of UV radiation in professional mountain guides reveals extremely high exposure. Int J Cancer. 2003;103(6):775-778. doi:10.1002/ijc.10884
41. Wittlich M, John SM, Tiplica GS, et al. Personal solar ultraviolet radiation dosimetry in an occupational set-ting across Europe. J Eur Acad Dermatol Venereol. 2020;34(8):1835-1841. doi:10.1111/jdv.16303
42. Rosenthal FS, Phoon C, Bakalian AE, Taylor HR. The ocular dose of ultraviolet radiation to outdoor work-ers. Invest Ophthalmol Vis Sci. 1988;29(4):649-656
43. Duncan DD, Schneider W, West KJ, Kirkpatrick SJ, West SK. The development of personal dosimeters for use in the visible and ultraviolet wavelengths regions. The Salisbury Eye Evaluation Team. Photochem Photobiol. 1995;62(1):94-100. doi:10.1111/j.1751-1097.1995.tb05244.x
44. Sydenham MM, Collins MJ, Hirst LW. Measurement of ultraviolet radiation at the surface of the eye. Invest Ophthalmol Vis Sci. 1997;38(8):1485-1492.
45. Duncan DD, Muñoz B, Bandeen-Roche K, West SK. Visible and ultraviolet-B ocular-ambient exposure ratios for a general population. Salisbury Eye Evaluation Project Team. Invest Ophthalmol Vis Sci. 1997;38(5):1003-1011
46. Tenkate, T.; Strahlendorf, P. Sun Safety at Work: A Management Systems Approach to Occupational Sun Safety, 2020. Available online: https://sunsafetyatwork.ca/sites/default/files/ssp_guide_final-e-version.pdf (accessed on 27 April 2023)
47. European Commission. Non-binding guide to good practice for implementing Directive 2006/25/EC "arti-ficial optical radiation". Available online: https://op.europa.eu/en/publication-detail/-/publication/556b55ab-5d1a-4119-8c5a-5be4fd845b68 (accessed on 27 April 2023)
48. Alfonso JH, Bauer A, Bensefa-Colas L, et al. Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe - position paper of the COST Action StanDerm (TD 1206). J Eur Acad Dermatol Venereol. 2017;31 Suppl 4:31-43. doi:10.1111/jdv.14319
49. Backes C, Religi A, Moccozet L, Vuilleumier L, Vernez D, Bulliard JL. Facial exposure to ultraviolet radia-tion: Predicted sun protection effectiveness of various hat styles. Photodermatol Photoimmunol Pho-tomed. 2018;34(5):330-337. doi:10.1111/phpp.12388
50. Backes C, Religi A, Moccozet L, et al. Sun exposure to the eyes: predicted UV protection effectiveness of various sunglasses. J Expo Sci Environ Epidemiol. 2019;29(6):753-764. doi:10.1038/s41370-018-0087-0
51. International Organization for Standardization. ISO 16321-1: 2021 Eye and face protection for occupa-tional use - Part 1: General requirements. Geneva, 2021. Available online: https://www.iso.org/standard/62527.html (accessed on 27 April 2023)
52. American National Standards Institute. ANSI/ISEA Z87.1: 2020 American National Standard for Occupa-tional and Educational Personal Eye and Face Protection Devices. Washington, 2020. Available online: https://www.shannonoptical.com/files/ANSI-ISEA-Z87-1-2020.pdf (accessed on 27 April 2023)