Pharmacy Practice: Eye and Ear Preparations

Eye and Ear Preparations

Red Eye

• Conjunctivitis: a common condition causing red eyes, due to infection, allergy, or irritation
• Symptoms: eye redness, discharge, pain, gritty feeling, photophobia, and change in vision
• Referral to GP surgery is necessary if:
  • Eye pain and change in vision are significant features
  • Patient wears contact lenses
• Causes of red eye:
  • Conjunctivitis (infective, allergic, or irritative)
  • Corneal ulcers
  • Keratitis
  • Iritis/uveitis
  • Glaucoma

Conjunctivitis

• Inflammation of the conjunctiva, a membrane covering the anterior white part of the eye (sclera) and the inside of the eyelids
• Two main features: eye redness and discharge
• Infective conjunctivitis:
  • Caused by bacteria or viruses
  • Viral conjunctivitis is the most common cause and usually does not require treatment
• Management:
  • Gentle cleansing of the outside of affected eye(s) with cotton wool soaked in water
  • Antibiotic eye drops or ointment may be used for bacterial conjunctivitis
  • Contact lenses should not be worn until the infection has completely cleared and 24 hours after treatment has been completed

Allergic Conjunctivitis

• Produces irritation and a watery discharge
• Itchiness may be a significant feature, and the conjunctiva over the whites of the eyes may be swollen
• Management:
  • Oral anti-histamines and nasal corticosteroids may relieve eye symptoms if there are other symptoms related to allergic rhinitis
  • Referral to the GP surgery is needed if there is doubt between infection and allergy

Blepharitis

• Inflammation of the margin of the eyelids
• Characteristic symptoms: itchy, stinging, and sticky eyes
• Management:
  • Urgent referral to the optometrist or GP
  • A short course of antibiotic eye drops or ointment may be supplied to prevent secondary infection

Ear Problems

Earwax

• A normal physiological substance in the ear canal
• Aids removal of skin debris, cleans, lubricates, and protects the lining of the ear canal
• Excessive build-up of hard earwax can develop in some people
• Symptoms:
  • Wax blocking the ear, causing temporary deafness
  • Discomfort, sensation of the ear being blocked
  • Rarely, dizziness and nausea
• Management:
  • Ear drops to soften wax (olive oil or almond oil drops or sodium bicarbonate 5% ear drops)
  • Ear irrigation may be necessary if wax remains despite treatment

Otitis Externa

• Inflammation of the outer ear canal
• Symptoms: pain, itching, discharge
• Referral to the GP surgery is needed if:
  • There is severe pain or discharge
  • The ear is severely affected or if there are signs of infection (e.g., fever, swelling, redness)

Corneal Ulcers

• Inflammation of the cornea, often with infection
• Symptoms:
  • Pain
  • Surrounding scleral inflammation
• Causes:
  • Infection or traumatic abrasion
• Management:
  • Urgent referral to an eye specialist
  • Topical antibiotics may be needed

Keratitis

• Inflammation of the cornea
• Symptoms:
  • Unilateral, acutely painful red eye
  • Discomfort from bright light (photophobia)
• Causes:
  • Herpes simplex virus
  • Bacterial infection
• Management:
  • Urgent referral to an eye specialist
  • Antiviral medication may be needed