There is often a lot of concern about treating any disorder of the eye due to the sensitive nature of the eye and the possibility of damaging it further, which is right to a certain extent. If you are unsure of symptoms, it’s important that you go and see your GP. At the same time, just by following normal protocol and using a bit of common sense, it can usually be pretty easy to distinguish between what can be treated in the pharmacy and what can’t.
Eye problems can be broadly divided into 5 categories. We’re going to talk about the first three, the painless red eye, inflammation of the eye lids and disorders of tear drainage or production. The final two always require a GP visit, they are pain within the eye, so not just the gritty feeling on the surface but pain coming from within the eyeball and eye disorders as a result of some other disease, so maybe a bulging eye due to an overactive thyroid, blurred vision due to multiple sclerosis or constant movement of the eye or constant twitching of the eye can be due to some disorder of the brain. So anything within these two categories requires immediate attention by a GP. We’ll just go through some of the more common eye complains seen in the pharmacy within those first three categories.
The painless red eye, conjunctivitis is by far the most common eye ailment. Basically the conjunctiva is a clear membrane that covers the white part of the eye which is called the sclera. When this becomes inflamed it becomes red and we call it conjunctivitis, which is just inflammation of the conjunctiva. It can be allergic, in which case there will be no puss or anything, there’ll just be some clear watery discharge or it can be infective either due to a virus or bacteria, in which case there would usually be a bit of puss. Usually both eyes are affected but if only one eye is affected, it’s less likely that it’s conjunctivitis and more likely to be something like iritis, which is inflammation of the iris, the coloured part of the eye and the redness would usually be localised to the centre of the eye in that case. If it’s allergic you may have other symptoms like congestion or sneezing.
The most common cause of conjunctivitis is hayfever so you’ll often see the common hayfever symptoms along with allergic conjunctivitis so that will help diagnose it and treat it. If it’s viral, you will often have other symptoms of a cold, they’ll be coughing or a temperature and again this will help distinguish one from the other in order to choose the best treatment option. To diagnose conjunctivitis in the first place, it’s a very quick test, all you’ve to do is simply pull down the lower lid and have a look at the colour of the membrane inside because the conjunctiva not only covers the white part of the eye but also covers the inner lid, so in conjunctivitis it will be bright red and inflamed as opposed to the usual pale pink colour, so that’s a quick way to spot conjunctivitis. You can also get something called a subconjunctival haemorrhage, which is where a blood vessel just underneath the membrane bursts and very often the entire white part of the eye would be covered with blood and would be coloured red. It’s completely harmless, there’s nothing you can do about it, it’s usually more distressing for the patient and they’re usually very keen to treat it, but there’s really nothing you can do, it’ll take a little bit of time to clear up, but it is harmless so no treatment is required.
In terms of eyelids and inflammation, styes are the most common type of inflammation of the eyelids, this is an inffected hair follicle of the eye lash. So it’s just a small lump that appears on the lid margin so not quite inside the lid or on the outside but just on the margin. It may spread to the rest of the eyelid and usually resolves itself in a couple of days, but there are treatments which you can use which I will discuss later. Redness or irritation in the eyelids with scales or dry skin, it can be in one or both eyes, this is usually blepharitis. It’s commonly associated with seborrheic dermatitis or dandruff, they often go hand in hand with each other. It may be allergic, so you might see conjunctivitis with it, or rarely it might be infective but it’s usually just allergic. Antifungal shampoos that are used to treat dandruff often work well to clear up any scaly skin around the eyelids, so when you are washing your hair if you just let it drip down your face, that can often clear up any dry scaly skin around the eyes.
A small, hard, pea-like lump just on the inside lid, usually the upper lid but can be on the bottom lid as well is likely to be what’s called a meibomian cyst which is harmless, it resolves by itself but sometimes might need excision by surgery. It looks like an internal stye. A drooping upper eyelid then is called ptosis, it’s often a sign of systemic disease or something else going on in the body and would require a visit to the GP. It should be easy enough to tell the discomfort felt between conjunctivitis which would be an itchy and gritty feeling as opposed to actual pain from within the eye, which will always require a GP visitl.
In terms of tear production, dry eyes is a common complaint, which is not enough tear fluid being produced, it can also go the other way in which a patient might get what’s called lacrimation, which is tears just running down the face and it’s due to a problem with the drainage of the tear fluid, in babies this requires a visit to the GP, in adults often it can be fixed by just massaging the ducts which are at the inner corners of the eyes. And if it’s still not resolved, go to your GP.
Any disturbances in vision needs a visit to the GP, there should be no vision disturbance for conjunctivitis. It may occur with a migraine but patients will usually recognise that themselves and know what it is. Loss of vision is definitely a medical emergency and double vision especially with ptosis which is the drooping eyelid and a headache certainly requires a Doctors visit, these are all signs of a bleed within the brain. And then things like bizarre patterns or halos around lights especially coming out of a dark room into open light space definitely requires a GP because it could be a sign of multiple sclerosis or glaucoma or perhaps something more serious. Look at the pupil, if the pupil is of any irregular shape or if it changes into an irregular shape when it constricts or dilates, again this needs referral, it could be a sign of something more serious going on in the brain and if there is any hazy appearance to the pupil again this could be some inflammation or something going on within the eye and would also need a visit to a GP.
First of all none of the products for eye treatment should be used for more than 7 days, if it hasn’t worked after 7 days you need to go to a doctor. You can use antibacterial drops, Brolene are pretty much the only ones and are very effective for bacterial conjunctivitis, styes or blepharitis. It’s best to use this product pretty generously, even every hour especially for the first day and decreased after that. It’s very effective for those conditions. If scales are adhering to the skin around the eyes for a patient, what can work quite well for them is to rub some diluted baby shampoo on the eyelids and this should remove the scales or any puss clinging onto the skin there. There are what’s called vasoconstrictor substances like Murine irritation and redness relief. It contains naphazoline which constricts the vessels within the eye and stops the injection of blood into the conjunctiva so it reduces any redness or irritation associated with the conjunctivitis. These products shouldn’t be used in patients with already existing eye problems like glaucoma. Sodium cromoglycate is what’s called a mast cell stabiliser, it’s an anti-allergy drug, it’s a fantastic product for allergic conjunctivitis, so clear water discharge and itchiness, those hayfever type symptoms. Another similar product called Otrivine antistin eye drops, contains an antihistamine and would also be used for allergic conjunctivitis. Substances such as the one found in optrex are called astringents and work very well for irritation and red eyes. Witch hazel is the ingredient in Optrex products. It’s best used when there is a vague general complaint of tired eyes with no conjunctivitis, so where something mild is required, the Optrex works very well in these cases. The normal Optrex has just witch hazel in it. The Optrex clear eyes has witch hazel and the naphazoline, which is the vasoconstrictor substance in Murine, so again it shouldn’t be used in people with glaucoma. For dry eyes you can use the Tears Naturale or the Gel Tears which are polymers to lubricate the eye.
Garvan J. Lynch M.B.A.(Public Health) D.I.C.