Opthalmic Symptoms

👁️ OPHTHALMIC SYMPTOMS (MINOR AILMENTS)

🔴 RED EYE (CONJUNCTIVITIS / “PINK EYE”)

✔️ Definition

Red eye ranges from minor subconjunctival hemorrhage to serious conditions (e.g., keratitis, glaucoma), but most commonly refers to conjunctivitis.

✔️ Causes

• Conjunctivitis (allergic, bacterial, viral)
• Blepharitis
• Corneal abrasion / foreign body
• Keratitis
• Iritis (uveitis)
• Glaucoma
• Scleritis

✔️ Symptoms

• Redness
• Discharge
• Pain
• Photophobia
• Itching / watering
• Visual disturbances

🌼 ALLERGIC CONJUNCTIVITIS

✔️ Key Features

• Usually bilateral
• Caused by pollen, dust, allergens
• Associated with:
• Sneezing
• Runny nose
• Palatal itching

✔️ Symptoms

• Intense itching (hallmark)
• Redness
• Watery discharge
• Burning sensation

✔️ Management

Non-drug:

• Cold compress
• Artificial tears

Drugs:

• Topical H1 antihistamines (e.g., levocabastine)
• Mast cell stabilizer: ketotifen (OTC)
• Oral antihistamines

Decongestants (short-term only):

• Naphazoline, tetrahydrozoline, oxymetazoline
  ⚠️ Avoid long-term → rebound redness

✔️ Referral

• No improvement in 7 days

🦠 BACTERIAL CONJUNCTIVITIS

✔️ Key Features

• Purulent discharge
• Eyelids stuck (“glued”) in morning (important sign)

✔️ Symptoms

• Red eye
• Mild pain
• Foreign body sensation
• Blurred vision

✔️ Management

• Requires prescription antibiotics 👉 Refer to physician

🧴 BLEPHARITIS

✔️ Definition

Chronic inflammation of eyelid margins

✔️ Symptoms

• Itchy, gritty eyes
• Worse in morning
• Crusts/scales on eyelashes
• Swollen lids

✔️ Management

• Lid hygiene (baby shampoo / lid scrub)
• Warm compress + massage

✔️ Severe cases

• Topical/oral antibiotics
• Steroids (rare)

🔴 EPISCLERITIS

✔️ Features

• Inflammation of episclera
• Sectoral or diffuse redness
• Usually self-limiting (2–3 weeks)

✔️ Management

• Often no treatment
• Severe → NSAIDs / steroids

✔️ Referral

• Recurrent cases (possible autoimmune disease)

🦠 HERPES SIMPLEX (EYE)

✔️ Cause

HSV-1 infection

✔️ Symptoms

• Painful red eye
• Photophobia
• Blurred vision
• Vesicles around eyelids

✔️ Treatment

• Topical antivirals (trifluridine)
• Oral acyclovir / valacyclovir

⚠️ Avoid:

• Steroids (worsen infection)
• Prolonged topical antivirals (>2 weeks)

👉 Always refer

🔥 MARGINAL KERATITIS

✔️ Features

• Painful red eye
• Photophobia
• Reduced vision
• Mucopurulent discharge

✔️ Association

• Chronic staphylococcal blepharitis

✔️ Management

• Refer → topical steroids

🩸 SUBCONJUNCTIVAL HEMORRHAGE

✔️ Features

• Bright red patch
• Painless
• No vision loss

✔️ Causes

• Idiopathic (most common)
• Trauma / anticoagulants

✔️ Management

• Self-resolves in 1–2 weeks
• Warm compress

👁️ UVEITIS (IRITIS)

✔️ Features

• Deep eye pain (radiates to temple)
• Redness
• Photophobia
• Blurred vision

✔️ Management

• Urgent referral
• Steroid eye drops

⚪ ARCUS SENILIS

✔️ Features

• White ring around cornea
• Lipid deposition

✔️ Clinical Importance

• Normal in elderly
• <50 years → check lipid profile

💧 DRY EYE SYNDROME

✔️ Causes

• ↓ Tear production / ↑ evaporation
• Aging, screen use, drugs (antihistamines, OCPs, β-blockers)
• Autoimmune (Sjogren’s)

✔️ Symptoms

• Dryness
• Foreign body sensation

✔️ Management

• Artificial tears (prefer preservative-free)
• Humidifier

Prescription:

• Cyclosporine (↑ tear production)

⚫ FLOATERS

✔️ Description

• Dark spots / cobwebs in vision

✔️ Cause

• Vitreous degeneration (aging)

⚠️ Danger sign

• Sudden onset ± flashes → urgent referral

🟤 NEVUS

✔️ Features

• Pigmented conjunctival lesion

✔️ Management

• Usually harmless
• Refer if growing (malignancy risk)

🔴 STYE (HORDEOLUM)

✔️ Cause

• Staphylococcal infection

✔️ Symptoms

• Painful eyelid swelling

✔️ Management

• Warm compress
• Self-limiting (1–2 weeks)

👉 Refer if persistent (>2 weeks)

🔁 TRICHIASIS

✔️ Definition

Inward-growing eyelashes → corneal irritation

✔️ Management

• Epilation
• Electrolysis / cryotherapy

💦 WATERY EYES

✔️ Causes

• Allergy (most common)
• Infection
• Blepharitis

✔️ Management

• Treat underlying cause
• Antihistamines for allergy

🟡 XANTHELASMA

✔️ Features

• Yellow plaques on eyelids

✔️ Significance

• Associated with hypercholesterolemia

👉 Refer for lipid profile

⚠️ FOREIGN BODY IN EYE

✔️ Symptoms

• Pain
• Tearing
• Redness
• Scratching sensation

✔️ Management

• Eye irrigation (mild cases)

👉 Refer if:

• Vision loss
• Corneal injury

💊 PRESERVATIVES IN EYE DROPS

✔️ Example

• Benzalkonium chloride

✔️ Effects

• Irritation
• Tear film disruption
• Toxicity (especially with contact lenses)

✔️ Advice

• Avoid lenses for ≥1 hour after use
• Prefer preservative-free drops in sensitive patients

Role of the Pharmacist in Eye Care

Pharmacists play an important role in the initial management of minor eye conditions and in ensuring the safe and effective use of ophthalmic medications.

Key Responsibilities

• Demonstrate the correct technique for instilling ophthalmic (eye) drops.
• Provide patient education using leaflets or verbal instructions.
• Ensure patients understand:
• Dosage
• Frequency
• Hygiene during application
• Identify red flag symptoms and refer when necessary.

When to Refer Immediately

• Any eye pain
• Sudden loss or disturbance of vision
• Severe redness or trauma
• Suspected infection or injury

Pharmacist’s Advisory Role

Although pharmacists are not specialists in ophthalmology, they can:

• Assess symptoms such as:
• Dryness
• Watery eyes
• Redness
• Suggest appropriate over-the-counter (OTC) medications
• Provide guidance on lifestyle factors (e.g., screen time, hygiene)

Patient Consultation: Key Questions

During assessment, pharmacists should ask:

1.     Duration

• How long have you had this problem?

2.     History

• Have you had this problem before?

3.     Pattern

• What is the pattern of occurrence?
• Has it worsened or improved over time?

4.     Pain

• Is there any pain?

5.     Discharge

• Is there any discharge from the eye?

6.     Vision

• Is your vision affected?

7.     Cause

• Do you know what caused it?
• Is there any obvious reason?

8.     Lifestyle

• Have you been using a computer or screen for prolonged periods?

Key Points

·        Pharmacists are often the first point of contact in healthcare.

·        They play a major role in managing minor ailments, such as:

• Body pains and aches
• Dyspepsia
• Nausea and vomiting
• Gastritis
• Diarrhea
• Constipation

·        Responsibilities include:

• Understanding patient symptoms
• Recommending appropriate pharmacist-only/OTC medicines
• Providing counseling on medication use

·        Referral is essential when:

• Symptoms are severe
• Condition is unclear
• No improvement is seen

 

🚨 RED FLAG SIGNS 

👉 Immediate referral if:

• Severe pain
• Vision loss
• Photophobia
• Corneal involvement
• Trauma
• Sudden floaters/flashes
• No improvement with OTC