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Question
Posted : January 3, 2012
corneal erosion
I have a history of epithelial basement membrane dystrophy treated successfully by laser surgery many years ago (perhaps about 15 years ago). I am on holidays in Bali and have just had two episodes of very similar symptoms. The first was about 10 days ago. I woke with mild pain in my eye which settled within about 3 hours. The second was today, when I was woken at 4.30 a.m. by severe pain in the eye. I happened to have with me some artificial tear drops and applied them. The pain settled within a couple of hours. I have travelled to quite a remote area of Bali for the purpose of doing some diving and I do not have access to medical care and I only have another 3 days left of my holiday!
My opthalmologist back home has advised me not to dive (in fact not to snorkel or even swim) as I almost certainly have a corneal erosion and there would be a risk of infection.
Is this correct advice?
If so, how long would I have to wait before diving (also swimming or snorkelling) after the symptoms settle completely?
Answer
Posted : January 3, 2012
Thanks for the query.

I have to agree with the advice of your ophthalmologist - if a corneal erosion is present, then there is a risk of infection and hence the safest option is to avoid exposure to marine water altogether. Such water is "infested" (for want of a better word) with a myriad of plankton, algae and all sorts of other unusual organisms which could cause a nasty infection of the globe of the eye if the corneal protection has been breached.

Luckily corneal abrasions/erosions heal relatively quickly - probably not within the period of your remaining days in Bali, but certainly within a month or two. I would advise a visit to your ophthalmologist when you get back - they can stain the eye and examine it with a slit lamp to ensure the cornea has fully healed. Once healing has occurred you can dive again.

Regards

Dr O
Answer provided by Dr Oliver Firth
Dr Ollie Firth
Additional Comment

Posted : January 4, 2012 by - marioninoz
Thank you for your reply.
I guess your opinion would not change if I told you that, around 36 hours later and having applied artificial tears during the night, my eye continues to feel 100% normal, In addition, I have aquired some Chloramphenicol ointment which I could use prophylactically. And finally, I would be more than happy to snorkel rather than dive, where as long as the water is reasonably calm, I would feel fairly confident of keeping my mask on ... tomorrow would be my last chance before returning home - that would be 48 hours since the 2nd incident. By the way, I wonder whether the 2nd incident was precipitated by quite strong physical pressure from a tight sleeping mask over my eyes.
Additional Comment

Posted : January 5, 2012 by - Dr Oliver Firth
Well I guess it all depends on how much risk you are willing to accept. Personally I would not want to risk a serious eye infection in this situation, but each to their own!

Regards, Dr O
Additional Comment

Posted : January 8, 2012 by - marioninoz
Posted: Sun Jan 08, 2012 1:00 am Post subject:
Just to provide a bit of feedback ... my opthalmologist revised his opinion after I'd told him my symptoms had resolved 100% (within a few hours of the episode). He felt the pattern confirmed the diagnosis of corneal erosion and once I was asymptomatic it was safe to dive and snorkel. I decided to snorkel only, had a wonderful experience and am now safely home with no problems - the snorkelling was 3 days ago.
I thought I would snorkel rather than dive because I wanted to minimize the risk of getting sea water into my eye and felt there was less risk of this with snorkelling. However it does seem to me that even if no water visibly enters the mask, there is still a bit of sea water in contact with the eyes causing that slightly stinging feeling. I have yet to have my eyes checked by my opthalmologist (who is in holidays) but remain completely asymptomatic.
Thank you very much for your advice and I do appreciate the need to be very careful - and especially when you don't have the opportunity to examine the patient yourself!
Additional Comment

Posted : January 9, 2012 by - Dr Oliver Firth
Thanks for the feedback, and glad to hear you appear to be well. It is impossible to quantify the risk of infection with a corneal erosion/abrasion, so medical advice tends to err on the side of caution. Such advice is inevitably influenced by experience of cases that could have been avoided - I have seen a number of nasty corneal ulcers directly attributable to marine water exposure. As you say, it is nigh on impossible to prevent all water entering the mask space, and if there is a potential breach in the corneal defences, then to my mind infection risk is increased significantly. Still, hopefully you have got away with it!

Regards, Dr O
Disclaimer:
The views expressed by Dr Firth & Dr Jules are their own and the publishers accept no liability for the advice and views expressed by Dr Firth , Dr Jules, or other users, which are provided as a general service to divers. Users are warned that secondary posts are the views of other users and may not be medically correct.
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