Evaluating risks to eyesight

Many people are unaware of the everyday risks they may be taking with their optical health or that when things go wrong with eyesight the consequences can be devastating

Learning objectives

After reading this feature you should be able to: 

• Explain the link between smoking and sight loss/blindness
• Provide customers with key advice and support to preserve healthy vision
• Recognise the early signs of potentially serious eye conditions that warrant onward referral to an optometrist. 

Key facts

• Many people may not be aware of the link between smoking and sight loss
• Important steps to help preserve healthy vision include keeping blood pressure, cholesterol and blood glucose levels in check
• Common eye ailments such as conjunctivitis, blepharitis and dry eye can be effectively managed with self-care advice and OTC preparations. 

Smoking and eye care

Although the links between smoking and a host of different diseases such as lung cancer and stroke are well known, many people don’t realise that smoking can also lead to vision loss and blindness.

Smokers may therefore be surprised to learn that they are twice as likely to lose their eyesight as non-smokers.1 Cigarette smoke contains a hazardous cocktail of over 5,000 chemicals, many of which are toxic and damaging to the eye.² Smoking also affects the blood vessels, causing vasoconstriction, atherosclerosis and clotting, which choke off essential blood supply to the eyes.

As a result, smoking is both a direct cause and a contributory factor in a number of serious eye diseases including age-related macular degeneration (AMD), thyroid-related eye disease, cataracts, diabetic retinopathy and optic neuropathy.²

AMD currently ranks as one of the primary causes of vision loss in the UK in people over 50 years of age and smoking raises the risk of developing it by over three-fold due to damaging effects on the retina.^1,3 Similarly, smoking more than doubles the risk of age-related cataracts and is a significant risk factor for both Graves disease- related eye disease and diabetic retinopathy, the latter potentially leading to permanent blindness.

Smokers are also 16 times more likely to develop optic neuropathy, where the blood vessels to the eye become completely or partially occluded leading to sudden loss of vision.¹

By raising awareness of the links between smoking and eye health, and offering advice and support on smoking cessation, pharmacy teams can play an important role in improving customers’ overall eye health.

Other key steps to safeguarding vision include eating a healthy balanced diet (dark leafy greens and foods rich in omega-3 fatty acids are particularly good for the eyes), staying physically active, and keeping underlying conditions like diabetes, hypertension and high cholesterol levels well controlled.

It is important to take measures to protect the eyes from potentially damaging external factors. Wearing sunglasses with 99-100 per cent UVA and UVB blocking power is recommended even on cloudy days, and protective eye-wear should be used for some sports, DIY and construction.

Recognising danger signs

Pharmacy teams can also help in the early detection of potentially serious eye disorders by recognising red flag symptoms and expediting onward referral to an optician or optometrist. AMD affects the central vision so customers may notice distortion, blurring or a blank patch when looking directly at something.

Potential early warning signs include straight lines looking wavy or crooked, difficulty reading small print due to objects appearing smaller than normal or vision that is less bright or clear than it used to be. Some sufferers may also report increased sensitivity to bright lights or even visual hallucinations.

Diabetic retinopathy is another condition that can cause gradual worsening of the eyesight or blurred/patchy vision. Other symptoms include floaters, eye pain or redness. Any customer with known diabetes who experiences any of these eye complaints should be encouraged to consult their optician, GP or a member of the diabetes care team immediately. It is also important to encourage all diabetics to attend their annual diabetes eye screening appointments as most cases of diabetic retinopathy do not show symptoms until the condition is advanced.

Other potentially vision-limiting eye conditions to be alert for in the pharmacy setting, particularly among older customers, include glaucoma and cataracts. Glaucoma is another ‘silent’ condition but, where they do occur, symptoms include blurred vision or seeing rainbow-coloured rings around bright lights. Cataracts are characterised by misty or cloudy vision (customers may complain that their glasses lenses need cleaning even when they don’t), colours appearing faded/washed out and difficulty seeing in low light.

Customers should be advised to seek an urgent optometrist appointment if their eye sight suddenly deteriorates or becomes blurred, or if they notice a dark curtain or shadow moving across their vision – potential warning signs of a detached retina. This warrants immediate medical attention to avoid permanent sight loss.

Other indicators of possible retinal detachment include a sudden appearance or increase in the number of floaters in the eye or flashes of light in the visual field. Any eye that is very red and excessively painful also requires referral to an optician/optometrist.

Managing everyday eye ailments

As well as remaining vigilant for serious eye diseases, pharmacy staff can help customers manage minor eye ailments, such as conjunctivitis, dry eye (see p32) and blepharitis, which may occur on a day-to-day basis.

Conjunctivitis

Conjunctivitis is a common condition caused by either infection or allergies/irritants such as hayfever. The hallmark symptoms of both types of conjunctivitis are inflammation and redness of the thin conjunctival membrane that covers the white of the eye and lines the inner eyelid.

Infective conjunctivitis that is caused by a viral or bacterial infection is very contagious and easily spread from eye to eye and from person to person. Infected eyes produce a sticky discharge that causes the eyelashes to stick together on waking. The eyes may also feel gritty or irritated. 

Chloramphenicol antibiotic eye drops and ointment are available OTC but – as most cases of infective conjunctivitis are self-limiting and resolve in around a week – their use is not routinely recommended. Instead, self-care measures should be employed first. Advise customers to clean crusting and discharge from around their eyes with a clean cotton wool pad soaked in cooled boiled water (using a separate pad for each eye) and to apply cool compresses to the eyes to ease irritation.

To avoid spreading infective conjunctivitis, customers should be advised to wash hands, pillow cases and flannels regularly and not share towels, bedding or cosmetics with other people. Avoid rubbing the eyes and contact lenses should not be worn until the infection has resolved.

Conjunctivitis sufferers should seek further advice from a GP if their symptoms do not subside within two weeks. Similarly, any cases of red eyes in babies under the age of 28 days should be referred immediately to a GP. 

With allergic conjunctivitis eyes appear red but may also water, producing a stringy discharge, and feel itchy and irritated. Accompanying symptoms can include sneezing and a runny nose. Allergic conjunctivitis can be treated with eye drops containing sodium cromoglicate or anti-histamines as active ingredients.

Blepharitis

Blepharitis is another common yet uncomfortable eye condition where the eyelids become red, swollen and itchy. Symptoms include:

• Sore eyelids
• Irritated eyes that may feel itchy, gritty, burn or sting
• Flakes or crusts around the roots of the eyelashes
• Crusty eyes or eyelashes on waking
• Tears that are foamy or have small bubbles in them.

The condition is typically caused by an overgrowth of the skin-dwelling bacteria that live normally on the eyelids but may also be associated with other dermatological disorders such as atopic dermatitis. People who suffer from dandruff, rosacea and oily skin tend to be at higher risk of developing blepharitis. 

Although relatively benign in its own right, left untreated blepharitis can lead to other complications such as dry eyes, styes, chalazions, cysts and conjunctivitis. Daily eyelid hygiene is the cornerstone of treating blepharitis and involves warmth, massage and cleansing. Customers should be encouraged to practise the following routine every day:

• Apply a clean flannel soaked in warm water to the eyelids for 10 minutes
• Gently massage the eyelids for around 30 seconds, focusing on the area where the eyelash meets the eyelid
• Clean the eyelids with cotton wool or a soft cloth soaked in cooled boiled water or a dilute solution of baby shampoo in water.

Pharmacy staff can advise on suitable eye pads and wipes to use in this daily eyelid cleansing regimen and may also recommend eye drops such as artificial tears to relieve associated symptoms of dry eye. Anyone with blepharitis whose symptoms do not improve after a few weeks of daily cleansing should be referred.

The next step up in treatment may involve antibiotic creams or drops, or even oral antibiotics. Steroid eye drops can also be prescribed to help combat redness, swelling and irritation in the eye. In cases of blepharitis caused by other health problems, such as dandruff or rosacea, it is helpful to treat the underlying cause, and pharmacy staff should advise accordingly.

Customers can be reassured that blepharitis is not contagious and cannot be spread from person to person like conjunctivitis, despite the similarities in symptoms. However, blepharitis can be a chronic, recurring condition that requires an ongoing eyelid cleansing regimen to keep the symptoms under control.

References

1. Royal Free Hospital. Smoking and your eyes. Available online.
2. Action on Smoking and Health (ASH). Fact sheet no 22: Smoking and eye disease. February 2019
3. Specsavers. Macular degeneration. Available online.