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Protect eyes at higher elevation

Eye protection essential at altitude to defend against cumulative UV exposure

Ophthalmologist Dr. Nathan Hamburger (right) works with patient Rusty Kossler at the Helm Eye Center in Steamboat Springs. In addition to checking vision, Hamburger screens patients’ eyes for damage from UV rays.

As a dad of three children ages 10 and younger, Dr. Nathan Hamburger knows that keeping active children clad in protective sunglasses is a tough task. His family will start out on a hike with sunscreen applied and wearing hats and sunglasses, and, halfway through the hike, he notices some of the kids’ sunglasses have disappeared.

But as a medical doctor and busy ophthalmologist in Steamboat Springs, Hamburger also knows how vitally important it is for people recreating at higher elevations to protect their eyes from short- and long-term damage by blocking as much ultraviolet rays from the sun as possible. He said eye conditions that affect people who spend a lot of time outdoors without sunglasses can develop earlier in life in higher elevation locations, such as Routt County.

The best recourse for eye damage is prevention. Hamburger said the major causes of increased eye problems at higher elevation are UV exposure and dry air.



“Sunglasses are not a bad idea for babies. The sooner the better, because it’s all about cumulative exposure,” said Hamburger, 40, who also worked as an eye doctor at lower elevation in Michigan. “These eye conditions can happen in less time at higher altitude because the UV is more intense.”

The Hamburger family, from Routt County, including dad, Nathan, an ophthalmologist, and mom, Allison, a physician assistant, try to keep sunscreen, hats and sunglasses on their three children during hikes. Courtesy photo

Steamboat Resort Ski Patrol Director Wes Richey, who has been on patrol for 42 years, said skiers at the resort generally come well-prepared, but visitors sometimes lose sunglasses and goggles. So patrol staff try to keep loaner goggles on hand at the upper mountain patrol stations. Goggles are also strongly recommended to protect against hazards, such as tree branches and ski poles. Hamburger said he has treated a dad who had a pole-to-the-eye injury.



One eye condition Hamburger sees almost every day is pterygium, which is sometimes called surfer’s eye. Pterygium is a growth of pink, fleshy tissue on the conjunctiva (the clear covering over the white part of the eye) caused by UV light exposure. This tissue takes a long time to grow, usually starting on the side of the eye closest to the nose and growing toward the pupil area, yet Hamburger sees the condition during exams of patients as young as late 20s.

Pterygium develops in people who spend a lot of time outdoors without sunglasses, from ranchers to mountain bikers to longtime skiers. The doctor said the condition is irritating to the eye and can induce blurry vision or astigmatism that could require or change corrective lenses.

When pterygium is problematic, it can be removed surgically and covered with a conjunctiva graph, but the condition can reoccur after surgery. Hamburger said he performs up to 10 of those surgeries each year.

The second most common higher elevation concern Hamburger helps to identify is skin cancer on the face, especially on the lower eye lids. Other common areas for skin cancer on the face and head include nose, top of ears and scalp for people with shorter or less hair. The cancer ranges from basal cell carcinoma, which is unlikely to spread but can cause local damage, to squamous cell carcinoma that may spread to melanoma, which is more serious and can spread to other parts of the body.

The eye doctor can excise skin cancer from the lower eyelid, or more extensive work, including reconstruction, would be performed by an eyelid plastic surgeon in Denver.

The third most common condition Hamburger diagnoses in the mountain climate with lower humidity is dry-eye syndrome. The symptoms are burning, foreign body sensation, blurry vision, eye fatigue and redness. Lubricating eye drops are an important treatment followed by staying hydrated and eye protection, as well as “some evidence that omega-3s may be helpful,” he said.

Patients with dry-eye syndrome can use lubricating drops with preservatives up to four to six times per day and preservative-free drops even more often.

“Most people do one to two drops a day and ask me why it’s not working,” said Hamburger, an eye doctor for 13 years who has practiced locally at Helm Eye Center for almost four years.

Locals may also suffer from contact-lens-related issues and irritation from dryness, so the doctor advises reducing the length of time of contact wear.

Hamburger said he sees “plenty” of visitors in the ski town with a painful, temporary eye condition called photokeratitis, which is caused by exposure to UV rays or from acute dryness from wind. The condition can be likened to sunburn or wind burn to the corneas.


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