And eyes and ears…..
Most people will experience eye problems at one time or another. While many are minor and will resolve themselves over the course of a few days, others may require a visit to your pharmacy or will need signposted to the GP.
Conjunctivitis is the inflammation of the conjunctiva: the moist, transparent membrane that covers the eyeball and inner eyelid. It tends to only affect one eye at first, but usually affects both after a few hours.
There are three types of conjunctivitis:
• Infective conjunctivitis: a bacterial or viral infection, which is generally treated with chloramphenicol drops
• Allergic conjunctivitis: an allergic reaction to a substance such as pollen or dust mites. This type of conjunctivitis is usually treated with anti-allergy medications, such as antihistamines
• Irritant conjunctivitis, which occurs when the eye comes into contact with things such as shampoo, chlorinated water, smoke or fumes.
Generally clears up as soon as the patient is no longer in the vicinity of whatever caused it to flare up.
Styes are small, painful lumps on the inside or outside of the eyelid. They usually only affect one eye, although it is possible to have them in both eyes. An external stye is a swelling that develops along the edge of the eyelid, and which may turn into a yellow pus-filled spot that’s painful to touch. An internal stye is a swelling that develops on the inside of the eyelid. This is usually more painful than the internal type.
Styes often get better without treatment, particularly after they burst and release pus. They can be eased by using a warm compress, a cloth or flannel that has been warmed with hot water and held against the eye for five to ten minutes three or four times a day until the symptoms disappear. If the stye is very painful, then OTC painkillers such as paracetamol or ibuprofen should be recommended.
Dry eye syndrome arises when the tear film – the thin liquid layer that normally lubricates the eyes – fails to do its job properly, leading to the eyes becoming dry and gritty. It is usually managed by using: aqueous artificial tear products, which help to supplement the aqueous layer of the tear film; paraffin ointments, which lubricate the eyes for longer periods than drops; or liposomes, which stabilise the water layer and slow down its evaporation.
Watering/watery eyes are caused by excessive tear production. Left untreated, watery eyes can cause blurred vision, sore eyelids and sticky eyes. Most patients will feel that their watering eyes aren’t interfering with their life and will therefore opt for no treatment. Medication may be needed, however, if the cause is an allergy or infection.
Earwax is a natural substance, which is produced by glands in the skin of the outer ear canal. It helps to coat the skin of the ear canal where it acts as a temporary water repellent, and, without it, the ears can become dry and itchy, and infection may even arise.
If there is a build-up of earwax, this can cause a blockage. Many patients will immediately turn to cotton buds, but these can act as ‘ramrods’ and simply push the wax even further into the canal. If earwax is only causing a patient minor problems, then over-the-counter ear drops should be enough to help soften the wax so that it falls out naturally. Drops are now available in sodium bicarbonate, olive oil or almond oil versions.
In more serious cases, you should signpost patients to their GP for prescription ear drops that will soften the wax or for ear irrigation. This procedure – known as lavage – is a quick and painless procedure where an electric pump is used to push water into the ear and wash the earwax out.
Ear infections are extremely common and can occur in the ear canal (otitis externa), or behind the eardrum in the middle ear (otitis media).
Symptoms usually include itch, pain, discharge and hearing loss.
Outer ear infections are usually caused by a bacterial infection of the skin of the ear canal, although it can occasionally be caused by a fungus or yeast. The skin can become so swollen that the ear canal actually closes, causing temporary deafness, and there can be a scanty discharge from the ear.
Otitis externa tends to be more common in people who suffer from skin conditions such as psoriasis or eczema, and they will often experience an itch before the pain sets in. It can affect both ears and will often recur if the patient is run down or stressed over a period of time.
Treatment for outer ear infections is again usually in the form of antibiotic ear drops, which are applied to the ear canal for about a week. In more severe or long-lasting cases, however, oral antibiotics may be required.
Glue ear – otitis media with effusion – is experienced by up to 80 per cent of children before they start primary school. No one is really sure what causes the condition, but it often follows an ear infection. It generally occurs when the adenoid in the back of the nose becomes infected by a cough or cold. The bacteria then spread into the ear, causing inflammation. It’s thought that the fluid (the ‘glue’) probably forms in the ear as a result of this inflammation.
Some children complain of pain in their ears as a result of the fluid, while others may experience poor attention or balance problems. In most cases, the glue ear will get better without treatment.