Burning wildlands, burning eyes

James P. DeVleming, O.D., hasn't seen a blue sky over Pullman, Washington, in nearly three weeks. His corner of the Evergreen State has been anything but recently, replaced by thick, drifting, gray smoke.

"It didn't really matter which way the wind was blowing, it came toward us, such that it smelled and looked like you were sitting around a campfire with the smoke drifting in your direction," AOA Trustee Dr. DeVleming notes.

Surrounded by fires in central Washington, northeast Oregon, northern Idaho—even British Columbia—Dr. DeVleming's community isn't in any immediate danger, but it doesn't have to be to suffer the fallout of a worse-than-predicted wildfire season. Currently, 62 wildfires are burning more than 1.6 million acres across nine western states; all told, some 48,300 fires have engulfed 8.1 million acres this year, the National Interagency Fire Center reports. That's roughly the size of Maryland. And, to flip the familiar saying: Where there's fire ...

... There's smoke—and lots of it. For days, even weeks, on end this fire season, communities in the northwestern U.S. have dealt with unhealthy to downright hazardous air quality from wildfire smoke. Often, it's not only the population immediately adjacent to a blaze but also those hundreds of miles downwind that contend with the choking, smoke-laden air.

"We didn't get too much 'big' particulate matter raining down like Seattle did with some 'ash storms' where people could make tracks in it as they walked, but our air was deemed hazardous by the weather service for many days in a row," Dr. DeVleming says. Those advisories urged people to stay indoors, or to wear sturdy respirator masks if outdoors.

Choking, scratchy, unbearable smoke

Wildfires eject deleterious carbon and dust particles into the air, some only microns in diameter. This fine particulate matter (PM), when inhaled, can cause inflammation, headaches and aggravate respiratory conditions, even in tiny concentrations. So, too, that ever-present smoky haze can wreak havoc on people's eyes, gumming up the ocular surface and causing discomfort.

At its worst, chronic smoke irritation may exacerbate the inflammatory response on the conjunctival surface and promote conjunctival scarring; however, most often, wildfire smoke aggravates dry eye symptoms, ocular allergies and worsens discomfort among contact lens wearers. Dr. DeVleming quickly went through a monthly supply of lubricating drop samples, and has been prescribing anti-allergy drops ever since the smoke billowed into town.

Tad Buckingham, O.D., assistant professor and attending physician at Pacific University College of Optometry and a captain with Forest Grove Fire & Rescue in Oregon, says alternating wind patterns have created a whirlpool effect of wildfire smoke, swirling about these communities for prolonged periods of time. When this happens, patients on the borderline of ocular surface issues—who might never have had ocular complaints—are affected hard.

"We've definitely seen an uptake in red-eye patients," Dr. Buckingham says, "A lot of these people are living with a little palliative care, and the same thing with contact lens patients—they're just getting by. But when you have something like this, as the smoke levels go up, it pushes them over the edge."

4 tips for clearing up smoky eyes

So, what does Dr. Buckingham suggest to these patients?

1. Remove patients from the environment. If possible, this is the easiest solution. Limit outdoor exposure where that smoke and PM can affect the ocular surface, and make sure car/home air conditioners are set to recirculate so outside air isn't drawn inward.
2. Suggest simple, palliative care options. Again, another easy, behavior-based therapy that patients can do on their own. Educate patients about what is happening on their ocular surface, then suggest self-treatments, such as nightly ointments, daily artificial tears or a cold compress.
3. Try more aggressive options if necessary. If patients fit into that borderline, ocular surface disease category, then it may be appropriate to step up treatment to include NSAIDs or steroids. Follow this up with education about how to keep patients from regressing.
4. Emphasize good hygiene. Contact lens patients may begin suffering discomfort or even slight inflammation, associated with the increased PM in the air. Educate patients about the importance of proper contact lens hygiene, e.g., adhering to the lens replacement and cleaning schedule, washing and drying hands before handling lenses, and never rinsing in water.
   

Optometry on the front

It's anticipated that the western fire season will peak mid-September, and hopefully conclude into October. But, Dr. Buckingham says, this has been one of the driest, warmest summers on record, a recipe for ripe fire conditions. Already, Forest Grove Fire & Rescue has deployed on four or five statewide conflagrations this season, whereas one or two a season is the norm.

Putting on his fire chief's hat-helmet—Dr. Buckingham lists off the wildfires his crew has been on this season alone: Warm Springs, Sisters, Eagle Creek and Columbia Gorge, and Brookings. The latter two fires threatened the communities of Portland and Brookings, drifting embers, smoke and ash into residential areas.

"I hate the cliché, but it's raining fire and hot embers down on many of those homes," Dr. Buckingham says. "A lot of times, even when these fires are contained, they're still burning. Even though you get a handle on them, they're still burning and producing the smoke that causes all these issues."

In far-eastern Washington, Dr. DeVleming isn't deterred by the gloom. He's looking for the bright side in the midst of the smoke: the fabulous sunrises, sunsets and moonscapes.

"The reds, violets and purples of sunset and the blood-red moons we have had, have been really amazing to look at," Dr. DeVleming says. But, really, there's only one color Dr. DeVleming—and Pullman—is hoping to see right now.

"Today was the first day I've seen blue sky."

Read more about how wildfire conditions could affect ocular health in the September 2016 AOA Focus, and doctors affected by the wildfires can apply for emergency financial assistance through Optometry's Fund for Disaster Relief.