News The Eyes have it ... As Timbuk3 said in 1986; “The Future’s So Bright I Gotta Wear Shades”. If only I had listened back then. Ian Smith, Grounds Manager at St Albans School, offers a timely word of warning about eye damage from UV rays, and the importance of wearing sunglasses I LOVE this profession, and one of the great joys is being outdoors, whatever the weather, along with the different variety of tasks I carry out though the year. I wouldn’t change a thing. I seem <strong>to</strong> be one of the lucky people who actually enjoys going <strong>to</strong> work in the morning. But, I write this as a word of caution <strong>to</strong> all of you. I’m sure that, by now, you have all been made aware of the damage that the suns UV rays can cause <strong>to</strong> our skin, so, hopefully, we either stay covered up or we use sunscreen. But, it is not just our skin that we should be protecting. Pterygium is caused by UV rays Back in 2002, I went for a routine eye test and I was diagnosed as having something called pterygium. This is a benign growth <strong>to</strong> the conjunctiva, growing from the nasal side <strong>to</strong>wards the cornea, and forming a wing-shaped growth. Apart from looking unsightly, by the end of the day my eyes felt sore and gritty. If I wanted <strong>to</strong> wear contact lenses, with this condition, it would not have been possible. The optician asked me if I had ever worked in the Middle East or Australia. I said that I hadn’t, but that I spent the majority of my time outdoors. I was asked if I wore sunglasses. I explained 8 PC 4 PC FEBRUARY/MARCH 2012 that I never had, and was <strong>to</strong>ld that this was the reason I now had this condition, as it is caused by UV damage. After the diagnosis, I always wore sunglasses when outside. Unfortunately, this was all <strong>to</strong>o late for me; the damage was done. Whilst wearing sunglasses slowed the growth down, now, ten years on, the pterygium had growth <strong>to</strong> the edge of my cornea. This meant that, if it was not removed, it would continue <strong>to</strong> grow, over the cornea, and blind me. An operation was the only option if I wanted <strong>to</strong> keep my vision. The operation is really not very pleasant. The pterygium is cut out and removed, a graft is then taken from under the eye lid and stitched in the hole where the pteryguim had been. I have had one eye done, and it is not something that I would wish on Ian’s eye one week after the operation, showing new skin graft on left side of eye anybody! In a month or so, I have got <strong>to</strong> go through it all again for the other eye. The operation will probably change the shape of my eye, meaning visits <strong>to</strong> the opticians after both operations <strong>to</strong> get appropriate new lenses for each eye of my glasses. We must learn the lessons from the past. I know people go on about health and safety regulations being a pain but, as we become aware of issues that affect people’s health, we must try <strong>to</strong> avoid the same things happening <strong>to</strong> the next generation of groundsmen and greenkeepers. As well as this recent condition, my ears ring at night through not wearing defenders when I first started out, working on the machinery that was much noisier back then. We used <strong>to</strong> have fertiliser delivered in 50kg bags, which I could hardly move, so my back aches constantly ... and, now, my eyes. These things can all be prevented through risk assessments, and using the appropriate machinery that falls within EU regulations. We should only be carrying manageable weights, or using lifting equipment where necessary. We should be making sure that we, and our staff, wear the appropriate PPE; not just <strong>to</strong>etec<strong>to</strong>rs, ear defenders and hard hats but, now we are aware of the issues with UV, should also include sun screen and sun glasses for 100% UV protection. All <strong>these</strong> things your employers should supply <strong>to</strong> you as part of your terms of contract. For all my moans and groans, I still feel very lucky <strong>to</strong> work in this industry. Hopefully, it will be even better for the next generation of both greenkeepers and groundsmen. It’s not a fashion statement wearing sunglasses, it’s <strong>to</strong> s<strong>to</strong>p long term eye damage. It’s not soft carrying only 20kg at a time, it’s safer for your long term health. Let’s learn from our past mistakes. As I started by saying; “The Future’s So Bright, I Gotta Wear Shades”. PTERYGIUM in the conjunctiva is characterized by elas<strong>to</strong>tic degeneration of collagen (actinic elas<strong>to</strong>sis) and fibrovascular proliferation. It has an advancing portion, called the head of the pterygium, which is connected <strong>to</strong> the main body of the pterygium by the neck. Sometimes, a line of iron deposition can be seen adjacent <strong>to</strong> the head of the pterygium called S<strong>to</strong>cker’s line. The location of the line can give an indication of the pattern of growth. The exact cause is unknown, but it is associated with excessive exposure <strong>to</strong> wind, sunlight, or sand. In addition, pterygia are twice as likely <strong>to</strong> occur in men than women. Some research also suggests a genetic predisposition due <strong>to</strong> an expression of vimentin, which indicates cellular migration by the kera<strong>to</strong>blasts embryological development, which are the cells that give rise <strong>to</strong> the layers of the cornea. These cells also exhibit an increased P53 expression likely due <strong>to</strong> a deficit in the tumor suppressor gene. These indications give the impression of a migrating limbus because the cellular origin of the pterygium is actually initiated by the limbal epithelium. As it is associated with excessive sun or wind exposure, wearing protective sunglasses with side shields and/or wide brimmed hats and using artificial tears throughout the day may help prevent their formation or s<strong>to</strong>p further growth. Symp<strong>to</strong>ms Symp<strong>to</strong>ms of pterygium include persistent redness, inflammation, foreign body sensation, tearing, which can cause bleeding, dry and itchy eyes. In advanced cases the pterygium can affect vision as it invades the cornea with the potential of obscuring the optical center of the cornea and inducing astigmatism and corneal scarring. Treatment A variety of options are available for the management of pterygium, from irradiation, <strong>to</strong> conjunctival au<strong>to</strong>-grafting or amniotic membrane transplantation, along with glue and suture application. As it is a benign growth, pterygium typically does not require surgery unless it grows <strong>to</strong> such an extent that it covers the pupil, obstructing vision or presents with acute symp<strong>to</strong>ms. Some of the irritating symp<strong>to</strong>ms can be addressed with artificial tears. However, no reliable medical treatment exists <strong>to</strong> reduce or even prevent pterygium progression. Definitive treatment is achieved only by surgical removal. Longterm follow up is required as pterygium may recur even after complete surgical correction.
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