• Certificatory guidance for common eye conditions


    Conjunctivitis

    Cases should be assessed individually. Viral conjunctivitis is associated with sore throat and lymphadenopathy and is infectious. Conjunctivitis often requires topical medication (e.g. antibiotic drops) and can impact on certification when purulent secretions are copious or when drop administration is very frequent. Please note that topical eye ointments may cause reduced vision for a period after application.

    Minor eyelid infections

    Blepharitis, meibomian cyst (chalazion) or stye (hordeolum) do not normally impact on certification unless they cause discomfort or reduction in vision (e.g. due to mechanical ptosis or induced astigmatism). Topical treatment with warm compresses and topical medication, if required, can present practical problems with a busy flying schedule and so cases should be assessed individually.

    Keratitis

    Certificate holders should be assessed as unfit on diagnosis. Restoration of fit status can be considered once the condition has resolved and the applicant has stopped all medication, or occasionally when it is accepted that the condition requires low dose maintenance topical therapy. In the latter case, a consultant ophthalmology report is required (see CAA’s guidance on ophthalmic reports). Class 1 holders may be required to undertake assessment with a consultant aviation ophthalmologist, particularly if residual scarring is present. Consideration should be given to underlying causes (e.g. zoster).

    Anterior Uveitis

    Certificate holders should be assessed as unfit on diagnosis. Restoration of fit status can be considered once the condition has resolved and the applicant has stopped all medication, or occasionally when it is accepted that the condition requires low dose maintenance topical therapy. In the latter case, a consultant ophthalmology report is required (see CAA’s guidance on ophthalmic reports). Consideration should be given to underlying causes (such as ankylosing spondylitis), especially if the uveitis is recurrent.

    Posterior Uveitis

    This is associated with underlying disease (inflammatory bowel disease, sarcoidosis, etc). Certificate holders should be assessed as unfit on diagnosis and a formal consultant ophthalmologist report is required (see CAA’s guidance on ophthalmic reports) and should include the results of all systemic investigations. A return to fit status should be considered bearing in mind visual function, medication and identification and control of any underlying cause.

    Trauma

    Eye injuries sufficiently severe to require medical attention will require a formal ophthalmological report. Cases should be assessed individually and suspension of the validity of the medical certificate may be required. Class 1 and 3 holders may be required to undertake assessment with a consultant ophthalmologist.

    Cataract

    This is compatible with fit status provided that:
    a.visual standards are met; and
    b.there are no symptoms of glare, halos etc.
    Please refer to “Guidance following eye surgery”.

    Retinal Detachment

    Certificate holders should be assessed as unfit on diagnosis. Consultant ophthalmologist reports will be required. Restoration of fitness status is possible provided that the effect on visual function is such that the visual standards are met. Peripheral retinal tears treated successfully with laser can be considered for restoration of fit status following recovery from successful treatment. In complex retinal detachment resulting in loss of peripheral field, certification should be discussed with a CAA Medical Assessor. Please refer to the visual field guidance and substandard vision in one eye guidance.

    Central Serous Retinopathy

    Certificate holders should be assessed as unfit on diagnosis. Restoration of fitness status is possible when the condition has resolved or when no further improvement to vision is expected provided that the visual standards are met. If necessary, please also refer to the substandard vision in one eye guidance.

    Acquired Disorders of the Macula

    Certificate holders should be assessed as unfit on diagnosis as macular disorders can cause significant distortion (metamorphopsia) without necessarily reducing vision to below acceptable limits. Fitness may be reconsidered when ophthalmological reports are received. Restoration of fitness will be considered on an individual case basis as there is such a wide spectrum of macular disease severity. If necessary, please refer to the substandard vision in one eye guidance.

    Optic Disc Drusen

    This is compatible with certification provided that visual acuity and fields are acceptable and that these are monitored at a frequency to be determined in discussion with a CAA Medical Assessor (usually annually initially).

    Glaucoma and Ocular Hypertension

    The initial diagnosis should be reported to the CAA/AME and visual function assessed. In uncomplicated cases routine follow up reports (including visual fields when required by NHS/ RCOphth guidance) can be taken to the AME at each medical. In severe cases, please refer to the visual field and substandard vision policies, as well as the
    guidance on eye surgery. Applicants with any form of open or closed angle glaucoma may be considered for certification provided that the consultant ophthalmology reports confirm an acceptably low rate of recurrence (see CAA’s guidance on ophthalmic reports).