Rupal Patel Mansukhani, PharmD Mary Barna Bridgeman, PharmD
Case 1—Dry Eye
MM is a 30-year-old man who comes to the pharmacy looking for a recommendation for an OTC product to use for relief of his dry eyes. He says he is going to the beach today and every summer at the beach he has noticed that his eyes get extremely dry and irritated. He is seeking a product to minimize ocular irritation and make his trip more enjoyable.
MM states he does not wear contact lenses or glasses and his vision is perfectly intact. He has no medical conditions or drug allergies and takes no other medications. Is MM a candidate for self-treatment? What type of product would you recommend?
As MM has no medical history of conditions known to exacerbate dry eye, including rheumatoid arthritis or Sjögren’s syndrome, and does not report use of medications that can cause ocular dryness (ie, antihistamines, diuretics, betablockers), he would be an appropriate candidate for self-treatment. The primary goals for the self-treatment of dry eye are to decrease irritation and lubricate the eyes to prevent corneal damage.
In addition to nonpharmacologic interventions, such as avoiding the environment that is known to exacerbate MM’s symptoms or wearing protective eyewear, such as sunglasses, when at the beach, OTC treatment with an ocular lubricant could be recommended. Ocular lubricants are available in a variety of dosage forms, including ointments, gels, and solutions, all of which have their own advantages and limitations to use. Despite the fact that ocular ointments are very effective and have a prolonged effect on slowing tear evaporation, these products may cause blurred vision and are optimally used in conjunction with artificial tear solutions.
Artificial tear products vary by viscosity; increasing the viscosity will result in prolonged ocular contact time and greater resistance to tear dilution. 1 Common active ingredients found in ophthalmic lubricants for the treatment of dry eye are carboxymethylcellulose, povidone, polyvinyl alcohol, and hydroxypropyl methylcellulose. Products containing hydroxypropyl methylcellulose, such as GenTeal (Novartis) and Nature’s Tears (Bio-Logic Aqua Technologies), may have greater ocular retention time compared with products containing polyvinyl alcohol, such as Refresh (Allergan). Be sure to check the active ingredients in the product you recommend, as product line extensions and reformulations may result in certain products containing different ingredients. 1
MM has a mild case of acute dry eye that is exacerbated by an environmental exposure and therefore should be treated with a less viscous product. MM should avoid ointment products because they are usually used in severe cases and at bedtime. Some common ocular lubricant brands include Refresh, Systane (Alcon), and Tears Naturale (Alcon). MM should use the selected artificial tears product once or twice daily in both eyes.
Case 2—Preventive Skin Care
GR is a 55-year-old woman who comes to the pharmacy looking to purchase a lotion for dry skin. She states that she has bothersome, rough, dry skin on her legs. Normally she does not apply any lotion to her body. She says every winter her skin gets so dry that her heels crack. She wants to prevent cracking this year by using a lotion daily. She has no medical conditions, no drug allergies, and takes no other medications. What counseling points would you recommend to GR at this time?
The goals of self-treatment for xerosis (dry skin) are to restore skin hydration and prevent cracking. The most important first steps for the treatment of dry skin educating GR on proper bathing, use of moisturizers, and maintaining hydration. 2 GR should use warm or tepid water while showering or bathing and avoid hot water, which can further contribute to her dry skin. Within 3 minutes of getting out of the shower or bath, counsel GR to pat her body dry and apply a body lotion such as Eucerin (Beiersdorf) or Jergens (Kao Brands) to trap the moisture in. 2 She should also use lotion 3 to 4 times a day to the skin of the affected areas. Other nondrug therapy options for GR include using a humidifier to moisturize the air in her environment and drinking at least six 8-oz glasses of water per day. 2 If GR developed cracking, she could use a product containing urea or lactic acid to increase hydration. PT
Dr. Mansukhani is a clinical pharmacist in North Brunswick, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University. Dr. Bridgeman is an internal medicine clinical pharmacist in Trenton, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University.
Ophthalmic Disorders. In: Berardi RR, Ferreri SP, Hume AL, et al (eds). Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 16thed. Washington, DC: American Pharmacists Association, 2009:519-525.
Atopic dermatitis and dry skin. In: Berardi RR, Ferreri SP, Hume AL,et al (eds). Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care.16thed. Washington, DC: American Pharmacists Association; 2009:627-642