Definition

Dry eye is a condition where the eyes do not produce enough tears, or those tears produced evaporate quickly. The net effect is that the eyes dry out and become irritated and/or inflamed.

Symptoms in the Pharmacy

Dry eye may lead to the presentation of the following in the Pharmacy:

· Dry, gritty eyes with notable discomfort

· Watery eyes

· Irritation as the day progresses

· Mild light sensitivity

· Slight blurring of vision that may improve on blinking

· Both eyes typically affected

Signs

Clinical signs of dry eye may include:

· Redness of the eyes

· Spotty fluorescein staining

· Blepharitis, with crusting of the eye lashes or foamy tear film

Should the Pharmacist have any concerns with the patient then appropriate signposting to the Optometrist must take place.

Optometrist Considerations

During a consultation, the Optometrist will undertake the following:

· Wash their hands and prepare the assessment area

· Observe the eye structures (i.e. lid margins and conjunctiva) with a white light

· Instil one drop of fluorescein 0.25% and observe for corneal staining

· On diagnosis, treatment should be commenced as appropriate

Principles of Management

Patient-Centred Care

Consultations with the patient should consider individual concerns and patient characteristics (i.e. health literacy and co-morbidities). An effective partnership between the healthcare professional(s) is key with communication skills being integral to any management plan.

Management within the Pharmacy

The management of dry eye can be achieved by warm compresses (i.e. products that warm in the microwave that stimulate meibum production), lid hygiene or ocular lubricants in the form of eye drops or eye ointments.

Mild to moderate cases of dry eye generally respond well to over-the-counter artificial tear drops (i.e. Hypromellose) that are also referred to as ‘tear substitutes’.

Should the patient have severe symptoms and require eye drops more than 6 times per day, or if they use contact lenses, then preservative free eye drops (e.g. Hyloforte) should be used; this is to reduce the extent of eye irritation from the preservatives within the formulation.

Ointment formulations can be utilised to lubricate the eyes; however, the patient should be warned that blurred vision may ensue, so these products are best used at night (e.g. Hylonight).

Limitations within the healthcare space should always be considered. Referral to specialist services may be required. In this case, specialist medication or lacrimal punctual plugs can be necessary.

Further Information

More detail on dry eye is available from:

1. Moorfields Eye Hospital

2. TFOS DEWS II

Dry Eye: Red, watery eyes