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by Shlomit Schaal MD PhD

March 4, 2015

Answers to several common eye-related health questions

by Shlomit Schaal, MD, PhD, with Yam Schaal and Shivani Reddy, MD

We all know the feeling of getting out of the pool, physically sore yet pleasantly rejuvenated. But another perception many swimmers have immediately after practice is a stinging and burning sensation in and around their eyes. In fact, eye irritation, or “swimmer’s eye” as some call it, is one of the most commonly reported complaints from avid swimmers. So how exactly does swimming affect your eyes and what can you do to prevent swimmer’s eye?

Pool Chemicals and Your Eyes

The external surface of the eye is coated with a chemically complex thin tear film. This tear film is composed of multiple layers (water, protein, and lipid) that perfectly interact with each other not only to keep your eye lubricated, but also to keep your tear film from evaporating too quickly. Chemicals in pools, such as chlorine and saline, are used as disinfecting measures and can wreak havoc on the tear film, causing water from the film to evaporate, leaving the surface of your eye unlubricated and exposed to other chemicals and bacteria in the pool. Also, chlorine by itself can be a major irritant to the eye, resulting in a condition known as chemical conjunctivitis, an inflammatory condition that causes redness, irritation, itching, and tearing in the eye.

The best way to protect your eyes from harmful pool chemicals is to minimize exposure to them. Wearing goggles can offer good protection. Rinsing your eyes with fresh water while showering after a swim is a good way to get rid of chlorine deposited around the lids and lashes. For sensitive eyes, over-the-counter lubricating eye drops may restore the composition of a healthy tear film and provide immediate symptom relief.

Swimming and Dry Eye

Dry eye syndrome is one of the most common eye disorders observed in the adult population in the U.S. In this condition, either the baseline tear production is too low, or the tear film is chemically unstable and evaporates too easily. Factors such as exposure to cold air or dry heat, contact lens wear, and extended use of computer screens can exacerbate this condition. People who have dry eye syndrome experience redness, irritation, a gritty sensation in the eye, and blurry vision. Swimmers frequently complain of new onset or worsening of dry eye syndrome symptoms.

As described above, pool chemicals can interfere with the normal stability of the tear film, causing faster evaporation of tears from the eye and loss of the aqueous, or watery, layer of the tear film, causing the remaining tears to be thicker and poor lubrication for the eye.

Goggles can help minimize exposure to these chemicals and improve tear film stability. Patients suffering from dry eye syndrome can use artificial teardrops prior to putting on their goggles as a prophylactic measure, giving their eyes an extra layer of protection. Staying well hydrated prior to a swim is also essential, as this helps maintain the aqueous layer of the tear film. Swimmers with severe dry eye syndrome should see an ophthalmologist as prescription drops are also available to alleviate symptoms.

Contact Lenses in the Pool

Swimmers who suffer from nearsightedness (myopia) or farsightedness (hyperopia) may prefer to use contact lenses for their refractive correction while swimming. Contact lenses may seem like the ideal solution and can occasionally make your eyes feel less irritated after a swim. However, wearing contact lenses during swimming can be harmful at times.

Firstly, contact lenses act like scaffolding for pool chemicals and various substances in lakes and oceans, essentially providing a surface for bacterial growth and colonization. In fact, studies have shown microbial growth on contact lenses after just one swim. Contact lenses, therefore, essentially facilitate prolonged exposure to bacteria and chemicals, which can lead to complications such as corneal ulcers and, in some complicated cases, even vision loss. Contact lenses also tend to become dry and brittle more quickly under water, which can cause a lot of discomfort.

If you want to wear contact lenses while swimming, you must take extra-special care to prevent possible complications. Disinfect your lenses thoroughly with lens cleaning solution after every swim and change your lens case frequently. Daily disposable lenses are the ideal contact lenses for swimmers because they require very little maintenance. Another option for swimmers with eyeglass or contact lens prescriptions is to invest in a pair of prescription swimming goggles that can be purchased at most optical shops.

Swimming After Eye Surgery

Today, in ophthalmology’s golden age, many eye surgeries have become minimally invasive and now require minimal anesthesia while generally promising a benign post-operative course. However, surgical incisions do create an artificial opening between the outside environment and inside of the eye. Exposure to infections or chemicals during the early post-operative period (usually, the first six weeks after an eye surgery) when incisions are still closing and healing can therefore lead to devastating consequences such as permanent vision loss. Also, goggle wear in the early post-operative period may place higher pressure on surgical incisions and delay healing. Swimming after eye surgery should be left up to the discretion of your ophthalmologist.

Swimming and Chronic Eye Diseases

There is no definitive scientific evidence that swimming affects the progression of chronic eye conditions such as cataracts or retinal diseases such as macular degeneration. Although some concerns did exist over the last decade regarding the effect of increased pressure on the eye from goggles in patients suffering from glaucoma, a recent study has demonstrated no long-term effects in those patients.

Bottom Line: Wear Goggles!

Eye health is essential for all swimmers. Wearing protective swimming goggles and not wearing contacts while swimming can minimize most risks. It’s important to share your concerns and potential symptoms with your ophthalmologist. Incorporating the small changes discussed above will allow you to follow to your passion safely for a long time to come.

About the Authors

Yam Schaal is a student at DuPont Manual High School in Kentucky. She is a swimmer on Louisville’s Cardinal Swim Team.

Shivani Reddy is an ophthalmology resident in the Department of Ophthalmology and Visual Sciences at the University of Louisville in Kentucky. She enjoys recreational swimming.


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