Cases address questions about how to relieve dry eyes.
CASE 1: Dry Eye Relief
LF is a 36-year-old woman who presents to the pharmacy asking for an OTC eye product to relieve her dry eyes. She tells you that she has been experiencing dry eyes for the past 2 weeks. Her ophthalmologist recommended that she try artificial tears eye drops, but she is not sure about the appropriate steps for administering the eye drops. What counseling points would you provide to facilitate the correct administration of her eye drops?
LF should be educated about the correct sequence of steps to promote safe, effective administration of eye drops. Prior to using her eye drops, LF should wash her hands with soap and water to prevent infection. Once LF is ready to administer the eye drops, she should be instructed to tilt her head back and look upward. Next, she should create a pocket for the eye drops by pulling the lower eyelid of the affected eye down and away from her face. Then LF should use her other hand to hold the dropper toward her eyeball, with the tip held just above the pocket created for instillation. Important counseling points at this point of instillation include ensuring that LF does not touch the tip of the dropper with her hands, eye, or eyelid to prevent introduction of bacteria to the tip. Lastly, LF must squeeze the recommended number of drops into the pocket to administer the appropriate dose and hold her eyes closed for 1 minute to ensure retention of the medication in the eye.1
CASE 2: Dry Eyes With Contact Lenses
SF is a 26-year-old woman in line at the pharmacy counter to purchase an OTC lubricant eye drop. She has no significant medical history, but she did recently start wearing contact lenses to correct her vision. She has noticed that since starting to wear contacts, she experiences irritating and uncomfortable dryness in her eyes, which has worsened in the warm weather. Upon browsing the OTC section for eye care, SF notices artificial tears and brings them to the pharmacy counter for assistance. She explains she has not used ocular lubricants in the past and is seeking advice regarding the safety of using these products while wearing contact lenses. What education points would you provide SF regarding the safe use of lubricant eye drops with her contact lenses?
SF may use ocular lubricants such as artificial tears while wearing contact lenses, although preservative-free formulations are preferred. Many ocular lubricants contain preservatives such as benzalkonium chloride, which can adhere to contact lenses and cause irritation to the eyeballs.2 In addition, many brands sell OTC lubricant eye drops specifically for contact lenses. If SF would prefer to utilize lubricating eye drops that are not preservative free, she should be counseled to remove her contact lenses prior to use to prevent irritation. SF also should be counseled to consult her eye doctor about the safe use of OTC lubricant solutions with her contact lenses. Additionally, SF should be educated on nonpharmacologic options for dry eye management that are safe for patients with contact lenses, such as air humidifiers, as well as avoidance of environmental irritants such as allergens.2
CASE 3: Eye Gels
HK is an 83-year-old female patient with a past medical history of irritable bowel syndrome, nonvalvular atrial fibrillation, and diabetes mellitus, for which she takes dicyclomine (Bentyl, Aptalis Pharma), metoprolol tartrate (Lopressor, Novartis), apixaban (Eliquis, Bristol Myers Squibb and Pfizer), and metformin. She is not allergic to any medications, but she does have severe seasonal allergies and takes OTC nasal decongestants and antihistamines to manage them. She has tried several eye drop products in the past but would like to try a stronger formulation like a gel. She approaches the pharmacy seeking counseling on how to appropriately administer ocular gel for the management of dry eye symptoms. What counseling points would you provide to guide HK through the administration of her eye gel?
Ocular lubricants are available over the counter in both eye drop and eye gel formulations with the same active ingredients for management of dry eyes. HK should first be instructed to wash her hands with soap and water prior to administration of the gel. Like with eye drop administration, HK should be instructed to gently pull down on her lower eyelid to create a pocket for placement of the gel. Next, HK should administer approximately 1/4 inch of gel into the inside of her eyelid. Lastly, HK should close her eye for approximately 1 minute to allow the gel to interact with the surface of her eye. It is important to educate patients that when they administer gels, their vision may be temporarily blurry, since gels are more effective at lubricating the surface. Therefore, overnight use may be better. Additional counseling points include avoiding touching the tip of the dropper to the eyeball, eyelid, or finger to prevent infection.2
CASE 4: Eye Drops for Dry Eyes
JT is a 45-year-old woman presenting to the pharmacy and requesting to speak with the pharmacist about her dry eyes. She has noticed that her eyes have been extremely dry the past month during the dry summer heat. She has no known drug allergies or past medical history. She is not taking any medications, and she has not tried anything yet to manage her dry eye symptoms. As the pharmacist, what OTC product would you recommend to JT to manage her dry eyes?
OTC ocular lubricants, including cellulose ethers, polyols, and polyvinyl alcohols, can be recommended. These agents all serve as artificial tears to help promote moisture in the eyes during episodes of dry eye. These agents are available as OTC ophthalmic solutions or gels in single or multiuse packages. JT should be counseled on appropriate administration as well as seeking medical attention if any changes in vision or continued irritation persists or worsens despite lubricant use. Additional strategies to manage dry eye caused by dry, warm climates include nonpharmacologic products, such as filters for dust and other particles, humidifiers, and warm compresses.3
About the Authors
Kylie Helfenbein, PharmD, is a postgraduate year 2 pharmacy resident at Atlantic Health System in Morristown, New Jersey.
Deanna Fox, PharmD, is a postgraduate year 2 pharmacy resident at Atlantic Health System in Morristown, New Jersey.
Rupal Patel Mansukhani, PharmD, FAPHA, NCTTP, is a clinical associate professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, and a transitions-of-care clinical pharmacist at Morristown Medical Center.