EYE HEALTH
first, main ingredient is a more likely to give longer lasting, effective relief for patients with dry eye symptoms compared to the more traditional saline or methyl cellulose derivatives.
3. CHOOSE HYPOTONIC FORMULATIONS
The quality of the tear film deteriorates in dry eye disease and the electrolytes become more concentrated, often giving rise to a stinging or burning sensation – we call this hyperosmolarity of the tear film. This is turn sets off the inflammatory process on the ocular surface, so avoiding this situation is beneficial in managing the condition over time. Even if you don’t have dry eyes you will have experienced this yourself if you have ever held your eyes open for too long and then felt the stinging which forces you to blink! The increasing modern trigger for dry eyes is computer use, notably because it encourages you to refrain from blinking for longer periods than is healthy for the ocular surface. Rather than feel the hyperosmolarity and correctly respond by blinking, when we are using our tablets and smartphones our engagement with the task means we can ignore the sensation, leading to chronic inflammation and dry eye.
Some pharmaceutical companies have now introduced hypotonic formulations for their dry eye
drops, and research has shown that symptoms are relieved more effectively by these solutions compared to isotonic formulations. Even more sophisticated is the inclusion of ‘bioprotectants’ in formulations: these are molecules or compounds chosen from nature that are known to protect cell walls in times of stressful conditions such as heat, cold, dryness and hyperosmolarity. One example is Trehalose, a disaccharide found in plants that need to survive extreme conditions, and commonly used in for medical and food conservation processes.
Hypotonicity and cellular protection are difficult concepts for consumers to appreciate that they might need, but as pharmacists you can encourage the selection of such products, particularly when the condition is long-standing.
4. THINK ABOUT THE BOTTLE
Having the most sophisticated eye drop product in the land is of no use if the patient cannot apply the drops easily. It is very common to experience difficulty with eye drops: many people think they have applied them correctly, but what they actually feel is the cold sensation of the drops on their face and not their eyes. Do ask your patients if they have any trouble applying their eye drops: whilst you may not have the time or facilities to teach them yourself, do suggest they ask a friend or relative to watch them
and direct them accordingly. For the success of any topical eye treatment this is important, but absolutely vital for preserving vision if patients are prescribed anti-glaucoma drops. Some bottle designs release a single, calibrated drop with a gentle squeeze whilst others will propel at quite a force with extreme pressure! You should also be aware that patients using novel bottles that require a three-point grip to depress a button typically need three times as much force to operate them, compared to traditional bottles; a level beyond most elderly female hands.
5.ADVISE A ‘PROPER’ POSOLOGY
It is now understood that taking eye drops to relieve dry eye symptoms is more effective when done by the clock, and not on demand, ie, taking them at 8am, 12, 4pm and bedtime, as opposed to when symptoms arise.
Compare this to other areas of chronic pain management that you know of and you will see the logic in this approach. This is something that patients are not often told; instead they tend to take them as many times as they wish, whenever their eyes become uncomfortable. What this does is allow inflammation to start before any palliative action is taken, so your best advice with any dry eye drop is to recommend they are
taken regularly, even when eyes feel comfortable.
AND LASTLY……….
Don’t forget you have an eye care specialist available in the community! Optometrists are trained to manage dry eye disease effectively, and have the specialist equipment to examine the ocular surface and tear film at high magnification. Eight out of ten cases of dry eye disease are in related to inflammation in the eyelids (blepharitis), and more specifically to dysfunction in the oil-producing glands. Optometrists can assess whether this inflammation is present and how best it can be managed over the longer term, so if you meet patients with long-standing problems do suggest they go and consult their local optometrist. For many patients this care is covered by their NHS entitlement, but they need to check locally. •
TIPS FOR YOUR CPD ENTRY ON DRY EYE MANAGEMENT
Reflect What is the most important thing to avoid in dry eye drops?
What makes a modern ingredient superior to traditional products?
Do you know the difference between the bottles you stock for dry eye products?
Do you discuss use of eye drops during an MUR?
Plan This article contains five easy principles to follow when recommending dry eye drops to patients in the pharmacy.
Act Read the article and start to offer recommendations at the counter. Arrange to share this article with counter staff.
Evaluate Are you now feeling more confident in your recommendations for dry eye drops? Can you explain on layman language why a patient should consider one of the more modern formulations for dry eye relief?
PhaRmacy IN fOcUS - 55
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