Textbook of Maritime Medicine

Introduction

In this chapter we shortly describe the problems of acute diseases and injuries of the eyes at sea. We do not go into details of anatomy or general clinical problems of the eyes, but offer simple methods for diagnosis and acute assistance.

Because treatment of eye conditions is difficult for the non-ophthalmologist, there is a fine line between local assistance and urgent transfer to specialized centres. Approximately 10 per cent of all eye injuries happen during work. Most of them can be prevented by appropriate measures, protection glasses, etc.

10.12.1   Injuries of the Outer Eye, the Deeper Eye and the Orbita

Blunt trauma

In general, the eye is well protected by its position deep in a bony cavity, as well as by the eye lids. A blunt trauma, which might frequently happen on board, may lead to haematoma of the eye lids which is easily visible. Only in severe cases a compression bandage for 1 – 2 days is indicated. Broken bones in the vicinity of the eye require medical assistance as soon as possible!

Injuries to the eyes may cause blood to appear in the anterior chamber of the eye (hyphaema), visible as a red segment below the pupil. This condition requires the attention of an ophthalmologist. This also is true for damage to the iris or lens without perforating injury because shockwaves might damage the retina in the posterior part of the eye.

Defects in the cornea

A direct trauma to the eye may lead to superficial defects of the corneal epithelium (the most external layer of corneal cells). This condition should be treated with a light compression bandage for at least 24 hours. If pain continues, ointment or drops contained in the medical chest should be applied.

Penetrating injury to the cornea

A penetration of the cornea can be diagnosed by means of a good pocket lamp by looking for irregularity of the pupil (not perfectly round) or dislocation of the iris (prolapse) as shown in Fig. 1. If the injury has caused damage to the lens, the lens will quite rapidly turn opaque (grey, non transparent). This can be observed by looking directly into the eye. Fig. 2.

All penetrating injuries require the attention of an ophthalmologist

Fig. 10.12.1 Prolapse of the iris

Fig. 10.12.2 Cataract

10.12.2   Foreign bodies

Sometime, e.g. working with a drill, foreign bodies might enter underneath the lids, or onto the cornea, sometimes causing pain. The foreign body can be located by turning the lids. This is done by pulling them off the eye at the eye lashes. Once located, the foreign body can be removed by the use of e.g. a cotton swab (Q-tip). If the foreign body is located on the conjunctiva (outside the cornea), ointment or drops and a compression bandage for 24 hours are helpful. In the rare cases where foreign bodies are stuck within the cornea anaesthesizing drops are helpful, even a cornea scraper. Superficial corneal defects – or defects after removal of foreign bodies – can be localized by use of fluorescine drops, resulting in green colour of the corneal defect.

10.12.3   Red Eye

Sometimes, even without an external injury eyes may turn “red”, indicating an abnormal filling of the superficial conjunctival or deeper scleral vessels. This may be caused by an internal inflammation due to bacteria or virus deriving from the general circulation. The local type of such an inflammation is called “iridocyclitis”. This condition can initially be treated with drops containing both antibiotics and corticoids. If the condition improves after 1 or 2 days without persisting pain or visual problems, control by an ophthalmologist is less urgent. However, corticoids may cause superficial corneal defects (fluorescein-test!) or even a rise in the intraocular pressure which could lead to glaucoma.

10.12.4   Manifestations of Eye Diseases

Glaucoma

Glaucomas are caused by an increase in the intraocular pressure.

The most common form is the chronic glaucoma which occurs even in younger people. The condition is often not recognised by the patient himself before damage to the nerve tissue, or visual defects have already occurred. The increased intraocular pressure cannot be measured on board. In severe cases the eye feels harder than a normal eye when pressure is applied to the eye with a finger tip. The condition is initially treated with special eye drops, but may later require surgery.

The acute glaucoma develops very rapidly and may within a few hours lead to serious pain and deterioration of the vision. In these cases the eye feels hard like a stone. The cause is generally a too short eye, a so called “hyperopia”. This may lead to a sudden closure of the chamber angle, caused by dilatation of the pupil, e.g. in darkness with consequent rapid increase in the intraocular pressure. Because this condition may lead to blindness within 1-2 days, a rapid transfer to specialist attention is mandatory.

Cataract

Cataract, a clowdy lens, is generally a disease of higher ages and very rarely occurs quickly.

10.12.5   Diseases of the Retina and adjacent Tissues

Diseases of the retina and the adjacent tissues occur mostly at high age. In some cases a circulation failure may cause bleedings that disturb the vision. These conditions require quick medical assistance.

In people with normal, healthy eyes, retinal detachment causing defects in the field of vision rarely happens. However, when they occur, rapid specialist attention is required.

Conclusion

In most cases eye problems can be diagnosed on board. Superficial injuries and mild diseases may be treated on board, whereas deep injuries and serious diseases need immediate medical assistance.