Ophthalmic nurse practitioner, Shirley Miller says that many of the patients referred to hospital with sore, gritty or watery eyes could be treated easily in the community with regular eye drops four times a day, but that the symptoms of dry eye syndrome are still not well recognised. Shirley wants to spread the message that dry eye can be a serious condition, “If patients don’t improve with this regime, then referral to the hospital eye service is appropriate”
Dry eye is a term used for a variety of tear film disorders that result in the inadequate lubrication of the eye, which includes insufficient tear production or too rapid evaporation. Shirley wants to spread the message that dry eye can be a serious condition, but the mainstay of treatment is still using lubricating drops very regularly.
Shirley says; “Many patients come in expecting that I will recommend punctal occlusion, but I would only do this in cases of moderate to severe dry eye, where the patient was using two-hourly drops throughout the day and this was not sufficient.” The punctum is a small opening on the inner eye lid and a plug is sometimes inserted to slow tear drainage. However, eye drops specifically developed for dry eye can often overcome the issue without more invasive treatment.
To help people ensure they are administering their eye drops correctly, ophthalmic product specialist Altacor has produced new advice sheets explaining the importance of a good technique and good hygiene. The company have also uploaded a training video to YouTube designed to help carers and others administer eye drops for elderly patients or for those who are unable to easily use eye drops themselves. Its Clinitas products for dry eye are available on prescription.
Altacor is also working with nurse practitioners like Shirley to improve diagnosis of dry eye syndrome in the community. “Lot’s of people think ‘oh it’s just dry eyes’,” says Shirley. “But what they don’t realise is that dry eye can be a very disabling condition and serious if not treated effectively. I’ve had two patients who have developed significant corneal ulcers due to untreated dry eye and another who had to undergo corneal ‘glueing’.”
Shirley Miller is an Ophthalmic Nurse Practitioner at the Queen Margaret Hospital in Dunfermline, Fife. Many of the patients Shirley sees in her dry eye clinic are referred directly from their GP or Optometrists. However, Shirley also sees a large number of patients who are referred to her internally from Rheumatology. These patients tend to have systemic illnesses such as rheumatoid arthritis or Sjögren’s syndrome that can cause problems with the tear film.
“The vast majority of patients referred from their GP or Optometrist have sore, gritty or sticky eyes. A small percentage of these patients will be suffering from watery eyes, but you could pick these patients up off the floor when I tell them their watery eyes are the result of dry eye syndrome. As they think the problem might be blocked tear ducts, but I explain that bilateral blockage of the tear ducts is very unusual, it is far more likely to be a problem with the tear film”.
Dry eye syndrome is often associated with the menopause and Shirley agrees that this group of women are particularly at higher risk in developing disorders of the tear film.
“Over 90 percent of the patients I see are women in their late 40’s and upwards. The men I do see tend to have more significant problems, which perhaps suggests that men are less likely to seek help, but there is definitely a relationship between dry eye and age for women.”
“We must improve confidence when it comes to diagnosing dry eye syndrome so that GPs and Optometrists are the ones to initiate treatment.”
“We are planning some education days with GPs and Optometrists. It is a wasted appointment if a patient comes to us and they haven’t been using drops correctly and regularly throughout the day.”
Nurse practitioners interested in offering training sessions in dry eye diagnosis are encouraged to contact Gareth Thomas at firstname.lastname@example.org.