July 26, 2023 – Summer is a time of fun and enjoyment, vacations, camp, and family trips. But many popular activities of summer, such as swimming, can have safety risks, especially to the eyes and ears.

Usiwoma Abugo, MD, an ophthalmologist in Norfolk, VA, and a spokesperson for the American Academy of Ophthalmology, shares the story of “Linda,” 16-year-old who recently consulted her because her right eye was red, irritated, and severely painful in sunlight. (Abugo changed the patient’s name and identifying information to protect her privacy.) Linda had no history of trauma, and nothing like this had ever happened to her before. She also had no illnesses that could account for these symptoms.

“When we stained the eye with a special dye that picks up defects on the surface of the eye, we found that she had a corneal ulcer,” Abugo said.

Linda usually wore contact lenses but couldn’t put them in, due to the pain in her right eye. She told Abugo that she occasionally swam with her contacts in because she’s “blind without them.”

Swimming with contact lenses is dangerous, Abugo said. Bacteria can grow on the lenses and cause serious infections. Linda needed more tests to see what organism was causing the problem.

“Because she had a vision-threatening central corneal ulcer, she had to put in eyedrops every hour until improvement was noted, and she had to be seen daily in clinic to make sure she was improving – or, more importantly, not declining,” Abugo said.

Linda ended up with a scar through part of her visual axis. “Further consideration is being done to decide whether she will need a corneal transplant in order to restore her vision,” Abugo said.

This injury could have been prevented by not swimming with contact lenses. Instead, Abugo said, people should wear prescription goggles – if you can afford them. 

Caring for the Eyes During Summertime

A new study published in the August issue of Ophthalmic Epidemiology looked at patterns of internet searches for eye symptoms, such as redness, dryness, pinkeye, and pain. The researchers analyzed publicly available Google Trends data from the United States from Jan. 1, 2015, to Dec. 31, 2019. Close to half of the searchers (45%) had seasonal patterns. For example, searches for eye redness peaked in the springtime, which the authors suggest might be connected with the peak time for allergies. Searches for eye pain were highest during the summertime, which they suggested might be linked to eye trauma.

Fireworks are a common cause of eye trauma, Abugo said. “Fireworks are beautiful but can also be blinding due to eye rupture, surface scratches, and burns, so ensure that you leave the handling of them to professionals,” she said. 

“If you’re in the presence of fireworks, even as a bystander, you should wear eye protection,” she continued. 

The American Academy of Ophthalmology recommends staying at least 35 feet away from ground-based fireworks and about 150 feet from aerial fireworks. 

Abugo suggests wearing sunglasses that provide 100% protection from ultraviolet rays when you’re outdoors. “This is the best way to prevent eye problems in the future, including cataracts or growth in the eyes.” 

She said that when sunlight shines off highly reflective surfaces, like water and sand (or, in the winter, ice and snow), “the sun’s UV rays burn the surface of the eye, causing pain, redness, blurriness, and even temporary vision loss.” Wearing the right sunglasses and a broad-rimmed hat for added eye protection can help.

So whether you’re playing sports or doing gardening or repair work, always wear proper protective eyeglasses. Abugo said more than half of all eye injuries occur at home, yet only about one out of every three people wear eye protection when they should.

Protecting Children’s Eyes

Abugo said that some “stunning statistics” surround eye injury in children under 18, many connected with fireworks. But along with summer fireworks, ATVs (all-terrain vehicles) are another culprit. Children under 16 account for 30% or more of ATV injury hospitalizations, which can range from eyelid cuts and fractures of the bones around the eye, to permanent blinding from optic nerve damage. “Because of these risks, protective eyewear and helmets must be worn by an operator of an ATV, but especially children,” she said.

She said there’s a “common misconception that babies and young children don’t need to wear sunglasses yet.” But everyone, regardless of age, should be wearing 100% UV-protected sunglasses, sunscreen, and hats whenever they’re outdoors. 

The Sounds of Summer

Jennifer Schumacher, a doctor of audiology and manager of medical communications at a company that makes hearing aids, said summer poses an array of issues that can damage the ears.

“One of the most common dangers comes from noise,” she said. This includes the noise of fireworks, but also includes noise from concerts and music festivals, which typically have very loud music and are more common in the summertime.

“When you’re listening to sounds that are not only above a certain level of loudness – usually regarded as around 85 decibels – but last a long time, which is what happens, during a music festival, that combination of volume and duration can permanently damage your hearing,” she said. The damage might not occur right away but can accumulate over time. “Overall, we’re seeing young people – even as young as teenagers – developing noise-induced hearing loss,” she said.

She advises wearing earplugs. “Certain types of earplugs, which are most accessible, are available at any corner drugstore and come with instructions about how to insert them correctly,” she said. 

But most of these earplugs are foam and, although they make loud noises safer, they also may muffle or distort the way the music sounds. “Listening to muffled or distorted music defeats the whole point of going to a concert because the music is less enjoyable,” Schumacher said. 

She advised getting earplugs that are custom-made to fit your ears. The overall volume is reduced but the frequency isn’t distorted and the sound isn’t muffled.

She acknowledged that these earplugs – which are may be purchased through an audiologist; an ear, nose, and throat doctor (ENT); or sometimes from a hospital – “aren’t cheap.” But they’re worth it if you’d like to preserve your hearing and enjoy your music at the same time.

Ear Care in Water and Air

Swimming also poses risks to the ears, Schumacher said. One is swimmer’s ear, usually a bacterial infection (although it can also be caused by a fungus) in the ear canal or outer ear. Symptoms can include itchiness in the ear, pain (often severe), trouble hearing (sound may seem muffled), or fluid or pus draining out of the ear. 

A less common condition is surfer’s ear, where a person can get a bony growth in the ear canal after repeated and prolonged exposure to cold water. 

“Since surfers tend to be in cold water at all times of the year, the condition is associated with them, but it can happen to other people as well, and can occur during the summer,” Schumacher said.

To avoid both conditions, it’s helpful to wear earplugs. Over-the-counter earplugs designed for swimming can do the trick, but if you’re really prone to ear infections or do a lot of swimming, it’s worth having earplugs that are customized to your ears, she said. These are different from the earplugs designed to reduce noise level. Rather, they’re specifically designed to protect the ears during water exposure. You can also get them from audiologists, ENTs, and sometimes from hospitals.

Air travel can be challenging to the ears, especially during takeoff and landing. “Air pressure changes with changes in altitude,” Schumacher said. “It’s the job of the ears’ eustachian tubes, which run from the eardrum into the throat, to equalize that pressure. But if that doesn’t happen, the ears can feel clogged or even quite painful.”

When you move your jaw by yawning, swallowing, chewing gum, or sucking candy, you can equalize the pressure. Sometimes, you’ll hear a “pop,” which is the eustachian tube opening up and equalizing the pressure in the middle ear. “For most people, that should be enough,” Schumacher said.

But if those jaw movements don’t work, she suggests special earplugs called EarPlanes, which are designed for this purpose. You can get them at pharmacies, often in airport gift shops, and online.

If neither of these measures is enough, you can consult a doctor, who might recommend or prescribe a nasal spray or other medication.

Schumacher said altitude issues can come up not only during air travel but also during mountain climbing. “If you’re changing altitudes, stop, take breaks, and engage in jaw movements. And it won’t hurt to try EarPlanes as well. Once you’ve reached your altitude and you’re used to it, that pressure should hopefully equalize and you won’t experience any more discomfort.”

During deep-sea or scuba diving, people may also have ear barotrauma, caused by the changes in pressure. “You should work with an experienced and highly trained diving instructor who can help you avoid this type of damage to the ear – and to other parts of the body as well,” she urged. 

Taking simple but thorough precautions can help ensure that you have a safe summer, free of injuries or long-term damage and filled with wonderful long-term memories.

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