Page 32 - Retail Pharmacy Assistants September 2020

30 EYE CARE FROM PAGE 29
“It may seem strange to tell patients one of the most common causes of
a watery eye is dry eye, but watering happens because your eye gets dry. Even though you might not sense dryness, the cornea senses and sends a message to the tear gland to flood the area, leading to an overflow issue. Always remember, with mild DED, reflex watering is a common symptom.”
Ms Zabell says sufferers may experience one, two, all, or even
none of the typical symptoms, while
the symptoms felt by the patient and the signs observed by the healthcare professional often don’t match. Therefore, when identifying DED, it’s important to understand there are some people at higher risk of suffering DED than others.
“The higher-risk groups include women, those aged 50-plus, Asians (more than Caucasians), long-term contact lens wearers, users of certain medications (including, but not limited to diuretics, antihistamines, multivitamins, analgesics, anti-depressants/anti- psychotics and NSAIDs), and sufferers of certain health conditions (including but not limited to rheumatoid arthritis, diabetes mellitus, Parkinson’s disease, rosacea, and psoriasis).1
“Dry eye symptoms can also be triggered/exacerbated by specific situations such as screen work, central heating and cooling, dry and windy environments, and smoky environments.”
Ms Zabell says if a customer is in a high-risk group for suffering from dry eye, you can ask three simple questions to “try and tease out any complaints”:
1. Do your eyes feel healthy?
Often patients can’t articulate the symptoms but know that something feels a bit off about their eyes.
2. Do you think your eyes look healthy?
With chronic dry eye, the nerves on the front of the eye change so patients may stop complaining of symptoms but say their eyes look red.
3. Do your eyes ever feel dry or uncomfortable?
Top-tier treatment
For patients suffering from DED, a range of OTC products are available in community pharmacies. These can offer effective temporary relief and are used by many patients to control their condition successfully.
In recommending the best product for each patient’s needs, consideration should be given to the type of DED (evaporative, aqueous or mixed), the severity of the patient’s symptoms, and if the patient wears contact lenses as some products are not compatible with lenses.
While some patients suffer from only aqueous dry eye, requiring eye drops without added lipids, a study found that up to 60 per cent of dry eye patients had an evaporative component to their dry eye.2 This is better treated with a drop that has some lipid/oil component to help reduce tear evaporation.
Generally, multipurpose or all-in-one eye drops contain a lipid/oil component and are suitable for treating aqueous, evaporative or mixed DED. Most manufacturers, including Alcon, Bausch + Lomb, and Sanofi, offer eye drops containing lipids.
When unsure what type of dry eye a patient has, Ms Zabell suggests an all- in-one product is a good choice.
“An all-in-one product such as
Systane Complete covers all the bases, addressing the tear film completely through both the lipid layer and the mucoaqueous layer,” she said. “This is achieved because it contains nano-sized mineral oil molecules to supplement
the oily layer of the tear film, while
also containing HP-guar, borate, and propylene glycol to supplement the mucoaqueous layer and help the drop adhere to the eye.
“For aqueous dry eye, Systane Hydration is a non-preserved drop
that hydrates and protects dry eyes
by using a combination of HP-guar
and borate, and hyaluronic acid. This particular combination has been shown
to provide two-times greater moisture retention than drops containing hyaluronic acid alone.”
Many patients use a combination of products to control their symptoms.
A popular approach is to apply
thicker, gel-based drops before going to bed (gel-based products can
cause temporary blurring of vision), supplementing the gel with single-dose drops as necessary during the day.
When selecting suitable eye drops, patients should also be advised on choosing between those containing preservatives and those that are preservative-free. While products containing preservative are longer lasting and may be more cost-effective, they present a higher risk of infection or complications than single-use, preservative-free products.
Associate Professor Chan suggests patients should be guided on when they should choose a preservative- free, single-use product rather than a product containing preservatives.
“My parameter for choosing is based on usage,” he said. “If a patient uses eye drops more than four times a
day, they probably should aim for preservative-free as the multi dosing won’t lead to preservative toxicity.”
Tips to pass on
Ms Zabell recommends passing on the following lifestyle tips to help patients manage their symptoms and reduce the need for eye drops.
• Stay sufficiently hydrated by drinking plenty of water. This makes a significant difference and is something often forgotten.
• Use the 20/20/20 rule to take breaks from screen work. For every 20 minutes of screen work, take a 20-second break to look at something 6 meters or more away. This relaxes your eyes and improves blinking.
• A healthy, balanced diet.
• (If a smoker), discuss how smoking
cessation can help reduce
DED symptoms.
• Wearing sunglasses that protect the
eyes when outside can help with some symptoms.
References
1. Stapleton et al. TFOS DEWS II Epidemiology Report. The Ocular Surface, 2017; 15 (3): 334-368. 2. Lemp et al. ‘Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: A retrospective study’. Cornea, 2012; 31: 472–478.
RETAIL PHARMACY ASSISTANTS • SEP 2020