Keeping an eye on things: eye health problems
Most people never give any thought to the health of their eyes, but many aspects of modern life — such as staring at computer monitors, increased lens wear and air conditioning — can disrupt the eyes’ natural lubrication, leading to irritation, infection or worse.
With the OTC eye care market worth £54.4 million in 2010 (according to Symphony IRI Group), it pays to know about the different common eye conditions your customers could present with, and what treatments might help.
Red eye and conjunctivitis
A red eye can look alarming but it is often simply a sign of conjunctivitis or another minor eye condition.
Conjunctivitis is inflammation of the conjunctiva — the transparent membrane that covers the white part of the eyeball and the inner surfaces of the eyelids.
There are three different types of conjunctivitis, each with a different cause.
Irritant conjunctivitis occurs when an irritant, such as chlorine or grit, gets into the eyes and makes them sore. Rubbing the eyes can make the condition worse, but the conjunctivitis should settle once the irritant is removed.
Infective conjunctivitis is caused by a virus or bacteria. Common symptoms include reddening and watering of the eyes, and a sticky coating on the eyelashes. It is highly contagious, so advise your customers not to share towels at home, or put their faces close to others.
Allergic conjunctivitis causes itchy, swollen eyes and occurs when the eyes come into with an allergen, and there are four main types:
- Seasonal allergic conjunctivitis
- Perennial allergic conjunctivitis
- Contact dermatoconjunctivitis
- Giant papillary conjunctivitis
Seasonal and perennial allergic conjunctivitis are usually triggered by common allergens, such as pollen, and can usually be managed effectively with antihistamines. Contact dermatoconjunctivitis and giant papillary conjunctivitis are usually caused by eye drops or lenses, so once the cause is identified and avoided the symptoms usually clear up. However, it may be necessary to recommend that your customer sees an ophthalmologist for further treatment.
Did you know...?
If you have double vision or other eye-related conditions, your driving ability is likely to be affected. Eye conditions, such as watering eyes, may also have implications for driving, and it is your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability.
A red eye can also indicate a burst blood vessel in the eye, caused by straining or coughing. This is called subconjunctival haemorrhage and, although it looks severe, it should clear up on its own within several weeks. Topical tear supplements can help if the eye is uncomfortable. However, as Robert Scott, consultant ophthalmologist at BMI Priory Hospital in Birmingham, explains, if a red eye is painful, there may be a more serious problem for which your customer should see their GP. “Red eyes are associated with a range of conditions that range from the inconsequential to sight threatening,” he says. “The actual redness of the eye is not a good indication of the severity of the condition. Severity is related to associated visual loss and eye pain. It is usually obvious when a red eye is serious and such cases should be immediately referred to a doctor for immediate medical and surgical management.”
Watering eyes can be caused when tears don’t drain away properly (epiphora) or too many tears are produced (hypersecretion). It can affect people of any age, but is most common in young babies (0–12 months) and people over the age of 60 years, bothering one or both eyes and causing blurred vision, sore eyelid skin and sticky eyes.
“Watering eyes can be a result of reduced tear drainage of the eye from blockage of the nasolacrimal duct, or shrinkage of the lacrimal punctae at the eye lid margin,” explains Mr Scott. “It can also be due to reflex tearing from an irritant such as a piece of grit or an abrasion, an allergy, or an infection. Occasionally the eyes water due to dysthyroid eye disease. Paradoxically, a watering eye is often associated with the gritty sensation from a dry eye. Here, the basal tear secretion is low, causing increased reflex tear secretion and a watery eye.”
Treatment isn’t always necessary for watering eyes and mild cases may not need treatment at all, but if you suspect infective conjunctivitis in your customer you should refer them to their GP, who may decide to prescribe a course of antibiotics.
If allergic conjunctivitis is causing watering eyes, antihistamines can help reduce the inflammation.
Blepharitis is where the rims of the eyelids become inflamed, resulting in burning, soreness or stinging eyes, crusty eyelashes and itchy eyelids. It is more common in people over 50, although it can develop at any age.
According to Mr Scott: “The treatment is to perform twice-daily lid hygiene, scrubbing the eyelash line using a cotton-wool bud dipped in a warm water that is made soapy by adding a drop of baby shampoo or a pinch of sodium bicarbonate to an egg-cup full of water. There are newer eye cleaning tissues that are also effective at cleaning the lashes and require no preparation. Patients should make sure that the eyes are not dry and give topical lubricant eye drops where necessary, as dry eyes make blepharitis much worse.
“When lid hygiene does not work, chloramphenicol antibiotic ointment can be applied to the lid margin to help the lid hygiene. If this does not control the problem within a month, you should advise your customer to see their doctor for treatment with antibiotic tablets.”
Blepharitis is not usually serious, although it can become a chronic condition, and it is not possible to catch blepharitis from someone else who has it. The most common complication is being unable to wear lenses while experiencing symptoms.
A stye, also known as a hordeolum, is a small abscess on the eyelid — usually caused by an infection with staphylococcal bacteria — which appears as a painful lump on the outside or inside of the eyelid.
“An external stye often causes pus to collect around the base of the eyelash,” says Mr Scott. “When the eyelid is infected, chloramphenicol ointment can be applied for a few days. If the infection is spreading, a course of [oral] antibiotics may be needed.”
Most styes get better without any treatment in one to three weeks but, as Mr Scott explains: “One way of making an external stye express itself is to use hot compresses with a cotton-wool ball dipped in hot water, or a spoon that has been dipped in a cup of hot water, gently pressed over the swelling. External styes virtually always disappear. Internal styes may form a residual lump in the lid, a chalazion, that can require surgical drainage by an ophthalmologist.”
Dry and gritty-feeling eyes are a common problem, thought to affect up to 30 per cent of the UK population at any time, and mostly in the over-60 age group.
In healthy eyes, tears help create a lubricating and cleaning film over the eye, but dry eyes occur when there is not enough fluid to create this film. Ironically, watery eyes — particularly in windy, sunny or dry conditions — can be a symptom of “dry eye” and can be triggered by many medical conditions as well as by certain medicines.
If the dry eye is not severe or caused by disease, it can be treated with tear supplements. Says Mr Scott: “I will always advise those with dry eyes to stop wearing lenses, unless they are under close medical supervision. I am always on the lookout for a systemic disease like rheumatoid arthritis, or dysthyroid eye disease in my dry eye patients. If you have any concerns, advise your patient to consult their doctor.”
More than three million people in the UK wear lenses, but many of them don’t follow the instructions. Wearing lenses increases the risk of eye infections in general, and failing to follow the instructions raises that risk even more. Contact lense specialist Bausch + Lomb advises the following tips for infection-free lense use:
Keeping eyes healthy
If you encourage your customers to look after their eyes in the first place, they can avoid many of these common eye problems. As Tony Whyatt, Altacor national business development manager, explains: “General advice should include taking regular breaks away from their computer monitor and reducing the glare by adjusting the brightness and contrast. The monitor should also be positioned at least 20 inches away and directly at eye level.
“Aside from these issues, everybody should be protecting their eyes from the sun as UV rays greatly increase the risk of conditions such as cataracts and macular degeneration. A healthy diet is also of great importance. Type II diabetes is associated with blurred vision, cataracts and most seriously, diabetic retinopathy, which involves the blood vessels that supply the retina. Vitamins A, C and E, found in fresh fruit and vegetables are associated with good eye health and can help protect against age-related eye conditions.”
With so many common eye conditions present in the general population, your pharmacy is bound to be a first port of call for many of your customers with eye health complaints. Being able to identity their problem and knowing when to refer them swiftly on for more serious conditions is vital, but also gives pharmacy yet another way in which to showcase its frontline health capabilities and skills in the community.
If customers ask about....
Products for dry eye
The Alcon Systane dry eye range is formulated to provide relief from symptoms of moderate to severe dry eye
Products for lense wearers
Bausch + Lomb Biotrue multi-purpose lens solution helps keep lenses moist for up to 20 hours and has disinfection properties
Supplements for eye health
Bausch + Lomb Ocuvite Complete (nutritional supplement) contains carotenoids, lutein and zeaxanthin, and omega-3 fatty acids, all of which are backed by extensive research linking their consumption to the maintenance of eye health.
Citation: Community Matters URI: 11095790
Recommended from Pharmaceutical Press
Guidance for students or researchers undertaking a multi-centre research project in health services, medicines use and professional practice.£38.00
All the information you need to provide patients with evidence-based advice on sports and exercise related health matters.£27.00
A complete source of current information about the US health care system. Includes concise reports on trends, regulations, policy and finances.£49.00
Health Economics is a practical analysis of the prominent economic issues facing the American health care system, and what mechanisms exist to counter it.£33.00