Stephen Brodovsky MD, FRCSCStephen Brodovsky MD, FRCSCUniversity of ManitobaUniversity of ManitobaWinnipeg, MBWinnipeg, MB

Travel Health:Travel Health: iTips iTips for Travelfor TravelVision 2020: ChallengesVision 2020: Challenges in Globalin Global

Eye CareEye Care

Travel Health:Travel Health: iTips iTips for Travelfor Travel

Dual Objectives:• Describe common ocular problems experienced by

traveling Canadians• Describe eye diseases and aid programs in the

developing world

Travel Health:Travel Health: iTips iTips for Travelfor Travel

Common travel problemsCommon travel problems

• “Pink eye”• Dry eye• Contact lens related problems• Viral, bacterial or allergic conjunctivitis• Corneal infections

• Flashes and floaters• Trauma:

•Corneal abrasions•Blunt trauma

Cartoon

“Pink Eye”Usually refers to a viral or bacterial conjunctivitis90% are viral and will resolve without antibioticsUsually associated with an URTI

Conjunctival injection: one or both eyesMucopurulent dischargeLids crusted shut in am, swelling +/-, cellulitisMay have a pre-auricular lymph nodeOther family members have been affected

Treated with topical antibiotics: eg. Polysporin, Ciprofloxacin or Erythromycin drops

“Pink Eye”Can also be allergic: itchy and bilateralSeasonalTreated with a combination drop (topical antihistamine & mast cell stabilizer) eg. Patanol, Zaditor

“Pink Eye” treatment for travel

Topical polysporin is available over the counter and is useful for the common bacterial pathogens (Strep, H. Flu, Staph)1 drop (not 2 to 3) qid for 7 days is all that is requiredPrescription drops such as ofloxacin or ciprofloxacinRemember it is usually viral!

Pink Eye = Dry Eye?

Dry Eye: anatomy

Symptoms include:

•Redness

•Irritation

•Foreign body sensation

•Tearing

•Blurred vision

Dry Eye: Symptoms

• common ocular complaint resulting from •decreased tear production •excessive evaporation

•Tear deficient dry eye:•Sjogren’s associated with connective tissue disease (Rheumatoid arthritis)•Non-Sjogren’s (primary or 2ndary)

•Evaporative dry eye•Blepharitis with obstructed Meibomian glands (assoc with Rosacea)•Blink and lid positional disorders

Dry Eye : etiology and classification

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Dry Eye: Travel tips

Exacerbated by air travel (dehumidified air)Worse in dry environments: deserts, air conditioningMore common in women, especially with onset of menopause.

Dry Eye: RecommendationsRemove contact lens prior to flightUse artificial tears (bottled or preservative free)Deal with dry eye symptoms prior to travel

Contact lens problems

Dry eyeRed eye: overwear, dirty lenses, reaction to lensesCorneal ulcers

Contact lens problems

Worn by 12% of the populationSoft disposable contacts are most popularDaily disposable, Biweekly, MonthlyHard contact lenses in special circumstancesAnnual incidence 0.2% (1 in 500)Sleeping in contacts increases the risk of infection 5-10 fold

Contact lenses: Prevention

Discourage bad care habitsOver-wearing disposable lensesSleeping in contact lensesSwimming in contacts in tropical areasOld casesOld solutions

Corneal Ulcers: Symptoms

Red eyeSevere pain (mistaken for a scratch/abrasion)TearingDischargeWhite spot on the cornea whose visibility with the naked eye depends on the severity of the ulcerLight sensitivity (photophobia)

Contact lenses: corneal ulcers

Contact lenses: Travel suggestions

Daily disposable contact lensesBackup glassesTopical broad spectrum antibiotic??

Polysporin vs flouroquinolone (topicalciprofloxacin)

Flashes & floaters Figure

Flashes and FloatersCommon symptom in

Myopes (near sighted individuals)Persons aged 50-70 years of age with posterior vitreous detachmentsFollowing cataract surgery

Posterior Vitreous Detachment (PVD)

70% of individuals will have a PVD by age 70

Overall 10 - 15% will have a retinal tear which may lead to a retinal detachment

Retinal detachment

Retinal detachment

Starts with floaters and flashing lightsPt notices a shadow in their peripheral vision which gradually approaches the center of their vision (over hours/days/weeks)Should be repaired as an urgent/emergent problem especially once central vision is affected

Trauma

Corneal abrasionsBlunt or penetrating injuries

Corneal Abrasions

Usually due to trauma from a finger, tree branch or projectile

Corneal abrasions: Treatment

Patch with antibioticsTopical antibiotics and NSAIDBandage contact lens

Trauma-Blunt injuries: punch, ball, etc-Penetrating: ocular emergency

hyphemaCorneal laceration

Challenges in Global Eye Care

Vision 2020: WHO Challenges in Global Eye Care

Worldwide: 45 million people are blind80% is treatable or preventable50% of childhood blindness is avoidable90% of blind people live in the developing world

Number of blind expected to reach 76 million by the year 2020

Vision 2020: Global Facts 2008

Vision 2020: Main Causes of Blindness

Cataract (surgically treatable) 39%Refractive error (correctable with glasses) 18%Glaucoma 10%Macular Degeneration (retinal) 7%Corneal Scars 4%Trachoma 3%Other (diabetes, congenital) 19%

Vision 20/20: SolutionsTraining eye care professionals (ophthalmologists, ophthalmic assistants, technicians, opticians) andImproving accesibility and quality of careIncreasing public awareness that blindness can be treatedAdvocating for improved eye care services for woman, children and rural populations

Orbis: FLYING EYE HOSPITAL

Vision 20/20: Solutions

Many aid organizations:OrbisSeva Canada and Seva FoundationUnite for SightFred Hollows Foundation (Australia)Harold Ridley Foundation (UK)

CYBERSIGHT® and INTERNATIONAL FELLOWSHIPS

COUNTRY HOSPITAL-BASED PROGRAMS

ETHIOPIA 13 projects

Ethiopia has one of the highest levels of avoidable blindness in the world.

Yet there is only one ophthalmologist for every million people – almost all practice in Addis Ababa while 85% of the population live in the rural areas.

Ethiopia

TrachomaEthiopia

Trachoma is one of the oldest and most painful of all eye diseases. In some areas, 50% of children under 6 have active trachoma – an infection which causes the eyelids to turn inwards and rub against the eye eventually causing corneal ulceration and blindness.

Orbis: Lid effects of trachoma

Trachoma: Misdirected lashes causes scarring

Ethiopia:

ORBIS has introduced a surgical training program for local nurses so they can perform basic surgical procedures in order to make trichiasis treatment accessible to rural communities.

Trachoma

Orbis: Trachoma surgery

Mass treatment with Azithromycin has led to massive reductions in infection rates with decreased ocular sequelae

Orbis: Corneal disease5% of treatable blindness is due to corneal diseaseScars from infections, trauma, Vitamin A deficiencyand trachoma

Ethiopia: Orbis Corneal Transplants

Ethiopia: Orbis Corneal Transplants

Seva: Nepal Cataract surgery

Seva: Nepal Cataract surgery

Cataract surgery video

Seva: Nepal Cataract surgery

Seva: Nepal stats Cataract surgery

Seva: Nepal Cataract surgery

Tropical Eye Infections• Leprosy (Mycobacterium leprae): Africa, Asia, Central and South America. Corneal scarring and lid disease

•Toxoplasmosis (Protozoan parasite) Uveitis (intra-ocular inflammation)

•Trachoma: East Africa. Chronic conjunctivitis, lid disease with secondary corneal scarring

•Hydatid disease (cysticercosis): worldwide (associated with domestic animals) Orbital lesions and intra-ocular cysts

•Dengue fever (arboviral infection) (south east Asia, Brazil & Caribbean) blurred vision due to retinal hemorrhages & inflammation

•Onchocerciasis: Sub-Saharan Africa•River Blindness. Nematode transmitted by black fly bites•Corneal scarring and uveitis (intraocular inflammation)•Treatable with Ivermectin

•Schistosomiasis: Sub-Saharan Africa, China, South Asia• Fresh water exposure with intraocular inflammation (uveitis/retinitis)

•Loa loa•Sub-Saharan Africa•Sub-conjunctival worm•Not sight threatening

Tropical Eye Infections

Reference:

Conclusion•Summary of common ocular travel concerns/conditions

•Causes of global blindness

•Spectrum of tropical eye diseases