A Pharmacist's Guide to OTC Therapy

APRIL 01, 2007
Yvette C. Terrie, BSPharm, RPh

Ophthalmic Products

An array of OTC ophthalmic products is available for the self-treatment of minor ophthalmic disorders.

Dry Eye

Common treatments for minor dry eye episodes include the use of OTC ophthalmic lubricants (Table 1), including artificial tear products, as well as nonmedicated ointments and gels. Artificial tear products typically contain substituted cellulose ethers, such as hydroxypropyl methylcellulose, hydroxyethylcellulose, and carboxymethylcellulose.

Other vehicles commonly used include polyvinyl alcohol and povidone.1 The primary ingredients in OTC ophthalmic ointments are white petrolatum, which acts as a lubricant and an ointment base; mineral oil, which assists the ointment in melting at body temperature; and lanolin, which aids in the absorption of water-soluble medications and also inhibits evaporation.1

Allergic Conjunctivitis

Allergic conjunctivitis, also sometimes referred to as ocular allergy, is an inflammation of the conjunctiva that is caused by an allergic reaction and is not contagious. It can occur alone or in conjunction with nasal allergy symptoms.

Artificial tear products typically are used as the initial therapy. If the symptoms persist, however, OTC ophthalmic products such as decongestant and/or antihistamine ocular drops may be warranted when appropriate. The ophthalmic decongestants available include phenylephrine, naphazoline, tetrahydrozoline, and oxymetazoline (Table 2). Ophthalmic antihistamine products include pheniramine maleate and antazoline phosphate1 (Table 3).

The Role of the Pharmacist

Because these ophthalmic conditions can negatively impact an individual's quality of life, pharmacists can be a fundamental source of information for consumers seeking relief. Pharmacists should ensure that the nature and extent of a patient's ophthalmic condition is thoroughly evaluated and that self-treatment is appropriate before recommending any OTC ophthalmic products. When warranted, patients should be advised to seek medical assistance from their ophthalmic health care provider.

It is important for pharmacists to inform patients with narrow-anterior-chamber or narrow-angle glaucoma that ophthalmic decongestants are inappropriate because of the risk of angle-closure glaucoma. Such individuals should be referred to their ophthalmic health care provider.1

Patients should be reminded that excessive use of ophthalmic decongestants may cause rebound congestion of the conjunctiva. In addition, the pharmacist should suggest that individuals currently using prescription ophthalmic products consult their ophthalmologist prior to using any of the OTC products. Patients also should be thoroughly counseled on the appropriate use and duration of use of these products and the adverse effects associated with their use.

Patients should be reminded always to wash their hands prior to administration of these products, as well as to avoid touching the applicator to prevent contamination. Individuals who wear contact lenses should be advised not to wear their lenses until the condition improves. In addition, it may be beneficial to inform patients of possible nonpharmacologic measures that may be incorporated into the recommended treatment plan to alleviate the discomfort associated with these ophthalmic conditions.

For more examples of OTC ophthalmic products, see Tables 4 and 5.

Proper Care of Soft Contact Lenses

Since soft contact lenses were first introduced in the 1970s, many advances and developments have occurred regarding the comfort, quality, and ease of care for soft contact lenses. Currently, they are available as daily-wear lenses, continuous-wear lenses, disposable lenses, soft toric lenses, and soft bifocal lenses. It is estimated that approximately 38 million individuals in the United States currently wear contact lenses. In addition, it is estimated that approximately 2.7 million individuals annually stop wearing contact lenses primarily due to lens discomfort.1

Avoiding Complications

Sometimes lens discomfort can be attributed to improper care of contact lenses; furthermore, improper lens care may increase the incidence of more serious complications that may include corneal infection, corneal ulcers, or other ophthalmic conditions that could cause permanent eye damage.1 It is therefore imperative that contact lens wearers thoroughly understand the proper protocol for the care of soft contact lenses to avoid these complications.

The Role of the Pharmacist

Pharmacists can be instrumental in assisting contact lens wearers in product selection, since a myriad of products are available for the proper care of soft contact lenses. Table 1 provides examples of contact lens products.

These products include surface-active cleaners, enzymatic cleaners, chemical disinfecting solutions, hydrogen peroxide disinfecting solutions, preserved saline solutions, preservative-free saline solutions, and rewetting/lubricating solutions, as well as multipurpose solutions that act as a surface-active cleaner, protein-removal, and disinfecting agent.

Many drug-induced adverse effects may occur in individuals who wear contact lenses. These interactions may occur with the use of topical ophthalmic agents as well as with many systemic agents, since many systemic agents are secreted into the tears. See Table 2 for a list of drugs that may result in drug/contact lens interactions.

Patients should be informed never to wear lenses while using any ophthalmic solutions, suspensions, ointments, or gels, with the exception of rewetting drops or those products recommended by the eye care professional for use with contact lenses. It is important for soft contact lens wearers to follow a basic cleaning care protocol to avoid possible complications and to utilize only the products recommended for use with soft contact lenses. Patients should be encouraged to remove lenses and seek assistance from their ophthalmic professional if they experience any problems such as redness, pain, excessive tearing, blurry vision, swelling, discharge from the eye, or any signs of infection to prevent further complications.

Ms. Terrie is a clinical pharmacy writer based in Haymarket,Va.


Ophthalmic Products

1. Fiscella R, Jensen M. Opthalmic disorders. In: Berardi RR, Kroon L, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006. Chapter 28.

Proper Care of Soft Contact Lenses

2. Engle J. Prevention of contact lens-related discomfort. In: Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006: 613-631.