EYE HEALTH
EYEcomplaints Common By Aaron Courtenay MPharm MPSNI
Some of the most common complaints that patients present with in a community pharmacy setting involve the eye. Many conditions affecting the eye can be successfully managed, following consultation with a Pharmacist, often leaving patients feeling fulfilled and relieved. This article aims to highlight some of the most common eye complaints including Dry eye disease, Blepharitis, and Meibomian gland dysfunction.
Dry eye disease Dry eye disease known as keratoconjunctivitis sicca, simply “dry eyes” occurs when the eyes are unable to make sufficient tears to coat the eye, or simply that the tears are evaporating too quickly.
Patients suffering from dry eyes, find that both eyes are usually affected, feeling gritty, sore, or experiencing a feeling of dryness that progressively gets worse throughout the day. The eyes can appear red, often as a sign of irritation from lack of tears to aid lubrication. Patients tend to find their eyelids stick together when they wake first thing in the morning, and can even suffer from temporarily blurred vision – however this usually improves after blinking once or twice.
Tear production is a complex process and can be segregated into three distinct types: Basal tears, reflex tears, and emotional tears. Basal tears have a critical role in ensuring the cornea of the eye is continually lubricated and nourished.
The cornea itself has no blood vessels, receiving its oxygen supply from the air, which is highly dependent on the
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tear film. The tear film helps to smooth irregularities in the surface of the eye to give high optical quality for vision. This tear film is re-laid every time you blink.
Reflex tears, similar to basal tears are produced specifically in response to external stimuli, such as excessive heat, dry atmospheric conditions, or molecules that can stimulate tear production, such as the volatile molecules given off when chopping an onion.
Emotional tears can be stimulated during periods of high emotional stress, for example pain, grief, or happiness. Stimulation of the parasympathetic branch of the autonomic system (unconscious control) can cause the lacrimal glands close to the eye to produce tears. [1]
Common causes of dry eye conditions can include wearing contact lenses, being in a hot environment, side effects as a result of some medicines, underlying medical conditions such as Blepharitis (discussed further below), or changes in hormones – particularly prevalent in women. Although the condition can affect any age group of
patients, prevalence increases as you get older, with estimates of up to 1 in 3 people > 65 years experiencing dry eye problems. [2]
Dry eye treatment options Often taking simple measures to reduce the environmental pressures on your eyes can have significant impact on a dry eye problem.
Keeping your eyes clean and protected from dust, smoke, wind, or excessively dry environments can help to reduce the need for tear production. It has been suggested that for people working with computers, following good operational practices, including taking regular breaks or using an air humidifier to moisten the air can help reduce the effects of dry eye disease.
Dry eye disease can usually be treated by, dealing with the primary cause - for example treating the disease state causing dry eyes, or stopping medication that is causing the symptoms. However, in some cases this is not always possible, and so a number of options are available for people to manage their condition. Some of the most common treatment options are listed below:
Lubricant treatments – the use of gels, drops, or ointments as lubricants can help reduce the effects of mild to moderate cases of dry eye disease. These preparations are often referred to as “artificial tears” and act to replace the water or oil components of the tear film. It is important to note, that although usually very effective at relieving the symptoms, these preparations are synthetic lubricants and do not contain the usual vitamins, antibodies, and nutrients found in normal tears, required to maintain eye health.
Patient preference usually determines whether a gel, drops, or ointment- based product is most appropriate. Patients tend to find ointment preparations, sticky and unacceptable during the daytime and so drops are generally favoured. Contrary to this, some patient’s feel ointments last longer and reduce the need for repeated application to the eyes.
Anti-inflammatory treatments – occasionally dry eye disease can be caused by inflammation conditions. Treating conditions that are inflammatory in nature can be achieved by application of
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