CASE 1
Eyes That Feel Gritty
Q: JM, a woman aged 54 years, comes to the pharmacy reporting dry eyes, stating they feel “almost gritty or sandy.” She noticed that it started a few weeks ago and thinks it coincided with when she began taking oxybutynin for overactive bladder. She works on a computer most of the day, and the dryness is worse in the afternoon. She has tried to rinse her eyes throughout the day to get some relief. She wants to know whether she should stop taking oxybutynin or whether there is something else she can do. How would you counsel JM?
A: Considering the timeline, it is probable that JM’s dry eyes are because of the oxybutynin’s anticholinergic action, which reduces tear secretion. A preservative-free artificial tears eye drop (eg, carboxymethylcellulose, propylene glycol) is an optimal recommendation, especially if she needs to use it more than 4 times per day. Eye drops with preservatives such as benzalkonium chloride can worsen ocular surface irritation and should typically be used fewer than 4 times a day. At night, she can use a lubricating ointment for longer relief, but she may experience temporary blurry vision.
CASE 2
Contact Lens Hygiene
Q: AK, a college student aged 18 years student who wears biweekly disposable contact lenses, says his eyes often feel dry and irritated throughout the day, especially when he has been studying or after he wakes up from a short nap. He says sometimes his lenses feel like they are sticking to his eyes by the end of the day. He reports that he occasionally falls asleep with his contacts in and wakes up with his eyes feeling sore and red the next morning. What can AK do to help himself?
About the Authors
Sneha Baxi Srivastava, PharmD, BCACP, CDE, is associate director of skills education and an associate professor at Rosalind Franklin University of Medicine and Science College of Pharmacy in North Chicago, Illinois. She is deeply passionate about embracing the pillars of lifestyle medicine, self-care, effective communication, and inclusivity to create lasting positive health and wellness outcomes.
Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP, is a clinical professor of pharmacy practice and administration at the 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 in New Jersey.
A: AK should use rewetting drops that are labeled for contact lens use. It is important to avoid rewetting drops that are not compatible with lenses because it can lead to deposit buildup, lens alteration, or corneal irritation. The rewetting drops will work to moisturize and create lubrication between the cornea and the contact lenses. Additionally, it is important to counsel AK against sleeping with his contacts in and urge him to follow proper lens hygiene. Although more expensive, daily disposable contact lenses can be an option he could discuss with his optometrist. He should be referred to see the optometrist if there is persistent redness, pain, or blurred vision.
CASE 3
Folic Acid
Q: SS is a boy aged 10 years who comes to the pharmacy with his father. SS says his eyes have been itchy, watery, and red for the past couple of weeks. He rubs his eyes frequently, and he has tried using cool washcloths to help. SS has also started taking fluticasone propionate (Flovent HFA; GSK) for allergies but says it is alleviating only the nasal symptoms. The pediatrician said he may need to start eye drops, and his father wants to know what SS should use for his eyes because the fluticasone does not seem to help with his ocular allergy symptoms.
A: SS may use OTC eye drops including ketotifen 0.025% ophthalmic solution (Alaway; Bausch + Lomb) twice a day (every 8-12 hours) or olopatadine hydrochloride 0.2% ophthalmic solution (Pataday; Alcon Laboratories, Inc) daily. These are FDA approved for children 3 years and older and are dosed twice daily. Artificial tears can also be used to help with the allergies. SS should be told to avoid rubbing his eyes, to continue to use cold compresses for relief, and to limit allergen exposure as much as possible. He should be referred back to the pediatrician if symptoms do not improve within 1 week, if vision changes occur, or if there is pain or symptoms of an infection.
CASE 4
Conjunctivitis
Q: TK, a man aged 48 years, presents with 1 red, painful eye that feels dry and irritated. He also noticed yellow crusting on his lashes this morning and says the eye is “sticking shut” when he wakes up. He has been using a lubricating eye drop to help with the irritation; however, it has not improved, and he feels that it may be getting worse.
A: This is likely bacterial conjunctivitis, and he should be referred to a physician for evaluation and possible antibiotic drops. He may use artificial tears to help soothe his symptoms; however, it will not treat infection. He can also use gentle warm compresses with a clean washcloth that is submerged in warm water and wrung out to remove the excess. He should also be counseled about hand hygiene to prevent the spread of the infection and to avoid sharing towels or pillows until the infection clears.
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