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THE EYES AND EB
Ms Gillian SIM Ophthalmic Nurse Specialist
Mr Malcolm Kerr-Muir Consultant Ophthalmologist
Tearfilm problems
The tearfilm is easily upset by any irregularities of the surface of
the eye, and this is a common problem in EB especially dystrophic EB, where scarring may
have occurred.
The irregularities cause pooling of the tears in some areas, and
drying of the tears in other areas. Overall the effectiveness of the tearfilm is
diminished and as a result there is increased friction of the lids over the eye. This is
especially noticeable on waking in the morning, when the lids, on opening, can cause
trauma to the surface of the eye resulting in blistering.
Tearfilm efficiency can be affected by other factors such as
environment (e.g. air conditioning), and reduced blinking (e.g. when concentrating on
looking at a computer screen). Hayfever, and other allergic reactions may also have an
effect, and these should be considered. |
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Treatment is routine lubricants. Ointment (e.g. Simple Eye Ointment), or Gels (e.g.
Lacri-Lube) are used at night, and drops (e.g. Viscotears or Hypromellose) are
administered as necessary during the day. These lubricants do not contain any medication,
so the frequency of administration is not a problem.Some
patients however, may develop sensitivity to the preservatives in the preparations, e.g.
Benzalkonium Chloride, and if this is so, preservative free preparations are available.
There are at least 15 different types of lubricant available, and
although the most commonly used are Viscotears, Lacri-Lube, Hypromellose and Simple Eye
Ointment, the patient may try several different types before finding one that suits them
best. This can be discussed with the clinician or pharmacist.
Washing the eye using eye baths is not recommended, since this will
only further disrupt the tear film, and although giving some initial relief, will only be
transient. However, if there is a foreign body in the eye (e.g. sand), flushing the eye
with a solution such as Normasol (Sodium Chloride 0.9% in sachets), or even boiled, cooled
water is recommended as an initial treatment, followed by a drop of lubricant once the
foreign body has gone. |
