Take care of your beautiful eyes (2 of 2)

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What common eye conditions usually require treatment by a doctor?

Trauma: Blunt trauma to the eye requires immediate evaluation by an ophthalmologist. Trauma to the eye can activate bleeding into the eye from ruptured blood vessels or cause detachment of the retina. Both situations can seriously impair vision.

Abrasion: An abrasion usually occurs when a fingernail or other foreign object rubs across the cornea or conjunctiva and removes some surface tissue. There is a risk of bacterial or fungal contamination and infection following an eye abrasion.

Chemical exposure: Exposure of the eye to household cleaning solutions, fumes, or an actual chemical splash requires immediate evaluation by a physician, though initially it may be self-treated with water or another irrigant.

Keratitis: Keratitis is an inflammation of the cornea that may occur alone or simultaneously with conjunctivitis. This inflammation may be infectious (resulting from a virus, bacteria, fungus, or parasite) or noninfectious in origin. The symptoms of keratitis include blurred vision, pain, and intolerance to light (photophobia). It may be due to contact lens overwear.

Corneal swelling: Corneal swelling, oredema, is a condition in which fluid accumulates in the cornea. The edema causes visual disturbances such as halos or starbursts around lights. Reduced vision may or may not occur. Corneal swelling can arise as a complication ofcontact lenses, surgical damage to the cornea, or an inherited defect. Hyperosmotic drops or ointment can be used to treat corneal swelling, but additional treatment by a physician may be necessary.

Uveitis: Uveitis is an inflammation of the eye structures in the uveal tract (the iris and other structures within the eye to which the iris attaches). Uveitis may occur without an obvious cause or may be due to trauma or an inflammatory disease present througout the body. Symptoms and signs of uveitis include eye pain, tearing, light sensitivity, and visual blurring.

Acute angle-closure glaucoma: Angle-closure glaucoma is due to an obstruction of the system that drains aqueous fluid from the inside of the eye. As a result, fluid accumulates and the pressure within the eye increases. Patients usually have a tendency to develop angle-closure glaucoma because of crowding of the anatomy of the front of their eye. It is more common in people who are hyperopic (farsighted). This disorder may be triggered after an eye exam in which the pupils have been dilated or by taking certain oral medications in the susceptible individual. Common symptoms include a severeheadache or eye pain accompanied bynausea and vomiting. Vision is also usually blurry. Angle-closure glaucomashould be suspected if these symptoms develop after an agent is used to dilate the pupils for an eye exam. Most patients withacute angle-closure glaucoma in one eye are at risk for developing it in the other eye. The treatment of acute angle-closure glaucoma is surgical.

What types of OTC eye care products are there?

There are eight types of OTC eye care products available. Each product contains one or more active and inactive ingredients.

1. Artificial tear drops: Lubricants (also called artificial tears) are synthetic (manmade), water-based solutions that are used to lubricate the eye and thicken tears. Artificial tears are formulated as solutions or suspensions, varying in viscosity. Popular examples of artificial tears include AquaSite, Bion Tears, Celluvisc, Duratears, Gen Teal, HypoTears, Liquifilm Tears, OcuCoat, Refresh, Systane, Tears Naturale, and TheraTears. Many people develop sensitivity to the preservatives in these solutions, causing increasing redness, burning, or itching. Most of these products are also available in a preservative-free (PF) form. Artificial tears usually are used two to five times a day as needed for relief of symptoms.
2. Ointments or emollients: Ointments also are useful lubricants. These products are not water-based and contain lubricating ingredients similar to petroleum jelly. Examples of ointments include Lacri-Lube, Moisture Eyes PM, and Refresh PM. Their advantage over a water-based solution is that they remain in the eye longer. These ointments cause visual blurring immediately after their use. Therefore, they are often used only prior to sleep.
3. Eye washes: Eye washes (also known as ocular irrigants) are used to cleanse and/or rinse debris from the eye. These products are balanced to the proper acidity and electrolyteconcentration so as to be non-irritating to the eye. Washes are available as liquids or drops. These products may contain boric acid with sodium borate, sodium phosphate, or sodium hydroxide to maintain the proper acidity. Examples of washes include AK Rinse, Dacriose, and Eye-Stream.
4. Hyperosmotics: Hyperosmotics are used to treat corneal swelling. Hyperosmotics draw water out of the cornea and thus reduce corneal swelling. Most OTC hyperosmotics contain sodium chloride in various concentrations as either a solution or an ointment. The 2% solution tends to cause less stinging and burning than the 5% solution. An example of a hyperosmotic for corneal swelling is Adsorbonac.
5. Scrubs: Eyelid scrubs are useful for removing oils, debris, or loose skin that can be associated with eyelid inflammation. Soap agents provide the foaming action. An example of this type of product is Eye-Scrub.
6. Decongestants: Decongestants are used to shrink swollen blood vessels in the congested (red) eye, for example, in conjunctivitis. Phenylephrine is the most commondecongestant for this purpose. Patients at risk for angle-closure glaucoma should cautiously use phenylephrine because it can cause an attack of the disease. Rebound congestion, in which blood vessels become dilated even with continued use of decongestants, is a common side effect of phenylephrine. Therefore, if no improvement in redness or symptoms occurs within 72 hours of use, phenylephrine should be discontinued. A frequent side effect of phenylephrine is dilation of the pupils. If phenylephrine is absorbed from the eye into the body, an increase in blood pressure may occur, although this is rare. Nevertheless, patients with high blood pressure should be cautious in using phenylephrine. Additionally, if phenylephrine is absorbed, side effects may occur due to interactions with atropine, tricyclic antidepressants (imipramine), andmonoamine oxidase inhibitors such as phenelzine sulfate (Nardil) or tranylcypromine sulfate (Parnate), reserpine (Hydropres), guanethidine (Ismelin), or methyldopa (Aldomet).
A second group of chemical decongestants are the imidazoles (naphazoline, tetrahydrozoline, and oxymetazoline). Imidazoles are longer acting than phenylephrine and have fewer side effects, including rebound congestion. Caution still is recommended with imidazoles because of the potential for an increase in blood pressure. Of the three imidazoles, oxymetazoline generally appears to exhibit the least side effects. Naphazoline may dilate pupils more in people with lightly pigmented (blue or green) eyes.
Examples of eye drops containing decongestants are Naphcon, Prefrin, and Opcon A.
7. Antihistamines: Ocular antihistamines are available OTC. These antihistamines are combined with ocular decongestants for the treatment of congestion (conjunctivitis), particularly when caused by allergy. Pheniramine maleate and antazoline both block histamine receptors in the eye, and thus provide relief from the symptoms of itchy, watery eyes. Antazoline may increase presses slightly in the eye (of concern to patients with glaucoma) whereas pheniramine maleate has little effect on pressure. Common side effects of antihistamines include burning, stinging, and discomfort in the eye. Important side effects that may be associated with oral antihistamines have not been reported with ocular antihistamines. Antihistamines should not be used in patients at risk for developing angle-closure glaucoma. Examples of products that combine an antihistamine and decongestant are Naphcon A and Ocuhist.
8. Newer allergy eye-drop preparations: Recently, new classes of eye drops for the treatment of itching due toallergy have become available over the counter. Zaditor, a nonsteroidal anti-inflammatory drop, is an example of these.

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