FIVE points about eye conditions (Conjunctivitis, Stye, Chalazion)

Often, customers come into the pharmacy, asking for eye antibiotics for their eye infections. Is that a real necessity ?

1. Ask a pharmacist or an optometrist or a doctor to work out what kind of eye condition you have

Usually, talking to a pharmacist is the easiest and cheapest way (their advice are free ! ^^ ). Talk to a pharmacist and figure out what kind of eye conditions you are experiencing. If the pharmacist could offer treatment or refer you to someone for further investigation. Often, patient thought they have bacterial conjunctivitis ( also known as "pink eye"), however, often it is not the case.

The pharmacist can check with you, in case there is serious underlying causes of your eye condition.

Referral points: 

1. Sensitive to light (photophobia)
2. Painful eye ball
3. Recent eye surgery
4. Different pupil size
5. Vision loss or sudden vision change 

2. Bacterial conjunctivitis - Do you really need topical eye antibiotics such as chloramphenicol eye drop or ointment? 

Bacterial conjunctivitis is self limiting. This means it will go away even if you DO NOTHING at all.

The sign and symptoms of bacterial conjunctivitis - green/yellow/greenish-yellow discharge, sticky eye lid (especially when you wake up in the morning) 

When the patient comes in the pharmacy, the eyes may not have sticky green-yellowish discharge as they may have wiped it already. Therefore, asking questions to probe further is important.

3. How to use topical antibiotic eye drops or ointment? 

For chloramphenicol eye drop - Instil 1-2 drops into affected eye(s) every 2-6 hours for the first 2-days and then reduce to FOUR times daily. Continue to use for 48 hours after the symptoms has cleared.

Do not touch the tip of the eye drop container to your eye to prevent contamination.

For chloramphenicol ointment - Apply a thin ribbon ( ~1.5cm - one fingertip unit) to the lower eyelids of affected eye(s) THREE times daily or ONCE daily at night (in addition to chloramphenicol eye drop).

Eye ointment can make your vision blurry. Do not drive or handle heavy machines if your vision is blurred.

4.  You DO NOT need topical antibiotic to treat your stye or chalazion !

Stye and chalazion are very similar to each other. It is hard for the patient to tell. For stye (medically known as hordeolum), it is a painful lump (yellow pus could be seen) inside or outside your eyelids.  On the other hand, chalazion is a small raised bump and usually not painful that caused by blocked oil gland at your upper or lower eyelid.  

Chalazion 

Stye 

Both eye conditions are self-limiting. NO topical eye antibiotics are needed. Even though you use topical eye antibiotics, the drug would not be able to get into the affected area. Therefore, there is no reason you should use topical eye antibiotics to treat these conditions. In addition, it increases the chance of antibiotic resistance - that is the last thing we wanted it to happen. 

Warm compression is the way to alleviate the symptoms (alleviate painful stye and make the pus burst faster) or fasten the healing process (clear the blocked oil gland). Soaking a face cloth in warm water and compress it at the affected area for 10-15 minutes several times a day (THREE to FOUR times daily). 

One more thing you can do for chalazion is to massage your eye gently. Rubbing the eyes can drain away oil accumulated at the blocked gland. 

For stye, do not try to squeeze or rub the stye and make it burst. Usually, stye will be there for few days and burst and release pus inside. Once the pus inside is drained, stye will heal.

If the stye makes you feel painful, oral painkiller such as paracetamol or ibuprofen can be taken to alleviate the pain. (Not to forget to do warm compress at the same time) 

Maintain good personal hygiene is important. Wash your hands before and after touching your eyes.

If the customer wants something from your pharmacy to help , recommending eye rinse may be a good choice such as Optrex. Otherwise, any artificial eye drops could be used for relieving eye pain or dryness. 

5. If you are contact lens wearer , BE CAREFUL when you have an eye condition! 

For contact lens (CL) wearer, it is important to maintain good eye hygiene. If you are experiencing red eyes or bacterial conjunctivitis, see a doctor or an optometrist. This is because CL wearers have higher risk of getting bacterial keratitis. Sometimes, it could be severe and cause visual loss or even blindness. Even though you use topical antibiotic eye drops such as chloramphenicol, it might not be effective as the bacteria that infect your eye might be Psuedomonas species, in which beyond chloramphenicol antibacterial spectrum.

If you are experiencing red eyes or conjunctivitis, do not wear your contact lenses!

Wear glasses instead until the eye condition is resolved.

In short, it is better to see a doctor or optometrist to have an eye check - just in case.

References 

1. http://www.healthline.com/health/chalazion

2. http://www.healthline.com/health/stye#Treatment5

3. http://www.nhs.uk/conditions/stye/Pages/introduction.aspx

4. New Zealand Formulary

5. http://www.webmd.com/eye-health/common-eye-problems#1

All photos obtained from google image search.