EYE HEALTH
such symptoms as the burning/ dry eyes, but, in terms of product, the most widely recommended is chloramphenicol drops, which have been available OTC from pharmacies across the UK since 2005.
In Scotland, local PGDs enable pharmacists to prescribe and dispense a POM pack of chloramphenicol eye drops to eligible patients using the Minor Ailment Service. Pharmacists must sign up to the PGD individually and send their completed form to their local health board before they are able to prescribe the POM pack.
In most health boards in Scotland, children over one year old can be supplied with a POM pack, but in some areas, supply is restricted to children over two years of age.
Allergic conjunctivitis is usually treated with anti-allergy medications, such as antihistamines.
Irritant conjunctivitis will clear up as soon as the patient is no longer in the vicinity of whatever caused it to flare up.
STYES
Styes also called hordeola - are small, painful lumps on the inside or outside of the eyelid. If present, the eye may also be watery and the eye or eyelid red.
Styes usually only affect one eye, although it is possible to have them in both eyes. They’re usually caused by staphylococcal species: bacteria which often live on the skin without causing any harm.
There are two types of stye:
An external stye is a swelling that develops along the edge of the eyelid, and which may turn into a yellow pus-filled spot that’s painful to touch.
It may be caused by an infection of: • an eyelash follicle
• the sebaceous gland, which is attached to the eyelash follicle and produces an oily substance called sebum, which lubricates the eyelash to prevent it drying out
• the apocrine gland: a sweat gland which empties into the eyelash follicle and helps prevent the eye from drying out
An internal stye is a swelling that develops on the inside of the eyelid. This is usually more painful than the internal type.
52 - SCOTTISH PHARMACIST
An internal stye is usually caused by an infection of the meibomian gland, which is found on the eyelids and produces an oily liquid, which makes up part of the tear film that covers the eye.
Styes often get better without treatment, particularly after they burst and release pus.
Symptoms can be eased by using a warm compress, a cloth or flannel that has been warmed with hot water and held against the eye for five to ten minutes three or four times a day until the symptoms disappear.
If the stye is very painful, then OTC painkillers such as paracetamol or ibuprofen should be recommended.
In most cases the stye will heal itself within one to two weeks, but referral - and a prescription for oral antibiotics - may be necessary if no relief is seen within two weeks.
DRY EYES
Dry eye syndrome – also known as keratoconjunctivitis sicca - is a very common condition. In fact, it is believed that up to ten per cent of the general population may be affected by this condition and as many as one in three people over 70 years of age. Women are also more likely to experience the symptoms of dry eye, probably as a result of fluctuating hormones.
Dry eye syndrome arises when the tear film – the thin liquid layer that normally lubricates the eyes – fails to do its job properly, leading to the eyes becoming dry and gritty. Patients often refer to the feeling of ‘having something in their eye’.
Underlying causes of the condition can include Sjögren’s syndrome, ageing, staring at a computer screen for too long, blinking problems, and environmental factors. Patients taking such medications as oral contraceptives, antihistamines, and beta-blockers may also experience dry eyes.
While the condition itself is common and not serious, the problem with dry eye syndrome is that it carries an increased risk of infections, ulcerations and vision impairment. The good news is that it can be easily treated and the symptoms managed by the patient.
Dry eye syndrome is usually managed by using:
• Aqueous artificial tear products:
these help to supplement the aqueous layer of the tear film, automatically preventing further irritation.
• Paraffin ointments: these tend to lubricate the eyes for longer periods than drops, but due to their more dense consistency, they can cause blurred vision and should only be recommended for night-time.
• Liposomes: these can be sprayed onto the closed lid and, from there, can migrate to the lipid layer in the tear film, stabilising the water layer and slowing down its evaporation
The dryness can also be counteracted by the patient using a humidifier at home.
WATERING/WATERY EYES
Watery eyes, on the other hand, are caused by excessive tear production, a natural process that keeps the eye lubricated and clean. The problem can affect anyone, but it’s most common in young babies and people older than 60.
Left untreated, watery eyes can cause blurred vision, sore eyelids and sticky eyes.
It’s thought that watery eyes are most likely caused by the meibomian glands in the eyelids, which normally secrete an oily substance that slows the evaporation of tears between blinks.
When these glands don’t function properly (known as meibomian gland dysfunction (MGD)), it can result in dry patches on the eyes. These become sore, and extra tears are produced as a reflex.
Other causes can include:
• the lower eyelid sagging away from the eye (ectropion) which makes it difficult for tears to reach the drainage ducts
• eyelids that roll inwards (entropion)
• inflammation of the edges of the eyelids (blepharitis)
• blocked or narrowed tear ducts
• eye irritation (for example, from chemical fumes or grit)
• an eye infection, such as conjunctivitis
• an allergy
Most patients will feel that their watering eyes aren’t interfering with their life and will therefore opt for no treatment. The only time that
As a rule of thumb for pharmacists, any patients presenting with pain in the eye should be referred for further investigation immediately.
medication may be needed is if the cause is an allergy or infection. If the GP considers it necessary, the patient will be referred to an ophthalmologist, who will look for blockages in tear ducts. If blockages are found, surgery will be required.
BLEPHARITIS
Blepharitis is the name given to chronic inflammation of the eyelids. It is a very common condition and GPs say that it accounts for five per cent of all eye problems that present.
Blepharitis tends to occur when the rims of the eyelids become inflamed, leading to pain, a ‘burning’ sensation or stinging eyes. In addition, there may be a ‘crusty’ appearance around the eyelashes.
While blepharitis can be
uncomfortable for the patient, it is not usually a serious condition and vision is seldom affected. It can, however, cause problems with the consistency of the tears, and this may lead to dry eye symptoms.
There are two types of blepharitis:
• Anterior blepharitis – which affects the area of the eyelids where the eyelashes sit
• Posterior blepharitis – which affects the meibomian glands which produce part of the tears
Blepharitis can be caused by either a bacterial infection, or can be a complication of rosacea: a skin condition that mainly affects the face.
Patients should be advised that they should wash the eyelids twice daily using a cotton wool bud dipped in warm water and diluted baby shampoo or eye scrub solution.
The eyes must be prevented from becoming dry as this can exacerbate the symptoms of the blepharitis. If necessary, the patient should use topical lubricant eye drops.
Chloramphenicol antibiotic cream can also be applied to the lid, but if this does not relieve the problem within one month, then the patient should be referred to the GP for a prescription ophthalmic antibiotic. •
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