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the examination. Eyelid eversion with a cotton-tipped applicator will help the examiner to
identify foreign bodies located on the upper tarsal plate. Once located, remove the foreign
body with a cotton-tipped applicator after the eye has been anesthetized and the cotton-
tipped applicator moistened with tetracaine. The eye is then stained with fluorescein to
check for a corneal abrasion. If no foreign body is visualized, but symptoms persist,
vigorous irrigation with artificial tears or sweeps of the conjunctival fornices with a
moistened cotton-tipped applicator after topical anesthesia may be successful in removing
the foreign body.
Dry eye: Symptomatic dry eye is commonly encountered in the wilderness, especially in
mountainous areas where the air is very dry and significant wind is often present. Dry eye
is usually bilateral and may result in secondary tearing. There may be a history of
previous episodes of symptomatic dry eye. Treatment is with artificial tears used as often
as needed to relieve symptoms. Dehydration may contribute to this condition. The use of
sunglasses may provide protection from the wind and be of significant benefit in
managing this disorder.
Contact Lens Overwear Syndrome: Contact lens overwear syndrome may be another
source of ocular discomfort in the wilderness. The considerations here are much as
described in the section above on dry eye, except that the symptoms are magnified by the
presence of contact lenses. Contact lens rewetting drops and sunglasses are the first line
of management. Should these measures be ineffective in relieving symptoms, remove the
contact lenses. If significant SPK are present on fluorescein staining, use gatifloxacin
0.3% drops or moxifloxacin 0.5% drops four times a day until the SPK have resolved. Do
not replace contact lenses until the eye is symptom-free. An individual who wears contact
lenses in the wilderness should always carry a pair of glasses that can be used if contact
lens problems arise.
Episcleritis: Episcleritis is a generally benign and self-limited inflammation of the
episclera (the lining of the eye between the conjunctiva and the sclera). There is usually
sectoral redness without discharge and often a history of previous episodes. Discomfort is
typically mild or absent. The presence of severe pain, photophobia, or decrease in vision
suggests another diagnosis. Episcleritis is often misdiagnosed as conjunctivitis, but the
lack of a discharge and the typical sectoral redness of episcleritis will help to differentiate
between the two disorders. Episcleritis usually resolves without treatment over several
weeks. If symptoms are troublesome, prednisolone 1% drops four times a day for 3 days
may be used.
Subconjunctival hemorrhage: This condition may occur in the absence of trauma, often in
association with coughing. Although the bright red appearance of the blood overlying the
sclera may be alarming to the affected individual, this disorder is innocuous and will
resolve without treatment over one to two weeks.
