Eye injuries in the extreme environment ultra-marathon runner

Abstract

SUMMARYWe present the case of an ultra-marathon runner who developed a painful irritated eye due to prolonged exposure to high wind speed and sub-zero temperatures causing transient freezing and subsequent abrasion of the cornea. We recommend that all ultra-marathon runners racing in windy or exposed conditions should wear wrap-around eye protection or goggles. If runners present to checkpoints or after the race to primary care or the emergency department with ocular pain, corneal freezing and abrasions should be considered. Management should include ocular examination and withdrawing the runner from harmful conditions. BACKGROUND

Recurrent unilateral corneal edema in a 54-year-old patient after endurance sports in low temperature

“…Primary superficial corneal damage to cold wind was not present. 10,11 Hence, there seems to be a fortuitous combination of cold temperature, physical activity, and, possibly, susceptibility of the corneal endothelium. The discrete accumulation of fluid in the LASIK interface during these episodes of edema is likely a secondary effect associated with uneven attachment and healing of the LASIK flap to the stromal bed.…”

The eye in extreme environments

“…Transient eye problems were reported in the case of an ultra‐marathon runner exposed to high wind speed and sub‐zero temperatures. After reporting decreased visual acuity, ‘cloudy’ vision, the sensation of having a foreign body in the eye and observing generalized oedema of cornea, the diagnosis of freezing of the cornea was made (Cope & Kropelnicki, 2015). Corneal oedema can also be caused by stromal lactate accumulation as a consequence of thermal stressors, enhanced glycolysis (Moshirfar, Ding, Ronquillo, Birdsong, & Murri, 2018), or attributable to hypoxia resulting from exercise‐induced hypoxaemia (Dempsey & Wagner, 1999; Winkle et al., 1998).…”

Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management

“…Wilderness sports carry a risk of ocular injuries. 48 Although corneal injuries and edema are most often reported in the wilderness athlete, 49,50 high altitude retinal hemorrhages are also known to occur, 51 but there have been no studies on high altitude’s effect on diabetic retinopathy. 48,52 Regardless, any retinal damage carries additional importance in individuals with diabetes, and it is recommended that individuals with diabetes have a dilated fundoscopic examination prior to ascent to high altitude.…”