It feels like a significant proportion of the Australian population has spent the cooler months enjoying a European summer vacation.
The joys of travel which were stifled during the pandemic have reignited in many, but with Aperol spritzes on the Amalfi coast, or yacht week in Croatia – come a 22-30 hour voyage across several continents.
As tourism returns to pre pandemic levels, it is important to medical practitioners and patients to be aware of the ocular complications that can arise during travel.
The low humidity inside aircraft can significantly affect the ocular surface, causing dryness and subsequent discomfort. Symptoms such as itch, pain, headache, watery eye, contact lens intolerance and headache can make a long trip very unpleasant.
The international headache society classifies ocular pain in air travellers, an “airplane headache”. Diagnostic criteria includes at least 2 attacks of severe pain in the fronto-orbital region lasting less than 30 minutes, with associated jabbing, stabbing or pulsating pain, with no other accompanying symptoms or any attributable to other causes. Airplane headaches tend to occur during descent or landing (but may occur during take-off). Males between 25-30 are most frequently affected. The underlying pathophysiology is thought to be related to sinus barotrauma or vasodilation in cerebral arteries due to changes in cabin pressure. Trigeminal nerve endings in the ethmoid sinuses are the likely cause of the fronto-orbital localisation. Analgesics and non-steroidal anti-inflammatory medications can be useful as prophylaxis. During an attack, Valsalva (or chewing, yawning or pulling on earlobes) or compression of the area may help alleviate discomfort.
Air travel does not pose a problem for patients with glaucoma of any severity, as the controlled atmospheric pressure of the airplane cabin compensates for the decrease in pressure at high altitudes that would otherwise cause in increase in intraocular pressure. The dim lighting in airplane cabins, however, can cause pupil mydriasis which does increase the risk of pupillary block in patients with risk factors for ‘angle closure’ glaucoma.
Some intraocular surgery requires patients to avoid flying for 2-6 weeks post operatively due to injection of gas into the eye. The most common of these is retinal surgery where sulphur hexafluoride or perfluoropropane are used to fill the globe intraoperatively. Even driving to high altitudes can cause gas expansion resulting in painful, and sight threatening increase in intraocular pressure.
As with any pre-existing medical conditions, it is recommended that patients pack sufficient ophthalmic medication in their carry-on baggage in their original bottles. It is best to use medication from the patient’s home country to ensure authenticity, accurate concentration, and tolerance. For patients with dry eye in particular, changes in humidity and temperature experienced during air travel, and in varying latitudes can exacerbate symptoms. Patients should consider increasing lubricant frequency to maintain control of their disease.
Headache Classification Committee of the International Headache Society (IHS). 2018. The International Classification of Headache Disorders, 3rd Edition. Cephalalgia, 38(1), pp.1-211
Lee JJ et al., 2023, Eye disease and international travel: a critical literature review and practical recommendations, Journal of Travel Medicine, 30(4), 1-9