Sight for Sore Eyes

Know the difference between a minor vision problem and an emergency.

Field & Stream Online Editors

Saturday, September 29, 9 a.m.¿¿¿8 p.m.: Hit two fish in Three Forks Pool. Tag 30234 orange, 28 inches.

So begins the entry in Fred Nelson's 2001 fishing diary about his steelhead trip to British Columbia's Bulkley River. He beached two fish, one with an orange tag clipped to its fin. But by early afternoon he started having trouble seeing out of his left eye and assumed it was eyestrain. It was, he recalls, as if a curtain were being lowered over his eye.

By morning his left eye was almost completely blind. John Cunningham, a Wenatchee, Washington, family practitioner who was part of our group, rushed Nelson to the emergency room. The doctor on call consulted an ophthalmologist, who made arrangements for Nelson to be operated on the next day in Vancouver for a probable detached retina. Putting him on a plane was a calculated risk: Changing cabin pressure could cause more damage. But Cunningham knew that timing was most important. He did not know if his friend would ever again be able to see out of his left eye.

Nor did Steve Dunn or I, who made up the rest of the fishing party. If Cunningham had not been there, critical decisions would have rested in our hands. Had we put off driving to the emergency room, Nelson might have missed the flight to Vancouver and permanently lost his vision in one eye. All hunters and fishermen should be aware of what vision problems warrant immediate evacuation.

One Eye or Two?
Dr. Ken Younger, the Montana ophthalmologist who treated Nelson after his surgery, says that one clue to an injury's severity is whether it involves one eye or two. "Dramatic unilateral [BRACKET "one-eye"] vision loss," he says, "is a good reason to get out of the woods." In layman's terms, if a companion suffers the loss of vision in one eye only, whether it's caused by overt injury or not, consider the situation an emergency. A problem with both eyes is probably less serious.

The first symptoms of retinal detachment (the retina is the thin tissue covering the back of the eye) include seeing floating spots or flashing light, followed by the curtain drop Nelson experienced.

Another red flag is blood in the eye, indicating that the eyeball has been perforated or badly jarred. In addition to vision loss, symptoms often include a dilated pupil. In such cases, avoid putting pressure on the eye. Instead, make a doughnut-shaped shield (see illustration above) or cut off the bottom 2 inches of a paper cup and tape or tie it in place over the eye. If an object is lodged in the eye, such as a treble hook, leave it for a doctor to remove. Patch the eye so it doesn't move and patch the other as well, to keep the injured one from wandering in unison.

Less serious, though painful, is a scratch on the cornea. This often feels like there is a piece of grit in the eye, even if the eye is clean. Debris can easily get lodged on the inside of the eyelid. To clear it, instruct the victim to look down, then pull the eyelid up and over a smooth, blunt object (a cotton swab or matchstick), so that the eyelid turns inside out. Irrigate the area with clean water or gently wipe it with a moistened cloth. As long as there is no pus, patch the eye overnight or wad up a tissue and place it under an eyeglass lens (slight pressure on the eye gives a person with a scratched cornea some relief, according to Younger). Give the victim an anti-inflammatory, such as ibuprofen.

Any gradual swelling or puffiness of the soft tissue around a single eye, sometimes spreading into the eyebrow or upper cheek, indicates an infection and is cause for immediate evacuation. In addition, any vision problems that persist or cause any discharge or pus are reason to see your doctor.

Double Trouble
When both eyes become swollen or irritated, the culprit may be an allergic reaction, too much campfire smoke, or snow blindness (ssee "Blinded by the Light," above). These problems usually heal on their own, but if symptoms fail to improve after patching the eyes overnight, or if there is any discharge, see a doctor. At high altitudes, irritation can also be caused by contact lenses, which don't admit as much oxygen as they do at sea level. You may want to switch to glasses in the high country.

Minor Irritants
A sty is a pimple at the base of an eyelash. It will eventually disappear or come to a head. Because deliberately bursting a pimple can cause infection, Younger suggests you let nature take its course unless you are far from help and the sty impairs vision. In that case, use a sterilized knifepoint or fishhook held in very steady fingers to zap the zit.

Fred Nelson's detached retina was unusual in that it was not caused by any type of trauma. Prompt surgery saved his sight, although images in his left eye now appear smaller than they are and straight lines appear wavy. The complications haven't given much relief to the fish, though. The last entry in Nelson's 2001 diary chronicles a day on British Columbia's majestic Thompson, the stingiest steelhead river in the world. It begins, In Graveyard hit three steelies on a blue string leech....