CALUM MURRAY, PRIMARY CARE CLINICAL PHARMACIST, EAST & MID ROSS PHARMACY TEAM, COUNTY COMMUNITY HOSPITAL
HOW OFTEN DO PATIENTS WITH EYE PROBLEMS PRESENT TO PHARMACISTS? AND IN PARTICULAR, HOW RECURRENT ARE CASES OF DRY EYE SYNDROME?
It is a condition that community pharmacists deal with on a daily basis. It is a very common condition that can affect people of all ages, but it is more common in those over 50 years of age and is more common in females. It can be a chronic condition that remits and relapses so recurrent symptoms can be common. There is usually no cure but symptomatic management can be provided in community pharmacies.
WHAT SIGNS AND SYMPTOMS OF DRY EYE SYNDROME ARE EXHIBITED?
Signs and symptoms can vary from person to person but they are usually bilateral. Signs and symptoms include irritation or discomfort (often described as burning, stinging or a ‘gritty’ sensation), dryness, intermittent blurred vision, redness of eyelids or conjunctiva, itching, photosensitivity, mucous discharge, and ocular fatigue.
WHAT ARE THE MAIN CAUSES OF THE CONDITION?
Dry eye can be caused by a number of factors. These include, meibomian gland dysfunction, blepharitis, age-related lacrimal gland deficiency, low blink rate, vitamin A deficiency, malposition of the eyelids, environmental causes (high wind, allergens etc.), contact lenses, certain medication, ocular surgery, and underlying medical conditions.
WHAT BENEFITS DO PHARMACIES BOAST AS A SOURCE OF EYECARE ASSISTANCE?
Community pharmacies are ideally placed to help with dry eye syndrome for a number of reasons. They are accessible so patients do not have a delay in being seen, given advice, or a product to help. Most pharmacies stock a wide range of products to help with dry eyes. Pharmacists are well-equipped to give advice on common eye conditions such as dry eye syndrome.
ARE PATIENTS SUFFICIENTLY AWARE OF THE HELP WHICH IS AT HAND FOR EYECARE VIA PHARMACIES?
Pharmacy is becoming increasingly popular as the first port-of-call, especially for a common condition such as dry eye syndrome.
HOW CAN THIS BE IMPROVED?
There is still work to be done to promote the Pharmacy First model. The more patients that have a positive experience in their community pharmacy, the more likely they are to tell their friends and relatives, which will encourage more patients to seek help from a community pharmacy before going to their GP or optometrist.
WHAT STEPS DO YOU RECOMMEND FOR SELF-MANAGEMENT OF DRY EYE SYNDROME?
There are a number of self-management techniques that can help. Using a warm compress, lid hygiene and massage are particularly helpful if the cause of the dry eye is
blepharitis or meibomian gland dysfunction. If contact lenses are the cause, wear them for shorter periods or not at all during a bout of dry eye. If environmental factors are the cause, patients should spend less time looking at computer or phone screens, avoid airconditioned environments, increase relative humidity, avoid alcohol and exposure to cigarette smoke.
WHAT TREATMENT PATHWAYS ARE PURSUED?
The first line of treatment is tear supplements, which there are a large amount of products available over-the-counter. Drops are helpful for daytime symptoms and ointments or gels should be reserved for use before bed because they can cause blurred vision but are longer-lasting to prevent the eye drying out overnight. There are
also preservative-free formulations available if a patient is intolerant to the preservative in tear supplements.
WHEN IS FURTHER TREATMENT REQUIRED FROM A GP OR OPHTHALMOLOGIST?
Urgent referral to ophthalmology is required if the patient is suspected of having a serious eye condition such as acute glaucoma, keratitis, iritis or corneal ulcer. Children should be referred urgently if they have any corneal change. Routine referral should occur if the diagnosis is unclear, they are suspected of having an underlying condition, if they have not responded to treatment after 12 weeks, or if they have an abnormal lid anatomy or function.