Management

When on the aircraft, if eyes become red or gritty it will help if the blowers above the seats are turned off. Artificial teardrops should be instilled when the eyes feel gritty—up to as often as every 15min. Those with severe dry eye or who are sensitive to preservatives can use preservative-free drops (also available 'over the counter').

Corneal Abrasion and Recurrences

Many people who have had previous corneal scratches or abrasion may experience a recurrence. This presents with a sudden onset of pain, watering and photophobia, usually on waking or after minor trauma. Treatment is the same as for a corneal abrasion with chloramphenicol ointment. To prevent the pain recurring, patients are advised to use ocular lubricants and simple eye ointment before sleeping.

Contact Lens Wear

The special problems of contact lens wearers is discussed in a later section.

Following Eye Operations

It is generally safe to travel by air following most eye operations, including for squints, cataracts, glaucoma, corneal grafts and after laser treatment for diabetic eye disease.

Patients who have had surgery less than 6 weeks previously are often advised by doctors not to do too much heavy lifting of luggage. This is because it is possible that straining can increase the pressure in the eye and could lead to rupture of the fine sutures holding the cornea. Nowadays most cataract surgery is carried out using small incision without sutures and therefore this precaution is probably unnecessary. Most patients who have cataract surgery are elderly and are therefore unlikely to be carrying large suitcases unaided but common sense should prevail.

Accidental eye damage is more likely and a more common scenario when a patient has had cataract surgery and vision is still not clear. These patients are more susceptible to bumping their face and operated eye when travelling, especially when attempting to load the overhead luggage rack. It may be better in the first 6 postoperative weeks to wear an eye shield for the transit periods. These can be of clear acrylic material for those with only one good eye.

Accidental Injury to the Operated Eye

If a bump to the eye is sustained on board the aircraft an attendant can usually tell if something serious has happened by asking the patient if there is a change of vision. Next, look at the pupil of the eye and see if it is round. If it is of a teardrop shape then there may be a rupture of the corneal wound. There may even be a blood level in the anterior chamber. Ask the patient if he or she remembers the pupil being irregularly shaped just after surgery: sometimes this predates the operation.

If a rupture of the wound is suspected, do not panic, because most injuries can wait for 24 h for repair. Cover the eye with a clean eye pad and plastic shield if available, to avoid pressure on the eye. (If a shield is not available then fashion one out of a polystyrene coffee cup, just cutting an oval in it and taping it over the eye, without exerting any undue pressure.) Do not instil antibiotic creams and drops as the intraocular contents need preservative-free drops and some antibiotics, e.g. gentamicin, are retinotoxic; however, oral ciprofloxacin should be given and this has good ocular penetration. If patients have a blood level, hyphaema, in the eye then it is probably best to keep them sitting upright in the aircraft seat to assist resolution, but the position adopted is not very important.

Retinal Detachment Surgery

Following retinal detachment surgery the surgeon will advise whether or not it is safe to fly. It depends on whether and which substances were used to tamponade the detachment. This could be either gases such as air, SF6 (sulphur hexafluoride) or C3F8, or silicone oil. Gases injected into the eye during surgery will expand because of the lower cabin pressure and cause a dangerous rise in intraocular pressure (Figure 22.5). Patients who have had C3F8, a heavy gas, have to wait about 6 weeks to allow absorption of the gas. In the case of air 2-3 days is usually sufficient, and with SF6 2-3 weeks.

Ocular Pain after Aircraft Travel

Air travel can precipitate sinusitis. People with a tendency to sinus problems often experience pain around the eye on descent of the aircraft. This is due to a relative vacuum in the sinuses. Air is unable to enter due to mucosal swelling acting as a valve. Tenderness is present over the affected sinus. Nose blowing and nasal decon-gestants are helpful. Pain is usually described as a dull ache behind the eye. Ask the patient if the pain shifts on sleeping or tilting the head to one side: this will indicate the presence of fluid in the sinuses.

Recently, people have been choosing holidays to the Far East to take advantage of the cheaper dental treatment. Root canal work with a dental abscess can result in pain referred to the eye. Treat with oral amoxicillin and refer to a dentist for further evaluation.

Sinus problems can develop into orbital cellulitis.

Diabetic Retinopathy

Patients who need treatment for diabetic eye disease should finish the course of treatment prior to travel. There is no evidence that vitreous haemorrhages are more likely during aircraft travel. However, trauma should be avoided. Diabetics need to continue good control of the diabetes despite the variation in diet and daily

Cornea becomes hazy due to raised pressure
segment following retinal detachment surgery. (b) As the air cabin pressure falls, the air bubble expands within the eye, pushing the lens forward and compressing the anterior chamber

routine, as well as jet lag. Blurring of vision can occur during hypoglycaemic attacks.

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