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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