COMMON EYE
CPD MODULE
CURRENT COMMON EYE CONDITIONS THINKING ON...
Welcome to our CPD module series for community pharmacy technicians. Written in conjunction with the Pharmacy Magazine CPD series, it will mirror the magazine's programme throughout the year. The series has been designed for you to use as part of your continuing professional development. Reflection exercises have been included to help start you off in the CPD learning cycle.
Contributing author: Andrea Tarr, BPharm, MSc, MRPharmS, clinical and medical writer.
Conjunctivitis
Conjunctivitis is inflammation of the mucous membrane that lines the front of the eye and the inside of the eyelids. It can be caused by an infection or an allergy.
Either viruses or bacteria can cause infective conjunctivitis, but it is not possible to determine the cause just
by looking. Only one, or both eyes, may be affected and the person will usually complain of a gritty or itchy sensation in the eye(s) for a few days. The eyes will usually be a bit red and have a watery or opaque discharge that can make the eyelids stick together after sleep. The condition does not
usually cause pain in the eyes or
affect vision. Conjunctivitis will usually get better on its own within about a week.
Treating infective conjunctivitis
Chloramphenicol is an antibiotic that kills a wide range of bacteria and is commonly prescribed for treating infective conjunctivitis.
MODULE NUMBER: 58
AIM: To provide an overview of the management of common eye conditions ? in particular conjunctivitis and dry eye syndrome.
OBJECTIVES: After completing this module, you should
be able to:
Explain the symptoms of
common eye conditions
and be familiar with over-the-counter treatments
LECT
PL
LUATE REF
AN
Discuss the
pros and cons of treatment with
CPD SUPPORT
topical
A
chloramphenicol
CT
EVA
with patients who
have infective
conjunctivitis
Make a suitable product
recommendation for dry eye syndrome.
Chloramphenicol eye drops and eye ointment have been available over-the-counter (OTC) from UK pharmacies as a treatment for conjunctivitis since 2005. Using chloramphenicol to treat conjunctivitis can shorten the
duration of the condition slightly, but most people recover within a week whether it is used or not. It may be appropriate to treat
troubling infective conjunctivitis as long as there is no reason to refer the patient to a doctor. Royal Pharmaceutical Society guidance says that when making a supply of OTC chloramphenicol, pharmacists need to be satisfied that it is in line with the marketing authorisation and is clinically beneficial. It is crucial for pharmacists to make sure a supply of chloramphenicol is appropriate and to rule out serious sight-threatening conditions. It is also important to discuss the pros and cons of treatment with the patient.
OTC chloramphenicol
reflection exercise
A customer who usually wears contact lenses comes to your pharmacy and tells you that she suffers from dry eye syndrome. Would you know which product(s) to recommend based on the severity of the condition and product ingredients?
28 T R A I N I N G M A T T E R S JULY 2015
The magazine for professional assistants
CPD MODULE
must not be used in children aged under two years.
The following points need to be considered and discussed with the patient:
? Conjunctivitis can be caused
by viruses or bacteria. It is not possible to know the cause just by looking. If caused by a virus, chloramphenicol will have no effect
? Conjunctivitis usually gets
better on its own within a week whether treated or not
? Chloramphenicol can help
speed up recovery slightly (by a day or so)
? Some people may have side
effects from treatment (e.g. stinging, allergy)
? Antibiotics must be used
responsibly to limit the development of bacterial resistance.
Practical advice
The following advice can be given to customers with infective conjunctivitis, regardless of whether or not OTC chloramphenicol is to be used, to help reduce symptoms and prevent the spread of infection:
? Bathe the eyelids with
lukewarm water to remove any discharge and help soothe the redness and itching. The eye should be cleaned by wiping from the bridge of the nose to the outer eye, using a fresh piece of cotton wool or gauze for each wipe. Tissues, gauze and cotton wool used to wipe the eyes should be disposed of
? Avoid wearing contact
lenses until symptoms have resolved
? Follow hygiene measures
(e.g. wash hands, avoid sharing pillows and towels)
? Seek medical advice if
symptoms do not settle within seven days, or if visual disturbance, significant eyelid swelling, photophobia or pain in the eye develop
? Seek medical advice if there
is no improvement after treatment with chloramphenicol, or symptoms deteriorate after two days of treatment.
Other OTC treatments
An antibacterial drug called propamidine, which has a less wide-ranging effect on bacteria than chloramphenicol, is also available OTC in Brolene Eye Drops and Golden Eye Ointment. These products are licensed for the treatment of "local, superficial" eye infections. Patients are advised
cromoglicate to take effect,
(e.g. Tears Naturale), are the
reflection exercise
and for breakthrough symptoms. There is no evidence that any one treatment is better than
most commonly used products, but they need to be used frequently (ideally at 30minute intervals initially until
Dry eye disease is a common chronic condition in older
another.
symptoms improve, then less
people, but do you know which other groups of people can suffer from dry eyes?
Practical advice ? Remove contact lenses, if
often). More viscous products (e.g.
Geltears, Systane) need less
worn, until symptoms resolve
? Avoid rubbing the eyes ? Avoid exposure to the
frequent application, but may be less well tolerated because of stinging or blurring.
allergen
? Use a cool compress (such as
Sodium chloride is shortacting and suitable as
a flannel soaked in cold water) "comfort drops". If a product
on the eyes to ease symptoms. causes irritation or if soft
Dry eye
contact lenses are worn, a preservative-free product may
Dry eye syndrome is a common be more suitable. There is no
eye condition, particularly in
clear evidence that any one
older people, and it can have a product is better than another.
significant impact on quality of The severity of the condition
life. Normally, tears are
and the person's preference
produced to protect and
should guide choice.
hydrate the surface of the eye,
flush away debris, limit
Practical advice
bacterial growth, and act as a Patient education is important
lubricant to prevent the eyelid in the management of dry eye
rubbing the surface on
syndrome. Patients need to
"Patient education is important in
blinking. In some people, the know that treatment is longquality of tear fluid is reduced, term and may be slow to take
the management of dry eye syndrome. leading to dry eye syndrome. effect. Non-drug interventions Symptoms include irritation that may improve dry eye
Patients need to know that treatment is long-term and may be slow to take
and burning of the eyes, which is often worse when reading or watching TV because concentrating reduces the
symptoms in some patients
include:
? Avoiding aggravating
factors, such as cigarette
effect"
blink rate, causing the corneas to dry further.
Dry eye syndrome occurs
smoke, dry heated air and
air conditioning
? Considering using a
as part of the normal ageing
humidifier to introduce
to seek medical advice if there is no stabilisation or
drugs can be been used to relieve symptoms. These
process, but people who wear contact lenses or who have
moisture into the air
? Limiting the use of contact
improvement after 48 hours. There appears to be no
include:
? Antihistamine eye drops or
had surgery to correct short sightedness, or who have
lenses
? Taking frequent breaks from
formal published assessment of the efficacy of propamidine
tablets/liquid ? useful for rapid relief of symptoms. Tablets or
dietary deficiencies or certain diseases that affect the
computer use
? Applying a hot compress
in the management of acute
liquid may be more
immune system (e.g.
(such as a facecloth soaked in
infective conjunctivitis.
appropriate if the person also rheumatoid arthritis) can also warm water) or other eyelid
Allergic conjunctivitis
has nasal symptoms
? Sodium cromoglicate eye
be affected. Older people and women are more likely to be
warming devices (such as eye masks) to the eyes for three to
Allergic conjunctivitis occurs
drops ? prevent the release of affected.
10 minutes. This may help
in people who are sensitive to histamine from mast cells.
Some drug treatments
unblock the meibomian glands
certain allergens, such as grass Sodium cromoglicate does not can also cause dry eyes. These on the eyelids, which produce
pollen or animal fur. The
reduce symptoms of allergy
include drugs used to treat
a fatty secretion (meibum) and
allergens dissolve in the tear
that are already present, but
hypertension, benign prostatic so improve tear film quality.
film and cause an allergic
can be used to prevent
hyperplasia, and depression.
Eyelid massage immediately
reaction in the conjunctiva (involving the release of
symptoms in someone who knows to expect them (i.e.
Treating dry eyes
afterwards helps the flow of meibum.
histamine from mast cells).
ahead of the hayfever season). There are several treatment
Patients with more severe
Usually, allergic conjunctivitis
Antihistamine eye drops,
options available, including
symptoms, and who are not
is seasonal and short-lived
tablets or liquid might be
eye drops, sprays and
helped by OTC products and
(e.g. it occurs only when pollen useful for symptom control in ointments. Aqueous tear
practical measures, should be
is in the air), but it can be
the first few weeks while
products, such as those
advised to seek medical
longer-lasting if the person
waiting for the sodium
containing hypromellose
assessment.
is allergic to something that
is always around (e.g. house
dust mites, animal dander). Typically, a person will have
Go to tmmagazine.co.uk to answer the CPD questions.
itchy, red, watery eyes with lid swelling, and perhaps a runny or stuffy nose.
When you pass, you'll be able to print out a certificate to showcase your learning. You can also add this to your online, personalised learning log.
Allergic conjunctivitis
usually affects both eyes. It will usually improve without
Next month: We focus on heart failure.
treatment, but a variety of
JULY 2015 T R A I N I N G M A T T E R S 29
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