Eye-related complaints are common in community pharmacy practice. Most conditions are simple and self-limiting, but some require referral to an eye specialist. Early identification of serious symptoms is important to prevent long-term damage.
Below are the most common ophthalmic symptoms and how a pharmacist can respond safely.
1. Red Eye (Conjunctivitis)
Red eye can be due to minor bleeding (sub-conjunctival hemorrhage) or irritation. The most common cause is conjunctivitis, often called “pink eye.”
Symptoms:
- Redness
- Eye discharge
- Itching or burning
- Photophobia
- Foreign-body sensation
Red eye may also occur due to glaucoma, iritis, keratitis, or a foreign body.
2. Allergic Conjunctivitis
A bilateral allergic reaction caused by pollen or environmental allergens. Sometimes, only one eye is affected if the allergen contacts only one side.
Symptoms:
- Red, itchy, watery eyes
- Burning sensation
- Associated symptoms: runny nose, itchy palate, sneezing
Cold compress and artificial tears help mild symptoms. OTC antihistamine eye drops such as ketotifen relieve itching. Topical decongestants like naphazoline, tetrahydrozoline or oxymetazoline may give quick but short relief. Avoid long-term use to prevent rebound redness.
If symptoms persist beyond 7 days, refer to an ophthalmologist. Prescription options include mast-cell stabilizers (sodium cromolyn, nedocromil) and topical NSAIDs.
3. Bacterial Conjunctivitis
Symptoms:
- Purulent (thick) discharge
- Mild to moderate pain
- Eye stuck together on waking (“glued eye”)
- Foreign-body sensation
Requires prescription antibiotic eye drops. Refer patients to a physician.
4. Blepharitis
Chronic inflammation of the eyelids.
Symptoms:
- Itchy, gritty feeling
- Red eyes
- Scaling on eyelashes
- Swollen eyelids
Management:
- Clean eyelids with diluted baby shampoo or eye scrub pads
- Warm compresses
- Gentle eyelid massage
If no improvement in a month, referral is needed. Severe cases may require antibiotics or steroids.
5. Episcleritis
Inflammation of the layer beneath the conjunctiva.
Symptoms:
- Localized or diffuse redness
- Mild discomfort
Generally self-limiting within 3 weeks. Persistent or recurrent cases require specialist referral. Topical NSAIDs or steroids may be prescribed for severe symptoms.
6. Herpes Simplex Eye Infection
Common in children aged 6 months to 5 years.
Symptoms:
- Pain and redness
- Tearing
- Photophobia
- Blurred vision
- Blisters around eyelid that crust in 7 days
Immediate referral is required. Treatment includes antiviral eye drops (trifluridine) and oral antivirals (acyclovir, valacyclovir, famciclovir). Avoid topical steroids in viral infections.
7. Marginal Keratitis
Inflammation of the cornea, usually unilateral.
Symptoms:
- Red painful eye
- Light sensitivity
- Mucopurulent discharge
- Reduced vision
Requires ophthalmologist referral. Treated using topical steroids.
8. Sub-Conjunctival Hemorrhage
Bleeding under the conjunctiva causing a bright red patch.
Features:
- Painless
- Clears in 7–14 days
Warm compresses may help. If recurrent, check for bleeding disorders or trauma.
9. Uveitis (Iritis)
Inflammation of the iris or uveal tract.
Symptoms:
- Deep eye pain radiating to brow
- Redness
- Watering
- Photophobia
- Blurred vision
Immediate referral required. Treatment typically includes steroid eye drops.
10. Arcus Senilis
White or grey ring at the edge of the cornea.
- Common in older adults
- Harmless and does not affect vision
If seen in patients under 50 years, referral is needed to check lipid levels.
11. Dry Eye Syndrome
Due to low tear production or excessive tear evaporation.
Symptoms:
- Soreness
- Foreign-body sensation
- Burning
Common causes include aging, screen overuse, Sjogren’s syndrome and medicines like antihistamines and beta-blockers.
Management:
- Artificial tears (Murine Tears, Visine Tears)
- Preservative-free drops if irritation occurs
- Humidifiers
Prescription option: Cyclosporine (Restasis) to increase tear production.
12. Floaters
Dark specks or cobweb-like shapes due to clumped fibers in the vitreous.
Common with aging, but sudden appearance of many floaters or flashes of light needs urgent referral to rule out retinal detachment.
13. Nevus
A mole on the conjunctiva or iris. Usually harmless.
If the mole grows, changes colour or shape, refer to an ophthalmologist.
14. Styes
Painful swelling on eyelid margin due to bacterial infection.
Management:
- Warm compresses
- Usually resolves in 1–2 weeks
- Refer if no improvement after 14 days
15. Trichiasis
Inward growth of eyelashes causing corneal irritation.
Requires trained removal of the lashes. Sometimes cryotherapy or electrolysis is used.
16. Watery Eyes
Usually due to allergies, infections or blepharitis.
OTC antihistamines help allergy-related tearing.
17. Xanthelasma
Yellow deposits on eyelids, common in elderly and patients with high cholesterol.
Refer for a lipid profile.
18. Foreign Body in the Eye
Causes sharp pain, tearing, irritation and redness.
If no corneal injury and vision is normal, an eyewash may remove the foreign body. If symptoms persist or vision is affected, immediate referral is required.
19. Preservatives in Eye Drops
Many eye drops contain preservatives like benzalkonium chloride, which may cause:
- Stinging or irritation
- Keratitis
- Dry eye
Patients wearing soft contact lenses should avoid using drops with preservatives for at least one hour after application.
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