Eyeworld

EW CORNEA 80 September 2018 by Rich Daly EyeWorld Contributing Writer Hawaiian ophthalmologist describes unique patients she has begun to see since volcanoes became active in recent months S usan Senft, MD, has long seen conjunctival inflam- mation cases from inter- mittent vog (volcanic air pollution secondary to sul- fur dioxide) among her patients on the Hawaiian island of Kailua-Kona. But striking new cases appeared after the Kilauea volcano became more active in recent months. Kailua-Kona, which is about 100 miles away from the active volcano, has received an unexpect- edly large amount of volcanic air pollution. "In the past, some days were better than others," Dr. Senft said. "From [normal pollution] people usually have itchy, burning eyes like an allergic conjunctivitis pattern. But what I have seen is different from that." In recent weeks, Dr. Senft has had two patients from Naalehu and South Point, which are located on her island and are the southern- most areas of the United States. Both patients came in with irrita- tion on the surface of their eyes on a day of "exceptional heavy active ash fall." "They had a punctate epithe- lial keratitis that was just in the interpalpebral fissure area—only the area that was exposed to where wind or air would hit the surface of the cornea," Dr. Senft said. "Under- neath the lids was fine. But in that little area, it was a stipple pattern of punctate epithelial erosion." The patients complained of pain, tearing, light sensitivity, and decreased vision. "It was different from the run of the mill allergic conjunctivitis that people get from the day-to-day vol- canic output, secondarily to sulfur dioxide in the air," Dr. Senft said. Residents of the Naalehu and South Point areas have received much more ash blowing in from the volcano than the rest of the Big Island, which is further northwest. "The trade winds blow from southeast to southwest normally around that area," Dr. Senft said. "If we are having a north wind, then it is all clear. If it is blowing from over there, for example the Hilo volcano side, which is only 12 miles away, it is clear air, but if it is from the Kilauea site, which is 100 miles away, we get the air pollution." Dr. Senft treated the patients, who presented the same day with the same complaints, with a combi- nation of mydriatics, mild steroids, and a long-lasting nonsteroidal, like bromfenac. "It only took a day or so for that to get better," Dr. Senft said. Ongoing treatments included lubricants and nonsteroidals once a day and steroids drops twice a day. "That seemed to help, and they haven't had it again," Dr. Senft said. "But it was at a time when there was a lot of ash in the air. Right now, I think the activity of the volcano is better." She noted that at that point up to 22 fissures were open and spewing volcanic gases in the air. By July, only one main fissure and eight actively flowing sites remained Volcanic eruptions present unique challenges W hen patients present with dry eye symptoms, one of the initial management strategies is to optimize their surrounding environment. For example, one should avoid direct air from heating or air conditioning vents from hitting the eyes, use a humidifier, lower a computer screen and reduce the computer brightness, take breaks from screen time, and wear sunglasses and even moisture chamber goggles in more severe cases. The prevalence of dry eye symptoms has been shown to be higher in cities with high levels of air pollution and in high altitude areas. Little has been shared about what patients experience who live in areas close to active volcanic eruptions. In this month's "Cornea editor's corner of the world," Susan Senft, MD, an ophthalmologist in Hawaii, shares some anecdotes about unique cases she has seen locally related to the intermittent ash blowing in from the Kilauea volcano. "Laze," another form of volcano-related pollutant, is discussed, and methods to best treat these patients are reviewed. Clara Chan, MD, Cornea editor Cornea editor's corner of the world continued on page 82

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