Patients with red and painful eyes frequently seek advice in the pharmacy. This article focuses on OTCtreatment options of the most common eye conditions: red eye and dry eye. It summarizes symptoms andunderlying causes and lists do’s and don’ts for healthy eyes.
Dr. Klaus Rudolph
“Now do you not see that the eye embraces the beauty
remedies (camomile) can worsen eye conditions.
of the whole world? It is the lord of astronomy and the
Thus, the pharmacist plays a crucial role in the
maker of cosmography; it counsels and corrects all the
differentiation of the patient’s underlying causes.
arts of mankind; it leads men to the different parts of
Moreover, the pharmacist can give valuable advice
the world; it is the prince of mathematics, and the
sciences founded on it are absolutely certain.”
Emergencies such as acute glaucoma or sudden
Leonardo da Vinci (1452-1519) expressed in poetic
vision loss should immediately be referred to the
ophthalmologist, because they are sight threatening.
orientation depends on healthy eyes. At da Vinci’s
An eye doctor should diagnose infections, glaucoma
time, eye conditions (mostly infections) were very
and severe inflammations. These diseases are
common. The eye can be the target of infections,
inflammations and tumours. Other diseases arechronic glaucoma (increased intraocular pressureand degeneration of the optic nerve head) and
retinal diseases. Without treatment, many eyediseases result in blindness.
A red eye is the consequence/symptom of manyeye-related problems. It is the most common of all
Today our hygienic standards and treatment options
have greatly improved. Eye conditions, however, stillexist. In 2003, worldwide more than 750 million
The conjunctiva is the thin, transparent tissue that
units of ophthalmic drugs such as eye drops,
begins at the outer edge of the clear cornea. It
covers the sclera, the outer coat of the eyeball, asconjunctiva bulbi and the inner side of the eyelidsas conjunctiva tarsi. The conjunctiva is rich in
nourishing blood vessels. In healthy eyes it has a
white appearance, since vessels are constricted andnearly invisible to the naked eye. The conjunctiva
This overview focuses on the red and the dry eye.
secretes mucus is part of the protective tear film.
Both conditions are usually treated locally with a
Many conditions may cause the conjunctival vessels
variety of OTC products. In 2003, 67 per cent of
to dilate.The irritated conjunctiva (“conjunctivitis”)
global ophthalmic sales (over 500 Million units,
turns red (Figure 1). It is important to keep in mind,
that a red eye is a symptom, not a diagnosis. Often,but not always, a red eye is combined with tearing,burning, pain or itching.
In Egypt, a yearly total of about US$18 million isspent for ophthalmics. About 50 per cent of all
A red eye may be caused by physical or chemical
units sold are anti-infectives. In contrast, dry eye
stimuli (wind, sand, sun, smoke, acids and bases), by
products made only 4 per cent. Do these salesreflect a tenfold higher percentage of eye infectionscompared to dry eye? Ophthalmic databases showan average prevalence for dry eye of 25 per centand a lower rate for eye infections. From thesefigures it can be concluded that a dry eye is afrequently under diagnosed eye condition.
Ophthalmic OTC - the role ofthe pharmacist
Self-medication is growing but has its hazards.
Chronic use of certain OTC eye medications, e.g.
vasoconstrictors or uncritical use of home
Figure 1: A red eye with irritated conjunctiva
viral or bacterial infections or results from tear film
should only be treated with artificial tears.
disturbances (dry eye). Patients should not useantibiotics, corticoids and vasoconstrictors unlessthe reason for the red eye is known. A scheme to
differentiate the different types of red eye is givenin Table 1.
Trachoma is an easily spread infection of the eye,caused by Chlamydia trachomatis. At its onset, it
Non-infectious, acute irritations of the eye may be
resembles conjunctivitis with symptoms of tearing,
treated locally with antihistamines. Vasoconstrictors
photophobia (light sensitivity), pain, swelling of the
(e.g. anthazolines, naphazolines, sympathomimetics)
eyelids, and superior keratitis. Repeated
should only be used for a short period of time.
occurrences scar the upper eyelid, eventually
They effectively reduce eye redness, but quickly
turning it inward. The eyelashes then scratch the
loose efficacy. When used chronically, they help to
cornea, leading to blindness. It is a gradual yet
develop a dry eye because they decrease tear
painful condition. If treated early with antibiotics,
the prognosis is excellent. Untreated, it can cause
The leading symptom of allergy is itching. “If it
blindness.Trachoma is usually accompanied by red
doesn’t itch, it’s probably not an allergy”.
eye and dry eye symptoms. Artificial tears in
reactions usually involve the eyes, nose (allergic
addition to antibiotics give relief to the patient.
rhino-conjunctivitis or hay fever) and therespiratory tract. Of patients who take systemicallergy medication, 73 per cent still suffer itchy, red,
watery eyes and need ophthalmic medication.
Customers seeking advice in the pharmacy may tell
Dry eyes are often masked by eye redness. Self-
you the following complaints: “My eyes are burning
medicating patients tend to use vasoconstrictors to
when watching TV or working at the computer”; “I have
get rid of the redness. However, when used
a sandy feeling in my eyes”; “In the morning my eye lids
chronically, symptoms will aggravate. Dry eyes
stick together and are difficult to open”.
Table 1: Red eye diagnostic and treatment scheme
Non-infectious irritative Dry eye (tear film
Cromoglycic acid (slow Antibiotics:
(Cellulose derivates, e.g. onset of action, should
Gentamycin,Tobramycin pressure: topical beta-
Brands:Visine® original, Brands:Tears natural®,
Brands: Emadine®(Emedastin); Alomide®(Lodoxamidetromethamine)
symptoms strongly point to a dry eye or kerato-
conjunctivitis sicca.This condition affects up to
• Computer screen work - the eyes “forget” to
• Cigarette smoke, wind, sand, UV-light, ozone, heat
The tear film protects, moistens and nourishes the
eye. It also inhibits bacterial growth and keeps thecornea clear. The tear film has 3 layers: lipid,
• Systemic medications (antihistamines,
A dry eye is characterised by disturbances of one
betablockers, oral contraceptives, sedatives)
or more layers of the tear film. A dry eye should
• Rheumatic diseases (Sjoegren’s syndrome),
always be taken seriously. If left untreated, the
cornea can be seriously damaged and lose itstransparency so that vision gets disturbed. Its
symptoms can be quantified by measuring the
Artificial tears give quick relief and protect the eye
amount of tear production per time (Schirmer test)
surface.They are available in different viscosities.
or the stability of the tear film (break up time). A
dry eye requires regular instillation of artificial
tears. Paradoxically, a dry eye may frequently
appear as a chronically tearing, wet eye when
the mucin layer is defect.
• Avoid smoke, stress and excess sun light (use eye
• Make a conscious effort to blink frequently -
especially when working with a computer orwatching television
• Drink plenty of soft drinks (mineral water, fruit
• Women taking contraceptives should consider
• Contact lens wearers: refresh lenses regularly
• Do not apply home remedies, e.g. camomile
extracts (Matricaria chamomilla)
to the eye.They
Figure 2: Scheme of tear film
Table 2: Clues to your customers’ red eyes
Table 3: Artificial tears
Low viscosity eye drops
High viscosity gels
P E A R L S TO S H A R E W I T H PAT I E N T S
This information does not replace what is in the package insert.The pharmacist should always use their judgement whendeciding what information to give a patient when selling a medicine. Always know if you are talking to the patient as they maynot know the patient well enough to answer important questions.
(OTC and Rx)
BEFORE SELLING THE MEDICINE
Do you wear contact lenses?
Many eye drops can cause problems with contact lenses, especially soft lenses – check the medicine leaflet.
Never use contact lenses during infections.
WHEN SELLING THE MEDICINE
Explain how to use them
• Wash and dry hands before putting in the drops
• Use a mirror if possible
• Avoid touching the dropper tip against the eye, eyelashes, or any other surface
• Tilt the head back and look upwards. Gently pull the lower eyelid down
• Hold the dropper above the lower eyelid and squeeze one drop inside the lower eyelid
• Gently release the lower eyelid and blink a few times to spread the drop over the eye
• Replace the cap
• If another drop of the same medicine or of another medicine is needed, wait for a few moments before
putting the next drop in. More than one or two drops will run out of the eye
• Press a finger against the corner of the eye (by the nose) for about a minute after using the drops - this can
help to stop the drops draining into the nose and throat , especially in children (reduces bitter taste,
increases contact with eye).
• Most proprietary eye drops are OK out of the fridge for up to one month (including chloramphenicol).
Keep at room temperature to avoid pain when used
• Discard eye drops 1 month after opening
• Brief stinging is usual but tell your pharmacist or doctor if this gets worse.
Current Drug Targets - CNS & Neurological Disorders , 2003, 2, 357-362 Exploring Genetic Influences on Cognition: Emerging Strategies for Target Validation and Treatment Optimization John A. Fossella*, Sonia Bishop and B.J. Casey The Sackler Institute for Developmental Psychobiology, Weill Medical College Cornell University, 1300 York Ave,New York, NY 10021, USA Abstract: Geno
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