Guidance for common eye conditions

Common eye conditions and the implication on aviation certification

Certificatory guidance for common eye conditions

Conjunctivitis
May require topical over the counter medication (eg, chloramphenicol and propamidine), but should not impact on certification unless causing reduction of vision or discomfort.  Note that some topical eye ointments may cause reduced vision immediately after insertion and so should not be used just before or during flight.

Minor eyelid infections
Such as chalazion (stye) do not normally impact on certification unless causing discomfort or reduction in vision due to ptosis or induced astigmatism.  Topical medications should not impact on certification unless causing reduction of vision or discomfort.  Note that some topical eye ointments may cause reduced vision immediately after insertion and so should not be used just before or during flight.

Blepharitis
Usually a chronic condition and should be managed to ensure no symptoms (eye rubbing, dry eye) during flight.

Keratitis/Anterior Uveitis
Should be declared “unfit” on diagnosis.  Recertification considered once condition resolved and off medication (or low dose topical therapy).  Consultant report required regarding diagnosis and follow-up.  Class 1 holders may be required to undertake assessment with a consultant aviation ophthalmology adviser, particularly if residual scarring is present.  Recurrent anterior uveitis should be investigated for systemic inflammatory conditions (such as ankylosing spondylitis).

Trauma
Eye injuries requiring ophthalmological assessment should be reported to the AME (Class 2) or AMS (Class 1).  The pilot may be made “”unfit”” whilst recovering, depending on the individual case.  Class 1 holders may be required to undertake assessment with a consultant aviation ophthalmology adviser.  Pilots with minor corneal abrasions should not fly with any discomfort or disturbance to vision, with or without treatment.

Pupil Abnormalities
Should be made “unfit” if recent onset and referred for further assessment by an ophthalmologist.  Recertification dependent on need for other investigations related to any underlying cause identified, and no symptoms (photophobia/difficulties with night vision).

Cataract
Can be certificated provided meets vision standards and asymptomatic (no glare, haloes etc).  If symptomatic or below vision standards with best correction, will be “unfit”.  Can be reconsidered following successful cataract surgery with an intraocular lens implant (see eye surgery guidance).

Posterior Uveitis
If active, should be declared “unfit”.  Certification can be reconsidered once treated provided vision and visual field standards are met.  Consideration should be given to any underlying cause (bowel or renal disease, sarcoidosis, parasitic infection).  Ophthalmological reports are required, and Class 1 holders may be required to undertake assessment by a consultant aviation ophthalmology adviser. 

Retinal Detachment
Pilot will be “unfit” on diagnosis.  Consultant reports will be required.  Recertification can be considered following successful treatment.  Recertification following surgery can be assessed individually.  Note retinal tears treated successfully with laser can be reconsidered for certification once confirmation that no further treatment is required.  Visual fields (monocular Esterman) are required and should be normal.  In complex cases including visual field loss, certification can be considered, following assessment by a consultant aviation ophthalmology adviser, for Class 1 with OML provided binocular visual field normal.  Class 2 cases with significant field loss should follow the ‘substandard vision in one eye’ guidance.

Central Serous Retinopathy
Pilot made “unfit” on diagnosis.  Recertification can be considered when condition resolved or when no further improvement to vision expected.  Pilot must be asymptomatic and adapted to any vision loss.  In cases of significant visual acuity loss, certification can be considered using the ‘substandard vision in one eye’ guidance.

Acquired Disorders of the Macula
Retinal drusen should be monitored.  Any distortion of central vision or reduction of visual acuity below standards, pilot should be made “unfit”.  Ophthalmological reports are required.  Recertification on individual basis but pilot must be asymptomatic and adapted to any vision loss.  In cases of significant visual acuity loss, certification can be considered using the substandard vision in one eye guidance.


Optic Disc Drusen
Fit provided visual fields (Esterman monocular) are acceptable.  Require submission of periodic (normally annual) field tests for ongoing certification.

Glaucoma
Initial diagnosis should be reported by the pilot to their AME who should then manage/advise the pilot appropriately. Class 1 cases should be referred onward to the AMS and Class 2 cases managed by the AME in consultation with the AMS.  Routine follow up reports including visual field results will be required.  If there is significant loss of field in one eye, certification can be considered using the ‘substandard vision in one eye’ guidance provided binocular visual field normal.  In cases of glaucoma in both eyes, binocular visual fields shall be normal.  Pilots undergoing glaucoma surgery will be made “unfit”.  Recertification is on an individual assessment basis.  Selective laser trabeculoplasty can, if successful, be recertificated subject to a satisfactory specialist report.  Assessment by a consultant aviation ophthalmology adviser may be required for Class 1 pilots following surgery for glaucoma, where pilots have significant visual field loss or aggressive glaucoma.