Article from July, 2012

eyeforaneye

Time for a quiz, readers.  What is the most exquisitely sensitive organ vulnerable to injury in the field?  No, it is not THAT one, silly…..it is the eye.  While most expeditions have basic first aid supplies, rarely do these kits contain items specifically for eye injuries without forethought.  Eye disorders that require evacuation fortunately are rare but even common problems easily treated in civilization can be painful or leave one miserable in the field.

The most important personal supplies to bring on expedition include ophthalmic antibiotic (ofloxacin drops, bacitracin/polymixin ointment), a topical ophthalmic anesthetic (tetracaine), eye drops for allergy (neosynephrine), a broad spectrum oral antibiotic, and artificial tears.  If you wear contacts, bring extra lenses, supplies, and glasses.  Most importantly, bring sunglasses.  There are several other items that a trained medical person will bring that are beyond the scope of this discussion.

A red eye is a symptom of inflammation seen with many acute eye disorders encountered on expeditions according to Stan Spielman FN ’96, a University of Miami ophthalmologist and veteran of many tropical expeditions. Common causes include viral or bacterial conjunctivitis, allergy, a foreign body (splinter, dirt, etc.), corneal abrasion, contact lens complications, irritation from chemicals or smoke, snow blindness, and trauma.  An infection is usually accompanied by a discharge.  Treatment of conjunctivitis depends on the cause.  University of Utah ophthalmologist and high altitude expert Geoff Tabin FN ’85 states that in most cases, the best treatment is antibiotics and allergy eye drops.  Do NOT patch the eye if infection is suspected.  For chemical causes, the best therapy is copious irrigation followed by antibiotics.

A common cause of ocular pain is from corneal abrasion which results from physical damage from a foreign object, including contact lenses.  Defects in the cornea can be identified using a fluorescein dye and ultraviolet (UV) light, something easily performed by medical personnel.  Ophthalmic antibiotics should be used and the eye patched but only if the abrasion occurred in a non-contaminated environment, unlikely in the field.  Abrasions usually heal within a few days and evacuation is not needed.

A foreign body in the eye is another cause of irritation and pain.  The eyelid must be retracted from the eye and a light and possibly magnification can identify the culprit.  Most foreign bodies can be removed by irrigation but if not easily removed, the foreign body is likely imbedded and removal should not be attempted in the field, necessitating evacuation.

Mention should be made of problems associated with contact lenses.  The common problems seen with contacts include infections and abrasions.  The key here is to remove the lens and treat as above.  It is important to note that some very serious infections can occur with the use on non-sterile water or solutions so those must be avoided and hands should be cleaned with antiseptic wipes or gel preparations before handling lenses.  Interestingly, people who have had corneal corrective surgery by the LASIK or PRK procedures are not at any increased risk in various austere environments.  However, those with the earlier corrective types of surgery such as radial keratotomy may have visual defects because of a shift in the cornea due to changes in pressure.  It is recommended for travelers with these types of surgery to seek the advice of their ophthalmologist if going to locales where pressure changes are expected such as at high altitude.

Trauma to the eye presents a significant challenge on an expedition and diagnosis is often difficult and treatment limited according to both Drs. Spielmen and Tabin.  Traumatic injuries result in closed eyeball trauma, retinal detachment, rupture of structures including the eyeball, fractures of the skull with eye involvement, lacerations, and penetrating injuries.  However, the significance of the eye injury may not be readily apparent so it is a good rule of thumb to evacuate anyone who has double vision, protracted or progressive visual impairment, loss of central vision, an open wound, or irregular pupils.  In the field, these are all difficult to deal with and the best course is to stabilize the patient, provide pain medication, cover the surface gently, administer oral antibiotics, and evacuate immediately.

Solar keratitis is a problem that occurs in any environment where eyes are exposed to high levels of UV light.  Corneal damage can arise from either direct or reflected light and is enhanced by dry air or wind, so high dry altitudes, deserts, snow, and oceans pose problems.  Blurred vision and extreme pain several hours after exposure are the hallmarks of solar keratitis.  Topical anesthetic drops, artificial tears, and antibiotics are the treatments employed.  Victims should be reassured that vision will return and pain subside.  Prevention of this problem is by sunglasses; the lens color does not matter and even plastic absorbs UV well.  In particularly higher risk areas, like on snowfields or high altitude, wrap-around sunglasses are advised.  Most importantly, it is imperative to wear sunglasses even on cloudy days as the UV light penetrates clouds.

 

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This article was published in The Explorers Journal

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