Guidance for common eye conditions

Cases should be assessed individually:

• Bacterial conjunctivitis is most common and can result in a thick discharge affecting the eyelids and vision.
• Allergic conjunctivitis can cause itching, ocular discomfort and can also affect vision.
• Viral conjunctivitis is infectious and is often associated with a generalised viral infection.

Conjunctivitis can be treated with topical medication (for example, antibiotic drops) and can impact on certification if there is significant discharge from the eye or when drop administration is very frequent. Topical eye ointments may cause reduced vision for a period after application.

Generally, applicants should not exercise the privileges of a medical certificate while they have symptoms that are distracting or irritating, or while they are taking treatment that can cause drowsiness (for example, some antihistamines) or reduce their vision, and should consult their aeromedical examiner (AME).

The diagnosis of vernal keratoconjunctivitis (VKC) requires a report from an eye specialist detailing the severity of the condition and its management. AMEs should discuss significant cases of VKC in Class 1 or 3 applicants with a Civil Aviation Authority (CAA) medical assessor.

Blepharitis, meibomian cyst (chalazion) or stye (hordeolum) do not normally impact on certification unless they cause discomfort or reduction in vision (for example, due to mechanical ptosis or induced astigmatism).

Topical treatment with warm compresses and topical medication, if required, can present practical problems during an applicant’s duty period and so cases should be assessed individually. Applicants requiring surgical removal of a chalazion should inform their aeromedical examiner (AME).

Applicants 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.

Occasionally low dose maintenance topical therapy may be acceptable. A consultant ophthalmology report is required once the condition is resolved or stable (the guidance on ophthalmic reports offers further advice). Ongoing reports will be required for those applicants requiring low dose maintenance topical therapy and an RXO endorsement should be considered.

Class 1 and 3 holders may be required to undertake assessment with an aviation eye specialist, particularly if residual corneal scarring is present (where objective measurement of glare sensitivity and contrast sensitivity will be undertaken).

Class 2 holders should see a vision specialist for formal assessment of glare sensitivity and contrast sensitivity if there are dysphotopsia symptoms present.

Consideration should be given to underlying causes (for example, herpes zoster) and risk of recurrence. Complex or recurrent cases in Class 1 or 3 applicants can be discussed with a Civil Aviation Authority (CAA) medical assessor.

Applicants 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.

Occasionally low dose maintenance topical therapy may be acceptable. A consultant ophthalmologist’s report is required once the condition is resolved or stable (the guidance on ophthalmic reports offers further advice). Ongoing reports will be required for those applicants requiring low dose maintenance topical therapy and an RXO endorsement should be considered. The ophthalmology report should state if there are any dysphotopsia symptoms present. Any positive symptoms may require objective testing of contrast sensitivity and glare sensitivity by an aviation eye specialist.

Consideration should be given to underlying causes (such as ankylosing spondylitis), especially if the uveitis is recurrent. Complex or recurrent anterior uveitis in Class 1 or 3 applicants may need to be discussed with a Civil Aviation Authority (CAA) medical assessor.

This may be associated with underlying disease (inflammatory bowel disease, sarcoidosis, and so on). Applicants should be assessed as unfit on diagnosis and a formal consultant ophthalmologist report is required (the guidance on ophthalmic reports offers further advice).

This should include the results of any systemic investigations. An evaluation for a return to fit status should consider visual acuity, visual fields (the visual field guidance offers further advice), medication and identification and control of any underlying cause.

Complex or recurrent cases and those cases with systemic associations in Class 1 or 3 applicants may need to be discussed with a Civil Aviation Authority (CAA) medical assessor and an RXO endorsement should be considered.

Eye injuries sufficiently severe that need medical attention will require a formal ophthalmological report. Cases should be assessed individually and suspension of medical certificate validity may be required. Class 1 and 3 holders may also be required to undertake assessment with an aviation eye specialist as any remaining effect to the ocular media (for example, corneal scarring), will require formal assessment of contrast sensitivity and glare sensitivity.

Class 2 holders should be questioned regarding any dysphotopsia symptoms before they do a fit assessment and may be asked to undergo objective assessment of contrast sensitivity and glare sensitivity if there are concerns.

Any Class 3 applicants requiring surgical management should have their fitness assessments referred to a Civil Aviation Authority (CAA) medical assessor once they have made a sufficient recovery. We suggest that Class 1 applicants are also referred. Other complex cases in Class 1 or 3 applicants may need to be discussed with a CAA medical assessor.

This is compatible with fit status provided that visual standards are met and there are no dysphotopsia symptoms. For applicants undergoing cataract surgery, please refer to guidance following eye surgery.

This is compatible with certification provided there is confirmation that it is purely a vitreous detachment and there is no retinal involvement (retinal tears, holes or detachments) and that the applicant has no distracting floaters or distortion of vision.

Applicants should be assessed as unfit on diagnosis. Consultant ophthalmologist reports will be required. A fit assessment can be considered once full recovery from treatment has been achieved.

Unrestricted certification is possible provided that the effect on visual function is such that the visual standards are met. Visual fields to Civil Aviation Authority (CAA) requirements will be required before a fit assessment can be considered (the visual field guidance offers further advice).

Peripheral retinal tears treated successfully with laser can be considered for restoration of fit status once recovery from successful treatment has been demonstrated and do not require referral to the CAA.

Cases of complex retinal detachment resulting in loss of peripheral field and /or central vision may be considered for certification subject to the requirements for substandard vision in one eye. In this scenario, Class 1 and 3 applicants should be referred to a CAA medical assessor whereas Class 2 applicants can be assessed by an aeromedical examiner (AME). Additionally, Class 3 applicants who have undergone surgery (excluding peripheral retinal laser treatment as described above) require referral to a CAA medical assessor. There is retinal eye surgery guidance available.

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 requirements for substandard vision in one eye (Class 1 and 3 applicants should be referred to a Civil Aviation Authority (CAA) medical assessor for a fitness assessment once they have made a satisfactory recovery).

Esterman fields are not normally required before recertification but central visual fields (such as macula threshold) may be required in cases where reduced vision or visual distortion (metamorphopsia) remains present.

Certificate holders should be assessed as unfit on diagnosis as macular disorders can cause significant metamorphopsia without necessarily reducing vision to below acceptable limits. Central visual fields (such as macula threshold) may be required.

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. Consideration should be given to the potential of drug side effect of treatment of systemic disorders such as rheumatoid arthritis or malaria. If necessary, please refer to the requirements for substandard vision in one eye.

Class 1 and 3 applicants with acquired loss of visual acuity and considered as having substandard vision in one eye should be referred to a Civil Aviation Authority (CAA) medical assessor whereas Class 2 applicants can be assessed by an aeromedical examiner (AME) in consultation with the CAA.

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 Civil Aviation Authority (CAA) medical assessor (usually annually initially) and an RXO endorsement should be considered.

The initial diagnosis should be reported to the aeromedical examiner (AME) and visual function assessed. For ocular hypertension and uncomplicated glaucoma cases, routine follow up reports (including visual fields when required by NHS/ Royal College of Ophthalmology guidance) can be taken to the AME at each medical. In more advanced cases or where central threshold field(s) are abnormal or appear to show progression, Esterman monocular and binocular fields are required (the visual field guidance offers further advice) and an RXO endorsement should be considered. 

The eye surgery guidance has information for applicants undergoing glaucoma surgery. An applicant with reduced vision or visual field in one eye may be acceptable for a fit assessment following the requirements for substandard vision. For these cases, Class 1 and 3 applicants should be referred to a Civil Aviation Authority (CAA) medical assessor, whereas Class 2 applicants can be assessed by an AME in consultation with the CAA. 

Please note that applicants undergoing selective laser or argon laser trabeculoplasty do not require referral to the CAA and can be revalidated with an acceptable report and provided they are asymptomatic.

Applicants with any form of acute open or closed angle glaucoma may be considered for certification provided that the consultant ophthalmology reports confirm an acceptably low rate of recurrence (there is further guidance available on ophthalmic reports).