Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

197

Section VI: Backcountry Medicine

Sometimes the abrasion can be seen by shining a flashlight across the eye from the side. Corneal abrasions are usually more annoying than serious. If no serious signs are present, treatment may be generic and symptomatic. Healing usually occurs within 72 hours.

A mild superficial infection will not cause seri- ous symptoms such as a headache or severe lid edema. Vision is blurred when tears or pus pass over the cornea, but it is otherwise unaffected. Pain is bothersome but not severe. The cornea remains clear, pupils respond normally to light, and extraoccular movements are intact. Most mild bacterial and viral conjunctivitis resolves spontaneously, but this is difficult to pre- dict. Contact lenses in use should be discarded. Allow the eyes to drain and do not use a patch. Field treatment using frequent irrigation and warm soaks may improve the symptoms. Treatment with antibiotics, either orally or as eye drops, is the preferred treatment, especially if symptoms appear to become progressively worse rather than stabilizing or improving. Serious infection evidenced by severe pain, headache, and lid swelling warrants an urgent evacuation along with antibiotic treatment. Note that an eye infection can be quite conta- gious. Instruct your group to avoid sharing towels, goggles, or face masks. Insist on frequent hand washing and discourage infected people from handling dishes and other objects that are used by other people. If you give antibiotic drops or ointment, treat both eyes even if only one eye is inflamed. Chemical Exposure Irritants like soap and caustic plant juices cause chemical conjunctivitis. In mild cases, the cornea remains clear. In severe cases, it may be pitted or cloudy in appearance. The treatment for chemical exposure is copious irrigation with water or saline solution. Expect mild redness following pro- longed irrigation, but it should begin to resolve within several hours following treatment. If it gets worse, the chemical may still be present. Irrigation should be repeated, and evacuation considered. Contact Lenses Contact lenses are another frequent cause of inflammation, especially at altitude. Dry air and reduced oxygen availability can cause corneal damage. Affected patients should use lubricating

Eye Problems

General Principles

45

Generic Treatment: • Sunglasses or goggles • Irrigation and lubrication • Antibiotic eye drops • NSAIDs • Pain free activity • Serious = Evacuation

*

©2018WMA

Sunburn Your first clue is a lot sun exposure without adequate eye protection. Your second is that the inflammation is limited to the sun-exposed part of the eye, leaving the conjunctiva under the lids unaffected. In severe cases, the cornea may become pitted and cloudy in appearance, causing the condition known as snow blindness. Fortunately, UV rays do not penetrate deeply, so damage is usually superficial. Symptomatic treat- ment with lubricating drops, painmedication, and protective glasses or goggles allow healing within several days. Contact lenses should be removed and not reused until symptoms are completely clear. Infection A viral or bacterial infection of the conjunctiva is what most people mean by the term conjunc- tivitis or pink eye. The typical signs and symp- toms include a yellow or green discharge that can stick the eyelids together during sleep. The eyelids themselves may appear slightly puffy and red- dened. The conjunctiva appears red with inflam- mation. The patient complains of an itching or burning sensation that may resemble a foreign body.