Summer & Your Eyes

The British summer is a cherished time of year. However, the very elements that define summer's charm – the warm intense sunlight and a heightened engagement in outdoor pursuits – can, paradoxically, introduce a range of challenges to our ocular health.

This comprehensive guide delves deeper into the common eye conditions that can surface or intensify during the summer months.

The Unseen Threat: UV Radiation's Impact on Your Eyes

We are well-versed in the perils of ultraviolet (UV) radiation for our skin, but the delicate tissues of our eyes are equally, if not more, susceptible to its damaging effects. Both UVA and UVB rays possess the capacity to penetrate the eye's structures, leading to both immediate, acute discomfort and a spectrum of chronic, long-term conditions.

1. Photokeratitis (Corneal Sunburn)

Often described as a "sunburn of the eye," photokeratitis is an acute, painful condition resulting from excessive exposure to UV radiation on the cornea – the clear, dome-shaped front surface of your eye. Common causes are direct sunlight reflecting off highly reflective surfaces like water, sand, snow (even in summer, think glaciers or high-altitude activities), or polished concrete. Welders are also susceptible without proper eye protection, leading to "welder's flash."

Mechanism: High-energy UV light damages the surface cells of the cornea and conjunctiva, leading to inflammation and cellular disruption.

Symptoms (typically appear 3-12 hours after exposure):

• Intense, stabbing eye pain: Often described as feeling like sand or grit is perpetually in the eye.

• Foreign body sensation: A persistent feeling that something is lodged in your eye.

• Profound redness: Bloodshot appearance due to dilated blood vessels.

• Excessive tearing (epiphora): The eyes attempt to flush out the irritant and lubricate the damaged surface.

• Extreme sensitivity to light (photophobia): Even moderate light can feel blindingly painful.

• Blurred vision: Due to corneal swelling and surface irregularities.

• Swelling of the eyelids (oedema): As a result of inflammation.

• Muscle spasms around the eyes: Caused by pain and irritation.

Management & What to do: Photokeratitis is generally self-limiting, resolving within 24-48 hours as the corneal cells heal. However, the discomfort can be significant.

• Seek medical advice: If symptoms are severe, vision is significantly impaired, or they persist beyond 48 hours, consult your GP, an optician, or an A&E department. They can rule out other more serious conditions and provide symptom relief.

• Pain relief: Over-the-counter pain relievers like paracetamol or ibuprofen can help.

• Artificial tears: Preservative-free lubricating eye drops can provide comfort and aid healing.

• Avoid bright light: Stay indoors or wear very dark sunglasses. Some professionals may recommend patching the eye in severe cases, but this is less common now.

• Rest your eyes: Avoid screen time or activities that strain your eyes.

• Do NOT rub your eyes: This can worsen the damage.

2. Pinguecula and Pterygium

These are non-cancerous growths on the conjunctiva, the transparent membrane that covers the white part of your eye (sclera) and lines the inside of your eyelids. Their development is strongly linked to chronic exposure to environmental factors: UV radiation, wind, and dust.

• Pinguecula: A yellowish, slightly raised patch or bump, typically located on the white of the eye, usually on the side closer to the nose (nasal side), but can occur on the temporal side. It's a deposit of protein, fat, or calcium. It does not grow onto the cornea.

• Pterygium: This is a fleshy, wedge-shaped growth of conjunctival tissue that can start as a pinguecula and then progressively extend over the cornea. If a pterygium grows large enough to encroach upon the pupil, it can directly obstruct vision.

Symptoms:

• Redness and irritation: Especially pronounced in windy, dry, or sunny conditions.

• Gritty or foreign body sensation: A feeling of something constantly in the eye.

• Dryness: The uneven surface can disrupt the tear film.

• Blurred vision: If a pterygium extends over the cornea, causing astigmatism or directly blocking the visual axis.

• Cosmetic concern: The visible growth can be unsightly.

Management & What to do:

• Prevention is key: Consistent use of UV-protective sunglasses (wraparound styles are best) and wide-brimmed hats is crucial to prevent formation and slow progression.

• Symptom relief: For mild irritation, over-the-counter artificial tears can lubricate the eye and reduce discomfort.

• Anti-inflammatory drops: Your optician or GP may prescribe mild steroid eye drops for acute inflammation.

• Surgical removal: This is considered if the pterygium is growing rapidly, significantly impacting vision, causing persistent severe irritation, or for cosmetic reasons. However, recurrence after surgery is a notable risk, sometimes with more aggressive growth. Post-operative care often includes anti-scarring agents or radiation.

3. Cataracts

While predominantly associated with ageing, evidence indicates that chronic, unprotected exposure to UV radiation significantly accelerates the development and progression of cataracts. A cataract is a clouding of the eye's natural lens. As it becomes opaque, light struggles to pass through to the retina, leading to impaired vision.

Mechanism: UV radiation can cause oxidative damage to the proteins within the lens, leading them to clump together and lose their transparency.

Symptoms (develop gradually over months or years):

• Cloudy, hazy, or blurred vision: Often described as looking through a frosty or dirty window.

• Fading or yellowing of colours: Colours may appear dull or less vibrant.

• Glare and halos around lights: Particularly problematic at night or in bright sunlight, making driving difficult.

• Poor night vision: Especially difficulty with headlights.

• Frequent changes in spectacle prescription: As the lens changes shape and density.

• Double vision in one eye: (Less common but can occur with certain types of cataracts).

Management & What to do:

• Prevention: Lifelong UV protection with sunglasses and hats is the most effective preventative measure.

• Early detection: Regular comprehensive eye examinations (every 1-2 years, or more frequently as advised by your optician) are vital for detecting cataracts in their early stages.

• Observation: In early stages, when vision is only mildly affected, lifestyle adjustments (better lighting, anti-glare glasses) may suffice.

• Cataract Surgery: When cataracts significantly impair daily activities, vision can be restored through a highly successful surgical procedure. This involves removing the clouded natural lens and replacing it with a clear, artificial intraocular lens (IOL). It is one of the most common surgical procedures performed globally.

4. Macular Degeneration (AMD)

Age-related Macular Degeneration (AMD) is the leading cause of irreversible vision loss in older adults in developed countries. It specifically affects the macula, the small central part of the retina responsible for sharp, detailed, colour vision and for tasks like reading and recognising faces. While AMD is a complex condition with multiple risk factors (age, genetics, smoking, diet), strong epidemiological studies suggest that prolonged, unprotected exposure to UV light may increase the risk of developing AMD and accelerate its progression.

Mechanism: Chronic UV exposure can contribute to oxidative stress and damage to the retinal cells, particularly those in the macula, leading to their degeneration.

Symptoms (affect central vision, peripheral vision usually remains intact):

• Blurred or distorted central vision: Straight lines may appear wavy or bent (metamorphopsia).

• Difficulty seeing in low light: Reduced contrast sensitivity.

• Dark, blurry, or blank spots in central vision: Scotomas.

• Difficulty recognising faces.

• Colours appearing less vivid.

Management & What to do:

• Prevention: Consistent UV protection from an early age is a crucial preventative step.

• Lifestyle factors: A healthy diet rich in leafy green vegetables, omega-3 fatty acids, and antioxidants, alongside not smoking, significantly reduces risk.

• Regular eye exams: Essential for early detection, especially if you have risk factors.

• Monitoring: Use an Amsler grid at home to self-monitor for distortions in your central vision.

• Treatments: While there is currently no cure for AMD, treatments exist to slow its progression, particularly for the 'wet' form (neovascular AMD). These include anti-VEGF injections into the eye (e.g., Avastin, Lucentis, Eylea) which inhibit the growth of abnormal blood vessels.

The Dry and Irritating Side of Summer: Environmental Factors

Summer air, often drier than other seasons, coupled with the use of air conditioning, fans, and increased exposure to wind and environmental allergens, can exacerbate dry eye symptoms.

1. Dry Eye Syndrome

Dry eye syndrome (DES), also known as ocular surface disease, occurs when the eyes do not produce enough tears, or when the tears produced are of poor quality and evaporate too quickly. This leads to insufficient lubrication of the eye surface.

Mechanism: Disruption of the tear film's delicate balance (aqueous, mucin, and lipid layers) due to environmental factors, gland dysfunction (e.g. Meibomian Gland Dysfunction), or inflammation.

Symptoms:

• Stinging, burning, or scratchy sensation: A persistent discomfort.

• A feeling of sand or grit in the eyes: Even when nothing is there.

• Redness of the eyes: Due to irritation and inflammation.

• Sensitivity to light (photophobia).

• Excessive tearing (reflex tearing): A paradoxical symptom where the eye produces a flood of poor-quality tears in response to irritation, which then evaporate quickly, worsening dryness.

• Blurred vision: Often fluctuating, especially after prolonged activities like reading or computer use.

• Difficulty wearing contact lenses.

• Eye fatigue.

Management & What to do:

• Over-the-counter artificial tears: Start with preservative-free drops, as preservatives can irritate sensitive eyes with frequent use. Use them regularly, not just when symptoms flare.

• Environmental modifications: Use a humidifier indoors, especially when air conditioning is on. Avoid direct fan or AC airflow onto your face. Wear wraparound sunglasses outdoors to shield eyes from wind and dry air.

• Lid hygiene: For MGD, warm compresses and gentle lid massage can help express oils from the Meibomian glands.

• Omega-3 fatty acids: Dietary supplements (e.g., flaxseed oil, fish oil) may improve tear film quality.

• Prescription eye drops: If over-the-counter remedies are insufficient, an optician or ophthalmologist may prescribe anti-inflammatory drops (e.g., cyclosporin or steroid) or discuss punctal plugs (tiny silicone inserts to block tear drainage).

• Consult a professional: Persistent or severe dry eye requires professional assessment to determine the underlying cause and tailor treatment.

2. Allergic Conjunctivitis (Hay Fever Eyes)

Airborne allergens like pollen (grass, tree, weed), mould spores, and pet dander become abundant during summer, triggering an allergic reaction. These allergens inflame the nasal passages and throat and can cause significant irritation to the eyes.

Mechanism: When allergens come the ocular surface, they trigger the release of histamine and other inflammatory mediators, leading to the characteristic allergic response.

Symptoms:

• Intense itching:

• Redness (hyperaemia): Bloodshot appearance due to dilated blood vessels.

• Watery discharge: Clear, watery tearing.

• Swollen eyelids (chemosis and oedema): The conjunctiva can become very swollen and jelly-like.

• Burning or gritty sensation.

• Sensitivity to light (photophobia).

• Associated nasal symptoms: Sneezing, runny nose, itchy throat.

Management & What to do:

• Minimise exposure:

  • Check daily pollen forecasts and try to stay indoors during peak times (early morning and early evening).

  • Keep windows and doors closed at home and in the car.

  • Shower and wash hair after being outdoors to remove pollen.

  • Change clothes immediately after coming indoors.

  • Avoid drying laundry outside.

• Over-the-counter antihistamine eye drops: These provide rapid relief by blocking histamine receptors. Some drops combine an antihistamine with a mast cell stabiliser for longer-term effect.

• Oral antihistamines: Can help with systemic symptoms, including eye itching.

• Cool compresses: Apply a cool, damp cloth to closed eyes to soothe irritation and reduce swelling.

• Avoid rubbing your eyes: This only releases more histamine and worsens the itching and inflammation.

• Prescription drops: If OTC remedies are ineffective, your GP or optician may prescribe stronger antihistamine/mast cell stabiliser drops, or even short courses of steroid eye drops for severe cases (under strict supervision due to potential side effects).

• Contact lens wearers: Consider switching to daily disposables or wearing glasses during peak allergy season.

Summer is a season to be enjoyed. By adopting these detailed preventative measures and understanding the potential risks, you can ensure your eyes remain healthy and comfortable.