Eye Conditions Almost two-thirds of New Zealanders will have an eye problem at some stage of their lives. Some of the more common conditions seen in the pharmacy include red eye, dry eye, conjunctivitis (allergic, bacterial, viral), minor eye irritations, blepharitis and styes. These conditions together with treatment options are discussed in more detail on the following pages. Initial assessment If the eye problem is not immediately obvious, ask your customer if they are willing for a pharmacist to perform a basic eye examination. Even for minor or ongoing conditions, a customer may benefit from further input from a pharmacist. Basic eye examination: Notes for pharmacists Wash your hands and ask the customer to sit down in a private area with good light. Ask the patient to look straight ahead and pull down the lower eyelid. Instruct the patient to look up, then down, to the left and right while you examine the conjunctiva. Look for signs of redness, dryness, foreign bodies (eg, wood splinters), and infection. Use the charts on the following pages to identify the most likely condition and recommended treatment. For foreign bodies, consider using an eye wash to flush out the object or refer the customer to the doctor if the object is strongly embedded or difficult to remove. Base your product recommendation or decision to refer on information gained during the examination. Customers wearing contact lenses, with eye or eyelid swelling, pupils that do not react to light, reporting vision disturbances or with an uncertain diagnosis should always be referred to a doctor or an optometrist holding a Therapeutic Pharmaceutical Agents (TPA) endorsement (able to prescribe a range of ophthalmic medicines). Advice for customers Applying eye drops • Wash hands first. • Shake the container if instructed to do so to mix the eye drops, then open. • Pull the lower eyelid down gently with the index finger to form a pocket. Tilt head slightly back and look up. • Hold the bottle between thumb and index finger and squeeze it gently to release the recommended number of drops into the pouch. • Do not touch eye with the dropper tip. • Do not blink (this draws the eye drop into the tear duct). • Close eye and press gently over the corner of the eye for a few minutes to stop the drop draining through the tear duct. Remove excess drops with a clean tissue. • Wait 10 minutes before adding other eye products to the eyes. Put eye drops into the eye before putting in eye ointment. Applying eye ointment • Hold tube between thumb and index finger and rest hand against base of nose to position the ointment tube tip. • Apply a small blob of ointment into the lower eyelid pocket. Do not touch the eye with tube tip. • Eye ointment may blur vision for a short time after use. Do not drive or operate machinery until vision is clear. TREATMENT OPTIONS Category Examples Comments Natural / herbal products / supplements Bilberry Euphrasia (eyebright) Vitamin C with bioflavonoids Styes Black tea Pulsatilla Dry eyes Omega 3 & 6 Flaxseed oil Bilberry is used for improving visual acuity including night vision, cataracts, degenerative retinal conditions. Euphrasia can help relieve sore and irritated eyes. Vitamin C may help decrease the risk of age-related macular degeneration. Several herbs have infection-fighting properties; however, eye washes containing these ingredients should only be made by a herbal practitioner trained in botanical medicine. Topically applied Pulsatilla may help with styes. A tea bag applied to the stye may help clear it. Increasing omega 3 and 6 intake can lower risk of developing dry eye syndrome. For severe or chronic dry eye Page 64 HEALTHCARE HANDBOOK 2017-2018 Common Disorders
CONTINUING OTC EDUCATION Eye mist sprays • Usually formulated to relieve dry eyes. • Spray directly onto closed eyelids. Moisturising particles are then swept into the eye with every blink. • Easier to use and last longer than regular eye drops; however, may be more expensive. Useful tips • Some eye products contain preservatives or ingredients that can affect contact lenses, or may cause a sensitivity with continued use. »» Check with the pharmacist or optometrist regarding compatibility. »» Preservative-free eye drops may be more suitable. »» Discontinue products that make eyes red or even more irritated. • Damage to the eyes can easily occur if eye conditions are left untreated. »» Without the protection of the tear film, the cornea can scratch easily which can result in infection, ulcers, scarring and potentially permanent vision loss. • Protect eyes from wind and sun by wearing sunglasses. • Discard multi-use eye products one month after opening unless otherwise stated. Single-use products are sterile until they are opened. Eye mist sprays are designed to keep the product sterile even when in use. Refer to package instructions for discard date. • Replace eye make-up frequently and do not share. • Contact lens wearers should always follow their optometrist's instructions with regards to lens hygiene (see Eye Conditions: Contact Lenses) • Consider visiting an optometrist every two years for an eye examination. »» Eye problems are more likely as people age. »» Eye diseases can be detected earlier, eg, glaucoma is symptomless. »» Contact lens wearers should see an optometrist at least yearly. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions that may cause eye problems (eg, immunosuppression, diabetes)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications) which might have adverse effects on the eyes? • Does the customer wear contact lenses? • Does the customer have a family history of eye problems (eg, glaucoma)? • Does the customer have pain in the eye(s) or is sensitive to light? • Is only one eye affected? • Do they have any deterioration, alteration or loss of sight? • Do they see halos or yellow/green colours around lights? • Is there any swelling of the iris or eyeball? • Are the pupils different sizes or an irregular shape? • Is there any coloured discharge or mucus from the eye? • Is there redness localised around the pupil? • Are the tissues around the eye(s) swollen, red or sore (indicates a more serious infection in the skin and underlying tissue) • Are there any systemic symptoms (eg, headache, vomiting)? • Is the cornea cloudy? • Has the problem persisted despite treatment? • Has the eye problem been ongoing or recurrent? • Is there or has there been a foreign body in the eye? • Is the customer a baby, young child, pregnant, menopausal or elderly? • Could the customer have a herpes zoster infection (shingles), indicated by a painful rash on the forehead or near the affected eye? • Does the customer have any allergies to topical eye products or preservatives? For mild or moderate dry eye Preservative and phosphate-free At least 300 sterile drops per bottle Use for 6 months after opening Use with all contact lenses Delivered through the unique COMOD ® multidose application system HYLO®-FRESH (Sodium hyaluronate 0.1% w/v, 10mL) and HYLO-FORTE® (Sodium hyaluronate 0.2% w/v, 10mL) eye drops are General Sales Medicines to improve the lubrication of the eye, in eyes that are dry, irritated and tired from external factors. AFT Pharmaceuticals, Auckland. TAPS 1733HA. Page 65
According to Stéphane Rossini, incoming Chairman of the Agency Council, the culture of collaboration will remain a factor in ensuring that Switzerland is successful in retaining a high-quality medicines control system: “A globalised economy and the international consumption of therapeutic products entail synergies and collaboration.”
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