A Flight with Sore Eyes: Vision Care for Travelers.
--Frank Gillingham, MD
Waiting for the ferry from Sifnos to Athens on a windy day in August, Boston attorney Scott Martin (an alias) felt something fly into his eye. Severe pain began immediately and continued throughout the six hour ferry ride despite all attempts to wash the eye clean. After an emergency room nurse told him the queue was five hours long, Scott's wife successfully inverted his eyelid and removed a small cinder from it using the tip of a paper towel.
Fortunately Scott had no complications from either the foreign body or the make-shift surgery--today his vision is perfect. The lesson for health conscious travelers is that eye problems are common and many can be prevented.
Keep in mind the following general advice. Air pollution can be particularly irritating to the eyes, as can polluted water--make sure you check with local contacts about air quality and safe places to swim. Finding high quality eye protection in certain countries can be difficult so bring your own, particularly if you require it for your job. Carry an extra pair of prescription glasses, packed in your carry on luggage if possible--and bring a copy of your latest eyeglass prescription (a contact lens prescription won't suffice).
If you take eye medications regularly (e.g. drops for glaucoma), pack extra because your medication may not be available in your destination. Bring written copies of the prescription in case you're stopped by Customs. When you see your eye doctor, let her know that you plan to travel internationally and follow her advice.
The most common eye problems travelers report are dryness/irritation, fatigue, sun exposure, foreign bodies and infections. Here are some specific tips for these problems:
- Airline and air conditioned air are extremely dry. Consider using artificial tear drops, in flight, to keep your corneas moist and avoid red, tired looking eyes.
- Don't rub--it can aggravate the existing irritation.
- Naphazoline opthalmic drops (NAPHCON-A and other brand names) are an excellent over-the-counter medication for dry, irritated, red eyes (as always, read the warning labels to make sure it's ok for you to use). Many ophthalmologists recommend avoiding drops that contain tetrahydrozoline.
- Smoke will aggravate your eyes so avoid smoking flights (these still occur!) and smoky air. In certain parts of the world this may require some planning.
- Remember, a dry, irritated eye is susceptible to infection.
- Remove contact lenses in flight--or at least have your case, solutions, and glasses available so you can do so if they become uncomfortable. If you wear disposable lenses, the end of a long flight is a good time to toss them.
- For allergies ALOCRIL eye drops (Nedocromil Sodium) are an excellent choice. Talk this option over with your eye doctor.
- Don't overdo reading and laptop computer work.
- Use overhead lights or bring a portable, battery operated light with you. Improved lighting will reduce eye strain.
- Bring your reading glasses and pack an extra set. Use them.
- Rest your eyes by taking breaks and walking the cabin at least once an hour. Focus on a distant object for a while. Closing your eyes will allow the tearfilm to spread across the eyes.
- Just as your skin can get too much sun, so can your eyes. Be particularly careful if you're traveling to the equator, or any other destination that gets direct sunlight.
- Sand and snow reflect sunlight and increase its effect. Mountain climbers need to take particular precautions against snow blindness and learn basic first aid for snow blindness.
- Wear sunglasses or a wide brimmed hat (you may need both). You don't need to buy expensive sunglasses--generally even low cost sunglasses sold in the in the United States provide excellent Ultraviolet (UV) protection.
- Foreign bodies are most commonly blown into the eyes, as was the case with attorney Scott Martin, so take greater precautions on windy days, avoid open vehicles and highly polluted areas.
- Sunglasses can protect you from foreign bodies especially if they have side shields--one piece wrap around spectacles work well.
- Flushing the eye can help remove a foreign body. Use saline solution, if available, or boiled (and cooled) water to which one teaspoon of kitchen salt has been added to each liter. Eye flushing devices are a very useful addition to a first aid kit. Use large volumes of saline. Do not use high pressure and don't use tap water--the tap is too high pressure and the water itself can be irritating.
- Do not try to remove objects from the eye (the cornea) itself. You are likely to make the situation worse.
- You can invert the eyelid to remove a foreign body that is trapped on the inside of the lid. To do so look down, place a cotton tipped swab high on the eyelid and apply gentle pressure while using the eye lashes to pull up the lid margin.
- Self-diagnosing an eye infection can be difficult. If you have a red, painful eye that's not getting better, seek medical attention. It's always preferable to see an ophthalmologist, a fully trained medical doctor and surgeon who has done advanced training in diseases of the eyes. Few general physicians are comfortable managing eye disease and trauma so find a specialist if you can.
- You can gently flush the eye you believe may be infected with saline and use warm compresses to remove pus and discharge.
- Remember you might be contagious so don't share towels etc. with your travel companions.
- If you are going to a medically remote area, consider bringing prescription antibiotics for the eyes, in addition to sterile eye wash and an eye flushing device. OCUFLOX (ofloxacin ophthalmic solution) is an excellent multi-use antibiotic for the eyes.
- Treat sties with warm compresses and, if available, antibiotic eyedrops.
- If your eye is red or painful and all else fails, patch it with lightly applied tape, take an analgesic and get help.