the otc treatment clinic

Supporting Training Initiatives
the otc
treatment clinic
Common conditions and their treatment options
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as part of their ongoing learning. Complete the questions at the end to include in your self-development portfolio
module 195
Welcome to TM’s OTC
Treatment Clinic series. This
handy, four-page section is
specially designed so that
you can detach it from the
magazine and keep it for
future reference.
Each month, TM covers a
different OTC treatment area
to help you keep up-to-date
with the latest product
developments. In this issue,
we focus on eye care. At the
end of the module there are
multiple choice questions
for you to complete, so your
progress can be monitored
by your pharmacist.
You can find out more in
the Counter Intelligence Plus
training guide.
The last six topics we have
covered are:
l Itchy skin
l Hair loss (alopecia)
l Heartburn and indigestion
l Ovulation and pregnancy
l Dry skin – part 1
l Nasal health and hygiene
You can download previous
modules from
Eye care
author: Jane Feely, PhD
for this module
OBJECTIVES: After studying this module, assistants will:
• Be familiar with the basic structure of the human eye
• Have an understanding of some of the common minor eye conditions
• Be aware of the importance of regular eye checks and of protecting eyes from UV light
• Have a basic understanding of some of the more serious eye conditions
• Be able to offer lifestyle advice for healthy eyes
• Know when to refer to the pharmacist.
Sight is one of our most important senses and it’s
probably the one we’d miss the most if something
happened. Just imagine if your sight were adversely
affected – think of your daily activities and how they
would be impacted.
Having said that, many people take their sight for
granted. They figure that as long as they can see
okay, then their eyes must be healthy, but that’s not
necessarily the case. Like so many other parts of our
bodies, we need to look after our eyes and make
sure that any conditions are identified before they
become more serious.
The eye conditions you encounter in the
pharmacy tend to be minor – things like dry eye,
conjunctivitis, styes, etc. But it’s important to be
aware of other conditions, too, so that you can
advise customers when to seek medical advice.
According to figures from the Royal National
Institute of Blind People (RNIB), almost two million
people in the UK are living with sight loss. Every day,
100 people in this country start to lose their sight – a
sad fact when you consider that sight loss can often
be avoided.
The structure of the eye
Before we look at common eye conditions, let’s
recap on the structure of the eye and how we see.
Sight is actually a series of events triggered by
light, which involve the eyes and the brain. Light
reflected from an object passes through the clear
cornea at the front of the eye and is focused by the
lens onto the retina at the back of the eyeball.
The retina is a layer of light-sensitive cells called
rods and cones. Rod cells are concentrated around
the edge of the retina. They help us to see things
that aren’t directly in front of us (peripheral vision).
They also help us to see things in dim light and to
see movement.
TM JULY 2013
the otc treatment clinic
reflective exercise
Anne, 52, asks you for eye drops. She tells
you her eyes feel dry, gritty and a bit sore.
Both her eyes are affected but there are no
other symptoms. You call the pharmacist,
who looks at Anne’s eyes – they are slightly
red. Anne is not taking any medicines.
What would you recommend?
This sounds like a mild case of dry eye
syndrome, which occurs when the eyes do
not make enough tears, or the tears
evaporate too quickly because the oil
glands are blocked or abnormal. This leads
to the eyes drying out and becoming
inflamed (red and swollen) and irritated.
Anne may be able to ease her
symptoms by keeping her eyes clean,
adjusting her environment and improving
her diet. A warm compress (eye pads
soaked in boiled water and cooled to room
temperature) can be placed over the eyes,
the eyelids can be massaged and the
eyelid margins cleaned.
It is also useful to avoid smoke and eye
make-up and if using a computer, to sit
correctly in relation to the screen to avoid
eye strain. Use of a humidifier will moisten
the air and opening the window will also
help to keep the air moist, which can help.
There is also increasing evidence that a
diet high in omega-3 fats can help
improve eye health. Reiterate the
Department of Health’s advice to consume
two portions of oily fish each week, as this
provides omega-3 fatty acids.
Mild to moderate cases of dry eye
syndrome can usually be treated using
lubricating drops, gels or ointments. These
aim to replace the missing water in the
tear film. Anne may need to try a few
products before she discovers which one
suits her best.
Cone cells are found in the centre of the
retina where the light is focused by the cornea
and lens. This area is called the macula. Cone
cells give us our detailed vision, which we use
when reading, watching TV, looking at people’s
faces, etc. They are also responsible for most of
our colour vision.
The rod and cone cells collect the light
signals and send them as electrical signals to the
optic nerve at the back of the eye. This is made
up of thousands of nerve fibres passing electrical
signals to the brain. It is the brain that processes
all of this information and interprets what we see.
Other important parts of the eye include:
TM JULY 2013
What if:
Anne wears contact lenses and presents with
the symptoms of dry eye?
Although anyone can suffer from dry
eyes, the risk can be higher in people
wearing certain types of contact lenses.
Some optometrists may recommend
changing the lenses. Lenses that are disposed
of each day do not build up deposits, which
can be a cause of poor wetting. Appropriate
care for contact lenses is also important. If
Anne wants to purchase eye drops, ask what
type of lenses she has and check on the
suitability of the eye drops.
What if:
Anne presents with the same gritty sensation
in her eye, but her eyes are red and itchy.
Anne has suffered from hayfever in previous
years, but usually suffers nasal symptoms.
This sounds like a case of allergic
conjunctivitis, but check with the pharmacist.
You could ask Anne if she has been in a
smoky environment or perhaps used any
new eye make-up or shampoo as these
products could irritate the conjunctiva. The
pharmacist may also want to establish
whether an eye infection could be the cause.
Assuming that Anne is suffering from allergic
conjunctivitis, eye drops containing sodium
cromoglicate can be recommended.
What if:
Anne asks you for an eye ointment for a stye?
Most styes get better without treatment
within a few days or weeks. Advise Anne to
place a warm compress over the closed eye –
this encourages the eye to release pus and
heal more quickly. This treatment should be
repeated for five to 10 minutes several times
a day. An eye ointment is not generally
required. Anne should not try to burst the
stye herself. If the stye persists and is painful,
Anne should see a doctor.
l Iris – the coloured, circular part of the eye in
front of the lens. It controls the size of the pupil
l Pupil – the circular opening at the centre of
the iris, which controls the amount of light that
enters the eyes
l Conjunctiva – mucous membrane that lines
the eyelids and covers the front part of the eye
l Sclera – the white part of the eye (a tough
coating that protects the outside of the eye)
l Aqueous humor – the clear, watery fluid that
fills the front part of the eye between the
cornea, lens and iris
l Vitreous body – a colourless mass of soft, gellike material that fills the eyeball behind the lens.
What are tears?
Tears are made up of a mix of components that
must be kept in perfect balance to ensure that
the eyes are properly moistened.
Every time a person blinks, a thin layer of
tears spreads across the eye’s surface. This layer
of moisture – the tear film – forms a protective
coat, lubricating the eye and washing away any
foreign material.
The tear film is made up of three layers:
l Aqueous (water) layer – the largest
component, this is produced by the lacrimal
gland located on the upper, outer portion of
each eye. On its own, this layer would quickly
run off the eye’s surface or evaporate, but the
other layers of the tear film help keep it in place
l Lipid layer – produced by oil-secreting
(meibomian) glands along the edge of the
upper and lower eyelids. This is found on top of
the aqueous layer and prevents it from
evaporating too quickly
l Mucin layer – created by cells on the
eyelids and on the surface of the eye, this
occurs below the aqueous layer. The mucin layer
coats the eye and allows the aqueous layer to
‘stick’ to the otherwise water-repellent cornea.
Common eye conditions
l Dry eye
Between 17 and 30 per cent of people
experience dry eye symptoms at some point in
their lives, according to the manufacturer of
Murine. In most cases, dry eye results in mild
discomfort that doesn’t cause any long-term
problems. However, in more severe cases, it can
become painful and the dryness can lead to
permanent damage to the front of the eye.
Dry eye is caused by a problem with tear
production. Some people don’t produce enough
tears, while for others it may be that their tears
are not of the right quality – there may be an
imbalance between the three layers described
above. For others, the tears that are produced
are not spread across the front of the eye
properly. As people age, for example, their
eyelids become less effective at spreading tears
when they blink.
In addition to being more common as we
age, dry eye can also be caused by:
• Hormonal changes (e.g. menopause)
• Certain medicines (e.g. antihistamines or oral
• Wearing contact lenses
• Environmental factors (e.g. low humidity,
wind, high altitude, and exposure to smoke)
• Prolonged reading, using a computer, etc
• Other health problems such as rheumatoid
arthritis or Sjogren’s syndrome
• Surgery or an accident that affects or scars the
eyes, although this may improve once the eye
has healed
• An infection or inflammation of the glands
around the eye such as blepharitis (see later).
the otc treatment clinic
the front of the eye. It is a common
condition and most often presents with
symptoms of itchy, watery eyes that
appear red and inflamed. Sufferers may
complain of a gritty feeling or a
burning sensation and there may also
be a sticky, yellow coating of the
eyelashes upon waking in the morning.
Anyone reporting the following
symptoms should seek medical advice:
• Pain
• Sensitivity to light
• Disturbed vision
• Intense redness in one or both eyes.
There are three common types of
conjunctivitis, based on the cause:
1) Infective conjunctivitis – caused by
a bacterial or viral infection
2) Allergic conjunctivitis – where
symptoms occur as a result of an
allergic reaction to substances such as
pollen, dust mites or animal dander
3) Irritant conjunctivitis – caused when
the eye comes into contact with
substances that irritate the conjunctiva
e.g. shampoo, chlorinated water,
Spending long hours at a computer can cause dry eye
smoke, etc.
Anyone who reports that their eyes feel dry,
Treatment options depend on the cause of
uncomfortable or irritated or who says that they
the condition.
feel like there is always something in their eyes
OTC products containing antibacterials (e.g.
should have their eyes checked.
chloramphenicol, propamidine isethionate,
dibromopropamidine) can be recommended if
Treating dry eye
a bacterial infection is suspected. Brands include
Although there is no cure for dry eye, there are
Brochlor, Brolene, Golden Eye and Optrex
two main ways to help dry eye sufferers:
Infected Eyes.
l Make the most of natural tears – lifestyle
For allergic conjunctivitis, sodium
changes such as lowering the temperature in a
cromoglicate eye drops can be recommended.
room or using a humidifier to make sure that the Brands include Opticrom Allergy, Optrex Allergy
air isn’t too dry can help. It’s also important to
and Otrivine Antistin Eye Drops.
blink frequently, something that can be an issue
Eye drops containing naphazoline, on the
when using a computer screen, for example.
other hand, work to reduce eye redness by
l Use lubricant eye drops – dry eye sufferers
reducing the size of the blood vessels in the
often benefit from using eye drops called
conjunctiva. These can be useful when the
‘artificial tears’. These drops supplement natural
redness is caused by a temporary irritation. OTC
tears and make the eyes feel more comfortable.
brands include Murine Irritation and Redness
These products don’t contain any drugs so can
Relief and Optrex Red Eyes.
be used frequently to alleviate symptoms.
l Styes
However, anyone who finds they need to use
these drops more often than four to six times a
A stye is a small collection of pus that forms on
day should let an optometrist know, as they may
the eyelid. It usually appears like a pimple or boil
need a different product.
on the outside or inside of the eyelid. Styes are
There are different brands available OTC and
fairly common and most people will experience
customers sometimes need to try multiple
them on one occasion during their lifetime. The
products before they find the one that suits
most common cause is a bacterial infection.
them best. OTC brands include Murine Dry &
However, chronic inflammation along the edge
Tired Eyes, Optrex Actimist Eye Spray, Optrex
of the eyelid (blepharitis) can also be a factor.
Dry Eye Drops, Rohto Dry Eye Relief and Systane
Most styes get better without treatment
Ultra Lubricant Eye Drops.
within a few days or weeks. However, a warm
compress may be used to encourage the stye
l Conjunctivitis
to release pus and heal more quickly. Sufferers
This general term applies to a condition that
should run warm water over a clean washcloth,
causes redness and inflammation of the
wring it out and place it over the closed eye.
conjunctiva, the thin layer of tissue that covers
Re-wet the cloth when it cools. Repeat for five
to 10 minutes, several times a day. Sufferers
should never try to burst the stye themselves.
Customers with styes that persist should be
referred as they may require treatment
prescribed by a doctor.
l Blepharitis
In this condition, there is inflammation of the
rims of the eyelids, causing them to become red
and swollen. It is common, accounting for
around one in 20 eye problems reported to GPs,
according to NHS Choices. It may develop at
any age, but is more likely to occur in people
over 50 years of age.
Symptoms of blepharitis include burning,
soreness and stinging in the eyes, crusty
eyelashes and itchy eyelids. It may be caused by
a bacterial infection or it may occur as a
complication of another skin condition such as
seborrhoeic dermatitis or rosacea.
Blepharitis is not usually serious, but it can be
a long-term, chronic condition. There is no cure
but establishing a daily eye-cleaning routine may
help control the symptoms.
Important eye conditions
The following conditions are major causes of
adult sight loss in the UK, according to RNIB.
l Glaucoma
The most common type of glaucoma is primary
open angle glaucoma (POAG). This chronic
condition occurs slowly over time, gradually
reducing peripheral vision. POAG is more
common in older people and those who are
very short sighted.
In acute angle closure glaucoma, there is a
sudden blockage of the flow of fluid in the eye.
This painful condition is a medical emergency –
sight can be lost if it is not treated promptly.
l Cataracts
These are cloudy patches in the lens that make
vision blurred or misty. They can develop in one
or both eyes and affect older men and women
equally. In the UK, it is estimated that more than
half of people over 65 have some cataract
l Age-related macular degeneration (AMD)
This occurs when the macula is unable to
function correctly, leading to a gradual loss of
central vision. Peripheral or side vision is
unaffected. AMD affects people over the age of
50 and is more common in women. Smoking
increases the risk of suffering.
l Diabetic retinopathy
This is a complication of diabetes where there
is damage to the blood vessels of the retina.
Initially, it causes only mild vision problems but
in severe forms it can cause blindness. It can
affect anyone with type 1 or type 2 diabetes.
The longer a person has had diabetes, and the
less controlled their blood sugar, the more likely
they are to develop this condition. Nearly one
person in 25 in the UK has diabetes.
TM JULY 2013
the otc treatment clinic
NHS eye tests
It is recommended that we all have an eye
examination once every two years, unless
advised otherwise by an optometrist. However,
according to the Eyecare Trust, 20 million
Britons risk avoidable sight loss because they fail
to have this regular health check. And one in 10
British adults have never had an eye exam.
Many people are entitled to a free eye exam
paid for by the NHS, including anyone who is:
• Over 60
• Under 16 or under 19 and still in full time
• Living in Scotland
• Diagnosed with diabetes or glaucoma
• Aged over 40 with a close relative with
• Registered blind or partially sighted
• In need of complex lenses.
People who are entitled to various types of
income support or working tax credit may also
be eligible and some will also qualify for help
with the cost of glasses or contact lenses.
Tips for healthy eyes
The RNIB recommends the following to help
keep eyes healthy:
l Regular eye tests – as mentioned, everyone
should have an eye examination every two years
unless, directed otherwise by an optometrist.
These tests are important even if there has been
no change in vision
l Stop smoking – smoking can double the risk
of developing AMD, according to the RNIB
l Eat a healthy diet – choose foods low in
saturated fats and opt for green, leafy vegetables
such as spinach and broccoli. Oranges, kiwi fruit,
nuts, seeds and oily fish may also be beneficial. A
healthy weight is also important as obesity
increases the risk of developing diabetes
l Protect eyes from the sun – the UVA and UVB
rays in sunlight can harm eyes and may increase
the risk of cataracts and AMD. Choose approved
sunglasses with UV filters, even for younger
children, and consider a wide-brimmed hat for
added protection
l Think safety first – according to the Eyecare
Trust, 20,000 eye accidents occur each year as a
direct result of DIY. Many of these could have
been prevented had the person been wearing
appropriate eye protection. Safety goggles are
also an option for certain sports
l Be screen smart – according to Screensmart,
a joint initiative from Simplyhealth and The
Eyecare Trust, we spend an average of 2,740
hours a year staring at a screen! So, its no
wonder that 90 per cent of computer users say
they suffer from screen fatigue – headaches, sore
or tired eyes and vision problems.
Tips for beating screen fatigue include:
l Take frequent breaks – give your eyes a rest
every 20 minutes or so
l Create an eye-friendly environment – position
documents at roughly the same distance from
the screen to avoid having to re-focus. Dim the
lights and minimise glare or reflection
l Position the computer monitor at arm’s
when to refer
l Dry eye symptoms not helped by OTC
l Prolonged, unexplained tearing
l Conjunctivitis that persists after two weeks
l Moderate or severe eye pain, especially if
accompanied by eye redness
l Sensitivity to light or seeing halos around
l Any eye injury, especially if there is
bleeding from the eye
l A foreign body in the eye that cannot be
l Any sudden, serious change in vision
l Suddenly see flashing lights or floaters
l If the customer has diabetes.
length, with the top of the screen at eye level.
Choose a font size no smaller than 12 points
and make sure the screen is clean
l Keep blinking – when you concentrate on the
screen for long periods, your blink rate can slow
by as much as 400 per cent.
More information
l Royal National Institute of Blind People –
l Eyecare Trust –
l Screen Smart initiative –
assessment questions: eye care
For each question, select one correct answer. Discuss your answers with your pharmacist.
1. Which of the following statements is
a) Almost two million people in the UK
are living with sight loss
b) The retina is a layer of light sensitive
cells called rods and cones found at
the back of the eyeball
c) The iris is the circular opening in the
front of the eye that controls the amount
of light that enters the eye
d) The tear film is made up of three
distinct layers that must occur in a
specific balance to ensure that the eyes
are properly moistened
2. Which of the following may cause
symptoms of dry eye?
a) Increasing age
b) Spending time in a dry climate
where the humidity is low
c) Prolonged detailed work, such as
reading or looking at a computer screen
d) All of the above
3. Which of the following
statements is TRUE?
a) Artificial tears can help supplement
natural tears helping to relieve the
symptoms of dry eye
b) All cases of conjunctivitis can be
traced back to a bacterial infection n
c) Eye drops containing
chloramphenicol are the products
of choice for treating allergic
d) Sufferers of styes can be advised
to burst the stye themselves to help
speed healing
4. Which of the following conditions
is NOT a major cause of sight loss in
a) Glaucoma
b) Age-related macular
c) Blepharitis
d) Cataracts
5. Which customer can safely self-medicate using
an appropriate OTC brand of artificial tears?
a) A middle-aged man who reports eye pain
accompanied by eye redness
b) An office worker in her early 20s who finds that
her eyes feel gritty and sore after a day working on
her computer
c) An elderly woman who says that her eyes are
constantly watering for no apparent reason
d) An older gentleman who has diabetes and who
says he finds it difficult to read in the morning
6. Which of the following statements is FALSE?
a) Everyone should have an eye examination
every two years, unless advised otherwise by an
b) Smoking can have a detrimental effect on
eye health
c) There is no evidence of a link between prolonged
exposure to the sun’s UV rays and damage to a
person’s sight
d) When working at a computer screen, it is
advisable to take a break every 20 minutes or so
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