Understanding eye care

Sight is one of our most vital senses, so it’s important that people take care of their eyes. Pharmacy teams can help customers, especially those suffering from dry eye disease

One in four adults in the UK experience dry eye disease, but 32 per cent wait to see if the symptoms will go away on their own instead of seeking treatment, according to a recent Théa Pharmaceuticals study entitled NoEyeDea. 

Dry eye disease can severely impact an individual’s quality of life, but the OTC recommendations and self care advice from pharmacy teams can make all the difference. It is therefore essential to be aware of the causes, recognise the signs and know when and which are the appropriate treatments to recommend. 

"Patients should utilise community pharmacists to seek advice in treating their dry eye symptoms," says Tania Cork, local community pharmacist and member of Théa’s eye team. "Nearly half (46 per cent) of people answering the survey said they would use products recommended by their pharmacist, which demonstrates we are well placed to help patients find the right products to manage their condition, from proper lid hygiene to finding the right drop."

What is dry eye disease?

Medically known as keratoconjunctivitis sicca, dry eye disease is a common condition that occurs when tears can’t provide the eye with sufficient lubrication, triggering inflammation and damage to the eye surface. 

The disease can be divided into two categories: evaporative and aqueous deficient. Those with evaporative dry eye disease have tears that evaporate too quickly. This is usually caused by problems with eyelids; blinking; abnormalities in the oil secreting glands, known as meibomian gland dysfunction (MGD); blepharitis; contact lens use, and health conditions such as eczema and rosacea. 

The less common aqueous deficient dry eye indicates that sufferers do not produce enough watery tears. This is often due to conditions that affect the lacrimal glands – small glands underneath the upper eyelid that produce a large proportion of a person’s tears. These include obstructions, certain medications, infections and conditions such as Sjörgen’s syndrome – an immune system disorder. 

Causes 

Dry eye disease is principally caused by a person not producing enough tears, the right quality tears, or tears that don’t spread properly across the front of the eye. 

As people age, the different tear-producing glands in their eyes may become less effective, causing the quality of their tear film to decrease. The tear film is the thin layer of liquid which spreads over the surface of the eye. It serves to keep the front surface of the eye healthy, also helping it to focus properly and provide clear vision. 

Dry eye is multifactorial and can sometimes be connected to other conditions that affect the body, such as diabetes and rheumatoid arthritis, so always check with a patient to see if they are suffering from these. Although the disease is common in men and women over the age of 50, women are especially susceptible due to changes in hormonal levels during pregnancy or the menopause. 

Additionally, customers may be more likely to get dry eye if they:

• Wear contact lenses 
• Spend a lot of time looking at computer screens, watching TV or reading
• Spend lots of time in air conditioned or heated environments
• Take certain medicines (for example, some blood pressure treatments)
• Have an eye condition such as blepharitis or MGD.

Symptoms and treatment

According to the NoEyeDea report, 35 per cent of people are unaware of the symptoms of dry eye disease, despite a rise in cases due to increased screen time and mask-wearing during the pandemic. 

The principal signs are:

• A burning, stinging or scratchy sensation in the eyes
• Stringy mucus in or around the eyes
• Sensitivity to light
• Eye redness 
• A sensation of having something in the eyes
• Difficulty wearing contact lenses and with night-time driving
• Watery eyes
• Blurred vision or eye fatigue. 

There is a variety of information that pharmacy teams can offer customers to tackle dry eye disease, from OTC treatments to self care advice. 

As Tania points out: "Dry eye is becoming a common condition in several patients that walk through the door, and it is our job to recommend the appropriate management regime and treatments to get it under control."

Eye drops

Eye drops are the most common form of treatment for dry eye disease. The aim is to supplement and replace natural tears to help keep the surface of the eyes lubricated, preventing any damage. 

There are three main types of eye drops that can be recommended to customers: 

• Artificial tears – these are made by various manufacturers, with some customers finding that one brand works better than another. Pharmacy teams should advise customers to try a brand for at least a month before switching, to give the product time to work
• Gel eye drops are made from lubricating agents, which means they should stay in the eyes for longer. These are good for customers who are unable to regularly apply artificial tears, as they work in the same way but do not have to be used as often
• Eye drops in the form of ointments are especially good for customers whose eyes get particularly dry at night. They should be applied just before going to sleep so that the eyes feel more comfortable in the morning. Remember to remind customers that ointments can cause blurry vision, so should only be used before bedtime. If eye drops are also needed during the day, artificial tears and gels can be used interchangeably as these do not affect vision.   

"When a diagnosis has been made, pharmacy teams play a key role in helping people follow through with treatment," says Dr Louise Gow, specialist lead for eye health for the Royal National Institute of Blind People (RNIB). "Knowing how to put eye drops in and supporting them with eye drop dispensers if they are struggling can really help, as well as explaining to patients the importance of using the drops as prescribed and speaking to their eye care professional if there is no significant improvement over a month."

Self care tips and prevention advice

Another tactic customers can consider is making permanent changes to their lifestyle. "It is time to think about lifestyle choices and how these can affect our eye health," says Sarah Farrant, optometrist and a member of Théa’s eye team. "Our everyday habits, such as makeup, screen use, wearing contact lenses and mask wearing can make eye conditions worse."

Pharmacy staff can offer pointers such as: 

• Make sure computer screens are at eye level so the eyes are not strained and try to blink more when reading or using a computer
• If wearing contact lenses, every so often, opt to wear glasses instead 
• Make sure to not smoke or drink too much alcohol
• Do not stop taking a prescribed medicine without getting medical advice first – even if it is thought to be causing symptoms
• Eat a diet rich in omega 3 and 6, and flaxseed oil.

"Simply checking when they had their last eye test when they buy ready readers or eye drops would be a wonderful step in the right direction," explains Dr Gow. "Even better would be to give them a leaflet such as the information from the Vision Matters website whenever they purchase something over the counter for their eyes."

General eye health should be maintained throughout a customer’s life. Sarah has four top tips for looking after the eyes, which pharmacy teams can pass on to patients. These include:  

• Use the 20-20-20 rule: when using a screen, look at something 20 feet away for 20 seconds every 20 minutes
• Choose preservative free eye drops, gels, sprays or wipes
• Keep an eye out for symptoms of eye conditions with a quick symptom checker
• Don’t wait for symptoms to appear – even if you think your eyes are fine, make sure you get an eye test every
  two years. 

Risk factors and complications

Dry eye disease should not be ignored, particularly as it can have a serious impact on an individual’s quality of life. According to the NoEyeDea report, of the people surveyed who suffered from dry eye disease, 24 per cent stated it reduced their ability to wear contact lenses, whilst 18 per cent said it affected their sleep pattern and 14 per cent said it impacted their overall mood. 

As tears protect the surface of the eyes from infection, dry eye disease significantly increases a person’s chances of damaging the surface of their eyes. If left untreated, the condition can lead to eye inflammation, abrasion of the corneal surface and loss of vision.

"It’s easy to neglect your eyes because they often do not hurt when there’s a problem," says Sarah. "We rely on our eyes for everyday tasks, and we tend to take them for granted. It’s long overdue that people place greater emphasis on looking after their eyes, like they do other parts of their body."

The importance of eye tests

Since the pandemic, eye care has plummeted on the list of public health priorities. For example, NoEyeDea data suggests that only nine per cent of people are putting more effort into looking after their eyes. Additionally, almost a fifth of those surveyed admitted to avoiding getting their eyes tested and of these, 29 per cent said they felt no need to go because they felt their eyes were healthy. 

"Eye examinations are essential in picking up eye disease in the earliest possible stages and therefore can be sight saving," says Dr Louise Gow, from the Royal National Institute of Blind People. "Some tests will pick up general health issues, such as brain lesions, diabetes and high blood pressure and therefore can be of significant benefit to someone’s general health too. It is estimated that 50 per cent of sight loss could have been avoided, and regular eye examinations are very important in catching this.

"Pharmacies that sell off the peg reading glasses could help the situation by reminding people of the need for an eye examination and point of sale displays could also be clearly marked with advice to have an eye test and the reasons why it is so important."

Other eye conditions

Dry eye disease is not the only common condition that affects the eyes. Here are a few more...

Conjunctivitis 

Conjunctivitis is inflammation of the conjunctiva, the clear membrane that covers part of the front surface of the eye and the inner surface of the eyelids. There are two main types of the condition: infective and allergic. 

• Infective conjunctivitis usually affects one eye first and then the other. The white of the eye will be inflamed and appear red or pink, whilst also feeling watery and gritty. The eye will also produce yellow or green discharge, causing lashes to become stuck together. This condition is contagious, so customers should be advised to wash their hands frequently and avoid sharing pillows and towels, to stop the spread of the infection. A cotton pad – one per eye – and warm water can be used to delicately rub the eyelashes to soak off any discharge. In severe cases, people can be referred to the pharmacist or GP for an antibiotic prescription.
• Allergic conjunctivitis is caused by a reaction to a specific substance, such as pollen or pet fur. Both eyes are usually infected and feel itchy and watery, but there will be no discharge. Allergic conjunctivitis is not infectious and can usually be treated by avoiding the allergen and using antihistamines. 

Blepharitis

Blepharitis occurs when the eyelid becomes inflamed. It is usually caused by an infection, allergy or skin condition. It is particularly common alongside dry eye disease and rosacea. 

The main symptom is sore eyelids, usually affecting both eyes, but the eyes may also feel gritty and itchy, become sticky and develop crusts around the roots of the eyelashes. These symptoms can be controlled with daily eyelid hygiene. Key steps include:

• Apply a warm compress to the eyelids for five to 10 minutes
• Massage eyelids with eyes closed for around 30 seconds
• Clean eyelids with cooled boiled water – adding a drop of baby shampoo to the water may help, according to the NHS.

Whilst blepharitis is a chronic condition – meaning there is no cure – pharmacy teams can be on hand with this advice to help customers manage flare-ups. If symptoms don’t clear, customers may need to be referred to the pharmacist or GP for antibiotic drops, cream or ointment. 

Glaucoma

As it directly affects the optic nerve, if not treated quickly, glaucoma can lead to vision loss. The condition is caused by fluid building up in the eye and usually affects people over the age of 75.

Often, there are no noticeable symptoms during the early stages of glaucoma, so pharmacy teams should be aware of the warning signs, which include intense pain, blurred vision, nausea and headache.

If you think a patient is suffering from glaucoma, refer them to the pharmacist as they may need to visit their GP for treatment. This might include laser treatment to drain fluid from the eyes. 

Cataracts 

Cataracts cause cloudy patches to appear on the lens of the eye, and usually affect both eyes. The patches grow slowly, making vision blurred and the eyes sensitive to light, eventually causing blindness.

Although the condition is often described as a symptom of old age, it is thought that smoking, poor diet, diabetes, high blood pressure and excessive alcohol consumption can all put a person at a higher risk. 

Signs include halos around bright lights, problems seeing well in bright conditions and poor vision. If a patient is suffering from suspected cataracts, they should be referred to their GP as the only known treatment is surgery to replace clouded lenses.

Pharmacy teams can, however, recommend lifestyle changes that may help to slow down progression of the cataracts, such as quitting smoking and eating a healthy, balanced diet.