EYE CARE

 

INTRODUCTION

 

The study of the eye is known as ophthalmology, hence a doctor who specialises in this field is known as an ophthalmologist. This is not to be confused with an optometrist, who is licensed to test and treat visual defects of the eye. The eye is protected by a cavity called the eye socket. Other protective accessories include eyebrows, eyelids, eyelashes, conjunctiva and tear glands. These structures in a variety of ways protect the eye from infections and direct damage/irritation. For example the eyebrows/lashes/lids all serve to trap any foreign material such as dust from coming into contact with eye. The conjunctiva and tear glands are designed to wash away any object that gets past these earlier barriers.

 

 Most problems that customers may come to us for help and advice is for the front surface of the eye only. For this reason all we will really focus on is four main conditions known as Glaucoma, Styes, Conjunctivitis and Dry eyes.

 

GLAUCOMA

 

This is when there is higher pressure than normal with in the eyeball. This can be accompanied by loss of vision, due to damage of the light receptors at the back of the eye. If glaucoma is not attended to, blindness eventually takes place.  It is more common in people over the age of 40 and often runs in families. The main problem is it often asymptomatic, hence regular check ups should be encouraged, as treatment is more successful the earlier its picked up. The normal period is at least every 2 years. The condition is easily managed with eye drops prescribed by the G.P

 

STYES

 

This is a common infection usually found at the root of an eyelash, on the margin of the eye. It is in fact a small boil that is painful and unsightly. After a few days a white head may develop and may exude pus.  The eye itself is not infected, so usually no permanent injury occurs. Treatment is via antibacterial eye drops or ointments. E.g. Bleph, Brolene, Golden eye ointment.  The treatment usually includes bathing the stye with warm sterile saline. Also the use of a hot compress may help with “pointing” which is designed to draw the infection to the surface and help it discharge.

 

 Styes often occur in people who suffer heavy eyestrain or have inadequate diet. Hence the following nutritional supplements should be recommended; Vitamins A,B,C,D,E, Bilberry, Eyebright, Ginko Biloba, Zinc, Bioflavonoids, Rutin and Echinacea.

 

 

CONJUNCTIVITS

 

Conjunctivitis is a common external eye problem and is so named because there is inflammation of the conjunctiva. This is the white of the eye (sclera) and is a mucous membrane that lines the inner surface of the eyelid.  The conjunctiva contains many blood vessels that can’t normally be seen, but when it becomes infected it’s irritated and turns red due to inflammation of the blood vessels.

 

 There are three causes of conjunctivitis, and all have similar symptoms. Eg clear/green/yellow discharge, redness, gritty feeling, itchy and light sensitivity followed by reduced vision.  A sticky crust can be washed off with warm saline using a cotton bud. Viral and Bacterial Conjunctivitis is contagious, so we recommend that children be kept home from school until condition clears.

 

1.Bacterial Conjunctivitis

This is the most common type and involves an infection of the thin layer of tears, which covers the eye. The most common sign is a yellow discharge, which can easily spread from one eye to the other. The eye becomes sticky making it difficult to open especially in the mornings. Treatment is with either Brolene or Bleph 10. The latter can only be recommended by a Pharmacist as its scheduled 3. In severe cases, refer to G.P. for stronger treatments.

 

2.Viral Conjunctivitis

This condition must immediately be referred to a GP. This can often follow a cold and flu. The symptoms are a gritty feeling, inflamed and watery eyes. Sometimes the eyes are sensitive to light. Generally little pus is involved.

 

3 Allergic Conjunctivitis

As the name suggests this is normally the result of an allergy. This produces irritation, discomfort and a watery discharge.  It typically occurs in the hay fever season. Avoiding the allergen is the first step to successful treatment.  The main treatments include Albalon A, Visine allergy, Murine allergy. Prefrin Z, Antistine Privine and Naphcon A. They consist of a decongestant combined with an antihistamine.  Oral antihistamines like Claratyne are also effective.

 

SORE, TIRED AND DRY EYES

 

This is when the eye has failed to produce an adequate amount of tears to provide the needed lubrication and protection leading to dry spots.  Dry eyes can lead to a feeling of something being in the eye along with a burning, gritty feel and stringy discharge. This may be caused by not enough tears being made, due to the aging process.  Other causes include:

 

-Atmosphere e.g. Wind, sun, air conditioning and smoky environments.

-Eye stress/strain e.g. Excessive amounts of concentrated work (computers, reading, needlework etc.), rubbing eyes

-Diseases e.g. Rhematoid arthritis, Parkinson’s Disease (as patients blink less)

-Allergies e.g. pollen, chlorine from swimming pools, smog, contact lens

-Drugs e.g. Medications such as antihistamines and antispasmodics, alcohol.

 

Eyes appear red when something causes blood vessels in the membrane covering the white of the eye to swell. This means that more blood flows to the area making it look red and feel hot. Red eyes are a symptom of a wide range of eye conditions, some are minor whilst some are serious and requires referral to GP.

 

It is interesting to note that people can still suffer from a dry watery eye. This is because tears are made up of water and oil, and there is an imbalance between these two components. Treatment generally consists of a lubricating eye drops such as any of the following; Tears plus, Liquifilm forte, Lacrilube, Lquifilm tears, Visco tears, Dura tears, Isopto tears, Methopt, Methopt forte, Poly tears, Tears naturale, Refresh, Murine revital, Cellufresh and Celluvisc.   The other treatment is the use of a decongestant such as; Visine (plain), Murine sore eyes, Murine clear eyes, Eyelite, Optazine, Optrex and Naphcon forte.  Alternatively you can use the preferred Combination of a decongestant and a lubricant such as; Visine revive, Isoptofrin, Albalon relief, and prefrin.

 

 

TYPES OF TREATMENT

 

ANTI-INFECTIVE EYE PREPARATIONS

 

This includes Brolene drops/ointment, Bleph 10 drops, Golden eye ointment and Chloramphenicol drops/ointment. All except the latter are available over the counter. However Bleph may only sold by a pharmacist as its schedule 3. This was the first antibacterial to be developed for eye use and has proved to be safe and effective in treating mild cases of conjunctivitis. It is suitable for children aged two months and over.  If the infection has not cleared after 3 days of treatment, referral to a GP is recommended.

 

Bleph 10 is delivered in a liquifilm-lubricating base there fore it’s very soothing to the eye. This also provides good retention with in the eye, giving the antibacterial maximum time to be effective.  If the drop causes irritation, burning or stinging it should not be used.  It is not suitable in pregnancy or breast-feeding. The eye should be rinsed with sterile normal saline, using cotton wool balls to cleanse the area if necessary. Then instill 1-2  drops onto the lower white of the eye of the affected eye/s every 2-3 hours.

 

LUBRICATING EYE PREPARARIONS

 

As mentioned above there are many brands available and they all work in the same mechanism. They are also available in an ointment form, which is useful at nighttime. They work by moisturizing the surface of the eye providing a soothing and cooling effect on irritated eyes. They can be used as often as necessary.

 

DECONGESTANT EYE DROPS

 

As the title suggests these anti-red eye drops are chemically related to the oral decongestants found in cold and flu tablets.  They have a vasoconsticting effect on the localized blood vessels in the white of the eye, thus minimizing the size of the blood vessels and subsequently reducing eye redness.

 

Red eyes can be made worse by the continual use of Vasoconstrictor eye drops. You should use them upto one week only, beyond this time the blood vessels develop dependence on the vasoconstrictor and will not go back to normal size without it.  This is call rebound congestion, a common problem. To treat this problem, Refresh eye drops used upto 4 times a day whilst slowly withdrawing the vasoconstrictor is best. 

 

Often these days you will find the combination of decongestant with either and antihistamine or a moisturiser or both. The combinations therefore offer better treatment and are cheaper for the patient than buying one of each.

 

CONCLUSION

 

It is very important to counter prescribe the right medication for the right conditions.  We in Pharmacy must advise the patient on the best treatment available to treat the eye problem. This may involve referring them to our Pharmacist or GP.  The most common ailments that our customers will require our help for include Conjunctivitis, Dry eyes and Styes. As Pharmacy assistants you need to know how to differentiate between these three conditions and recommend the best solution kits, and how to use the products effectively.

 

SOLUTION KITS

 

RED EYE AND DRY EYE SOLUTION

 

ALBALON RELIEF

1-2 drops 4 times a daily as required for redness relief. Contains a vasoconstrictor, so can only safely be used consecutively for 5-7 days

 

REFRESH EYE DROPS

To prevent rebound congestion, treat and prevent red eye, instill one-drop upto 4 times a day

 

STERILE NORMAL SALINE

Wash with saline if there is any discharge, or foreign objects in eye, via an eyebath.

NUTRASEARCH SF88

To aid the supply of Nutrients and keep the eye healthy. A balanced formula with emphasis on the B group vitamins. Take one tablet daily.

 

ALLERGY EYE SOLUTIONS

 

ALBALON A

If you suffer from itchy and watering eyes that are due to allergies use 1-2 drops 4 times daily as required. As well as the antihistamine it also contains a vasoconstrictor which means you can only use  safely for 5-7 consecutive days.

 

CLARATYNE

This is a once a day oral antihistamine which will work systemically, and is non drowsy

 

BIORESEARCH FORMULA HFV OR BRAUER HAYPLEX

This is a homeopathic remedy, which will help to ameliorate the symptoms of allergies and hayfever. E.g. Itchy red eyes. The dose for adults is high over the first 2-3 days then once under control you can reduce to maintenance of 5 drops morning and night only. The child dose is 2 drops three times per day, and then reduces to twice daily as per adult dose.

 

NUTRASEARCH SF88

To aid the supply of Nutrients and keep the eye healthy. A balanced formula with emphasis on the B group vitamins. Take one tablet daily.

 

BACTERIAL CONJUNCTIVITIS SOLUTIONS

 

BLEPH 10

Instill 1-2 drops into the eye every 2-3 hours during the day, less often at night.  Can be used in infants over 2 months of age, but not to be used in pregnancy.

 

REFRESH EYE DROPS

To prevent rebound congestion, treat and prevent red eye, instill one-drop upto 4 times a day

 

STERILE NORMAL SALINE

Wash with saline if there is any discharge, or foreign objects in eye, via an eyebath

 

NUTRASEARCH SF88

To aid the supply of Nutrients and keep the eye healthy. A balanced formula with emphasis on the B group vitamins. Take one tablet daily.

 

 

 

OTHER EYE VITAMINS

 

BILBERRY (BLACKMORES OR NATURAL NUTRITION)

Bilberry assists with night vision, and is beneficial where the eyes are over sensitive to glare, or where eyestrain is caused by prolonged close work, or which entails attention to fine detail. It also helps to maintain peripheral circulation, helps maintain the integrity of the collagen rich connective fibers, and to inhibit the release of inflammatory agents such as histamine. They also have antioxidant capabilities.

 

EYE BRIGHT

Protects and maintains the health of the eye. This herb acts as an internal tonic for the constitutional tendency to eye weakness. It also helps eliminate some of the problems associated with chronic conjunctivitis. And other eye irritations. It’s also useful for liver disorders, colds and hayfever.

 

EYE FORMULA WITH ANTIOXIDANTS (BLACKMORES OR NATURES OWN  T/FORMULA

This contains Eyebright, Ginko, Bilberry and Antioxidants. They all work synergistically to assist in relief of visual fatigue, eye strain, and sore red weeping eyes. NB; The Ginko aids peripheral circulation.

 

 

HOW TO USE EYE DROPS

 

 

 

 

USING EYEDROPS WITH COMFORT

·         Put your head back and close one eye. Squeeze a drop or two in the side corner of the eye. Then flutter your eyelids to let the drops go in. If you prefer to instill the drops with your eyes open, lean your head back gently and pull down the lower lid. Squeeze a drop just below the lower lid. Close your eye and rotate it once or twice. Then repeat for your other eye.

·         In both cases it’s a good idea to counsel patient to block their lacrimal duct whilst instilling the drops. This is done via pushing the cushion of the index finger against the inner corner of the eye. This way the drops will have a local affect, rather than going down the back of your throat.

·         Link putting in eye drops with daily activities; place a bottle on the bedside or breakfast table to remind you of morning and afternoon drops.

·         Place a bottle in a different place after use, keep a chart and tick doses.

·         When using more than one kind of drop wait at least five minutes between drops, otherwise one will wash out the other. The more viscous drops should be used last.

·         Warning Decongestant eyedrops should never be substituted for contact lens fluid and contact lens wearers should not use these drops with in 4 hours of inserting their contact lenses.

·         When using any eye product they have an expiry date of one month after breaking the seal. This is because only so much preservative can be put into the product before irritations may occur. If eye products are used beyond this period you have the chance of causing serious infections to the eye. It’s for these reason companies have come out with single dose vials. E.g. Refresh and Albalon Relief.

·         Patients should drink at least six glasses of water a day.

 

IMPORTANT QUESTIONS

·         What is your condition?

·         Are your eye’s itchy?

·         Do you wear contact lens?

·         Are you taking any medication?

·         Do you have glaucoma? (refer to pharmacist)

·         Are your eye’s sticky in the morning?

·         Are your eye’s dry?

·         Do you have tear ducts?

·         Is your vision distorted?

·         Are you a diabetic? (refer to pharmacist)

 

RESIST

·         Rubbing your eyes

·         Smoking and smoke filled rooms

·         Making the redness worse buy using vasoconstrictor eye drops for longer than 5-7 days

·         Use vasoconstrictor eye drops if you suffer narrow angle glaucoma.

·         Excessive alcohol intake

·         Using an eye product that was used or prescribed for someone else.

·         Ignoring more serious symptoms.

 

WHEN TO REFER

If any of the following symptoms accompany a red eye(s) see your GP. Urgently:

·         Discomfort in bright light

·         Blurred vision/discharge of pus

·         Redness immediately around the iris rather than around the whole white of the eye,

·         Pain and tenderness, rather than itching or burning.

·         Red eye that does not settle with in 24 hours.

·         A cold with a clear discharge from the eyes that does not settle with in a few days.

·         Eyelashes stuck together on waking.

·         All infants and elderly patients with sore eyes should be referred.

·         Ask the Pharmacist if unsure.