Five Common Problems with your Eyes-dry eyes: Blepharitis, Conjunctivitis, Styes and Allergy Eyes

Why eyes? - I have a lot of queries in Pharmacy regarding common eye problems, so here we are!

How does the Eye work?

In order to understand basic problems with your eye it is important to understand the parts of the eye. The eye is a complex structure made of muscles, nerves and blood vessels. Eyes constantly adjust the amount of light they let in as they focus on objects near and far, thus forming images which are transmitted to the brain.

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Your eye is a delicate but complex organ so it can be easily irritated when different parts of it are affected as they all have to work together and efficiently to enable clear vision. Some of the major parts are;

• Cornea - A clear dome over the iris and pupil which has five layers of its own. The cornea refracts light that enters the eye onto the lens and controls about 65-75% of the eye's total focusing power. Sometimes referred to as the "window" of the eye, the cornea also keeps foreign objects or debris from entering the eye.

• Tear ducts - As the name suggests, tear ducts are small tubes that drain tears from the eyes, which are produced in glands under the eyelids. Tears wash over the eyes to keep them clean and moist.

• Iris, Pupil, Lens and Retina - The iris regulates the size of the pupil, which controls the amount of light that enters the eye. When the intensity of light is high, the pupil shrinks to let less light in, and in low light the pupil enlarges to let more light in the eye.

• The lens of the eye is a transparent, biconvex flexible disc behind the iris. When light passes through the cornea, the lens focuses the light onto the retina. Retina is a like a film in a camera, it converts the light into neural signals and sends it via optic nerve to the brain for a visual image(picture). The retina is located at the back of the eye and is made up of light sensitive (photoreceptor cells) cells which are 2 types, rods and cones. Rods provide night vision and cones provide detailed vision and colour perception.

• Optic Nerve - It is located in the back of the eye and is made up of millions of nerve cells. It transmits sensory information in the form of electrical impulses from the eye to the brain which perceives it in the form of an image.

Since the eye is so complex, things can go wrong with any part to cause discomfort in the eye or affect vision. 5 eye conditions we may regularly encounter are:

• Dry eyes

• Conjunctivitis

• Styes

• Blepharitis

• Itchy allergy eyes

The most common problem I see in the Pharmacy is dry eye syndrome.

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Dry Eyes

Dry eyes seem trivial but it can be quite debilitating for sufferers. More commonly presented in older people, women, contact lens wearers and office workers. Eyes can get dry when less tears are produced or more evaporation from the tear film occurs. Both of these conditions can cause a burning and irritation sensation in the eyes which are typical symptoms of dry eyes. Other symptoms include:

• Watery eyes/ tearing ( eyes are trying to moisturise themselves)

• Grittiness

• Soreness

• Visual disturbance which includes blurred vision at times

• Slight redness

What Causes Dry Eyes?

Dry eyes are common in people who spend most of their time on computer screens as this reduces the rate of blinking. The demographic of this group is changing as more young people look at screens for longer periods of the day, so its no longer a condition seen in mostly older people! Not blinking as much leads to increased evaporation from the tear film, thus causing dryness.

Workers with chemical burns in their eye can also have dry eyes. Another cause is vitamin A deficiency. Some medications and medical conditions can also lead to dry eyes. Regular use of antihistamine tablets used for allergies and decongestant eye drops can exacerbate dry eye syndrome.

Rheumatoid Arthritis is also a contributing factor and natural aging process reduces tear production.

Treatment and Prevention

Artificial tear supplements which you can purchase here: https://amzn.to/3VOXE9i successfully alleviate dry eyes. They can be safely used 2-4 times daily. If your eyes get irritated with the use of one type of drops, try a preservative free eye drop such as Bion Tears available for you here. Most of these are single use disposable and each little ampoule should be discarded within 24 hours once opened. Eyes drops which last for 1 month should be discarded 28 days after opening . There are some longer lasting eye drops which can be kept for 6 months after opening such as Systane Ultra and Systane Complete readily accessible here. If eye drops are not ideal artificial mist spray is also available to spray on closed eyelids. Eye gels or ointments are longer lasting and should be used in conjunction with the drops for 24 hour relief!

Eating a healthy meal with vegetables ( carrots, broccoli) rich in vitamin A would be beneficial. Plant foods such as red, yellow, green and orange fruit and vegetables contain carotenoids and our body converts it to vitamin A when consumed. Meat, fish, eggs and dairy are also good source of vitamin A. Other helpful tips are to avoid smoking (read blog on quit smoking), use humidifiers during winter as heaters are quite drying , use sun glasses when outside and avoid fans and air conditioners directly on the face.

Stye

A stye is formed due to an infection at the base of an eye lash follicle obstructing oil glands on the eye lids. Sties usually present as red, inflamed bumps on eyelids (upper or lower). Some people are more prone to getting sties then others. They usually occur due to rubbing of eyes when they are itchy. Other causes can be:

• Rubbing your nose then touching your eyes as bacteria from your nose can transfer, usually when you have cold and flu symptoms

• Using contaminated eye makeup

• Not washing off makeup before bed or not cleaning eyelids properly

• Having had sties prior

• Blepharitis

• Diabetes

• Skin irritations such as seborrheic dermatitis or rosacea

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Treatment and Prevention

Stye can be painful and uncomfortable. Most sties last 3 to 7 days but can persist as long as a week or two. The healing process can be sped up by applying warm compresses for 10 to 15 minutes, three or four times a day for a few days.

This will relieve the pain and bring the stye to a head. In most cases, the stye will then open, drain and heal without further intervention.

Antibiotic ointment such as chloramphenicol can be used after warm compresses especially before bed as it helps heal overnight. You can get yours here or from your local pharmacy. Surgical intervention may be needed if the stye doesn't drain.

To help prevent stye formation:

• Wash your hands regularly with soap and warm water or use hand sanitisers

• Avoid touching or rubbing your eyes

• For itchy eyes due to hay fever , take antihistamine tablets or use antihistamine eye drops to reduce itchiness (see blog on hay fever). Zyrtec eye drops can be purchased via this link: https://amzn.to/3VKQnam

• Treat rosacea, and seborrheic dermatitis conditions

• Keep contacts clean and disinfected and discard disposable ones

• Discard contaminated eye makeup

Blepharitis

Blepharitis as the name suggests is an inflammatory condition of the eyelid margins. It commonly occurs when oil glands in the eyelids become inflamed causing the eyelids to become greasy and crusty. Ulcerative blepharitis is a bacterial infection caused by staphylococcus and seborrheic blepharitis is associated with seborrhoea of face and scalp. Eye lids are often itching and burning. If the cause is bacterial infection, eyelids are often yellowish crusted and glued together in the morning. It is harder to clean as it is often sticky.

Seborrheic blepharitis is more flaky like dandruff and scales can easily be removed.

Both types can be recurrent and stubborn to treatment.

Treatment

Seborrheic type is an inconvenience and unsightly but its not destructive. On the other hand ulcerative type can cause loss of eye lashes, scarring of the lids and sometimes corneal ulceration with repeated attacks. Since blepharitis can be a long term problem one of the simple methods to maintain it is by regularly cleaning the eyelids. Wash eyelids with few drops of tear free baby shampoo soaked cotton balls. Rinse thoroughly with warm water.

Normal saline eyelid cleansers can also be used as maintenance and are more convenient. It can be obtained here for your convenience. Topical antibiotics may be helpful with ulcerative types.

Conjunctivitis

This condition is commonly known as "pink eye" due to redness being one of the symptoms. As the name suggests conjunctivitis is the inflammation of the conjunctiva which becomes red, swollen and produces clear or purulent (coloured) discharge.

Conjunctivitis can be viral or bacterial. Viral conjunctivitis has a clear discharge while bacterial conjunctivitis has a coloured discharge ( usually yellow ). Both types present with red eye and are contagious.

Viral

Viral conjunctivitis is more prevalent in adults than in children. 65-90% of it is caused by adenovirus. A small percentage may be a complication of herpes simplex virus or zoster virus.

Symptoms include:

• Redness of the cornea

• Conjunctiva looks swollen

• Teary eyes, clear discharge

• Sandy, gritty feeling in the eye

• Itchy eyes

• Burning eyes

• Blurred vision

Viral conjunctivitis can follow cold and flu symptoms. It usually starts in one eye but the infection quickly spreads to the other eye. It is self limiting and antibiotics shouldn't be used for this condition although I see many people requesting antibiotics in the pharmacy. If it is viral, antibiotics won't help but increase antibiotic resistance.

Prevention and treatment

Since its highly contagious infected individuals should

• Wash hands frequently

• Avoid close contact

• Stay home from work or school

• Use separate towels

• Discard eye make-up if contaminated and avoid using eye make-up

Most acute cases are self limiting, although it can take 7-14 days. This process can be sped up by continually cleaning the discharge with cotton wool and 0.9% saline solution. Commercially available saline eye wipes are a convenient alternative. Clearing the discharge helps resolve conjunctivitis quicker. Cold compresses can be used for soothing purposes.

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Bacterial Conjunctivitis

Bacterial conjunctivitis is usually caused by staphylococcus aureus bacteria but there are complications with other types of bacteria. It is very contagious and is characterised by sticky, copious amounts of yellowish coloured discharge. The eyelids are usually matted together. It may last for 3-4 days with appropriate antibiotic treatment. Antibiotic drops and ointment ( available here ) reduce duration and discomfort. Eye drops should be used regularly during the day and ointments inside the lower lid prior to bed or as prescribed. Both drops and ointment should be discarded after course is finished.

Precautions and preventative care is the same as with viral conjunctivitis. Children should avoid swimming pools when infected. It is important not to touch the non infected eye after touching the infected eye. As with viral conjunctivitis, hand hygiene is of utmost importance.

Allergic Eyes

Allergic conjunctivitis is usually common in hay fever sufferers or who have other allergy related conditions such as asthma and eczema. It is an allergic response to grass, tree and weed pollen, dust mites, moulds, animal hair etc. Unlike viral and bacterial conjunctivitis, allergic conjunctivitis is not contagious. Usually presents with the following symptoms where both eyes are affected;

• Itchy eyes

• Watery discharge

• Redness in both eyes

• Swollen conjunctiva - may be due to rubbing

Prevention and Treatment

If possible avoid the allergen! Wear sunglasses when outside or eye protection when mowing the lawn especially on windy days. Read blog on hay fever for life other style tips. Treatment options are;

• Wash eyes with cold water to wash off pollen on eye lashes

• Use cold compress to soothe eyes

• Moisturising eye drops can be used to wash away allergen from tear film

• Antihistamine eye drops such as ketotifen available here, levocabastine available here, and azelastine available to you here will alleviate severe itchiness. These shouldn't be used more than 6 weeks without medical advice.

• Eye drops containing both antihistamine and decongestants such as Naphcon-A shouldn't be used continuously for longer than 3-5 days. Redness can continue with over use of decongestant eye drops due to rebound vasodilation.

• Antihistamine tablets may be of use but may give side effects such as dry eyes, mouth and nose. These shouldn't be be used if someone has glaucoma eye disease.

Eyes are one of the five major senses, so it is of utmost importance to look after your eyes for better, clearer and lasting vision.

The 5 common problems with eyes discussed here can be managed easily with a few simple preventative and treatment options. Most of these eye problems have similar symptoms with slight differences which can make diagnosis a trial an error process.

In summary, dry eyes manifest in people who don't blink often due to increased screen time or they get dry due to an aging process. Dry eyes are sore and feel dry so moisturising is key.

Blepharitis affects the eye lids and it becomes sore and flaky and can be managed by scrubbing the lids with eye lid wipes.

A stye on the other hand is a bump on the eye lids which is quite a different presentation to blepharitis.

Conjunctivitis can be viral, bacterial or allergic. The main difference in these are the type of discharge. You should see your doctor if bacterial conjunctivitis is suspected due to mucopurulent discharge.

With any of these conditions, if symptoms persist for longer than 3 days with no relief with preventative or treatment options above, see your health care professional.