Contact Lens Rewetting Solns etc

OPTOMS CAN SELL & SUPPLY GSL, SL & UNLICENSED PRODS IN COURSE OF PRACTICE AS LONG AS THEY HAVE A SECURE RETAIL PREMISES. THIS INCLUDES ALL OF THIS STUFF.

CL Rewetting solns

• For re-wetting a CL whilst in place on the eye.
• available to the general public SL/GSL for use as needed
• Question whether px should stay on em if they need them more than once an hour
• also 'CLs w/moisturisers' (in polymer matrix) now avail but no proof that they work yet
• Generally contain saline, a polymer, probs a wetting agent like poloxamer. Multi use bottles will have a preservative that isn't BkCl. More likely to be allergic to preservative or wetting agent.
  
• Wide range of multi-dose and unit dose products
• EG1 B&L Rewetting eye drops 10ml bottle w/NaCl, Hypromellose & a wetting agent. Preserved w/sorbic acid 0.25% & EDTA
• EG2 Blink revitalising eye drops 10ml bottle w/PVA 1.4%, phosphate buffer & chlorite/peroxyde preservative. Also avail as unit dose w/EDTA

• Regular use MAY offset adverse reactions to CL solns and MAY help keep CLs/oc surfaces clean. BUT these things are NOT LICENSED FOR THE TREATMENT OF THE CONSEQUENCES OF OCULAR SURFACE DRYING eg pitting staining or seal staining

What they should do

• Should promptly relieve symptoms - pretty much just provide comfort
  
• Help reduce chance of oc surface drying
• Older CL wearers may be more in need of them
• No standards yet on what makes a good rewetting drop

Moisturisers (SL/GSL)

• Supposed to provide soothing & refreshing effects for tired eyes
• NOT considered as true replacements w/tear deficiency
• Shouldn't be used with or just before CL wear and long term use should really be monitored esp w/multidose bottles
• All contain a polymer and various 'special ingredients'. No medicinal claims allowed to be made although 'dry eye'/'lubrication' could be written on bottle. Dry eye being the symptom! If you see signs of dry eye you're going to need at least an artificial tear.
  
• Used as needed for temporary relief of ocular discomfort
• EG1 SL Vital Eyes moisturiser 10ml bottle w/hydroxymethylpropyl cellulose 0.4%, Vit A and Vit E. Preserved w/chlorbutanol and polyhexanide
• EG2 SL Extreme Cooling Rohto Zi for Eyes 8ml bottle w/polysorbate 80 preserved w/chlorhexidine, Vit B6, Vit E, Potassium L-Aspartate and plant extracts like menthol for which no medicinal claims are made.

Astringent Eyewashes (GSL/SL)

• Usually saline w/small amount of phosphate buffer or are a mix of boric acid and sodium borate. Borate has more cleansing power than simple saline 110-300ml bottles are usually available. They often contain a preservative like BkCl or Thiomerosal and other astringents to promote cleansing like witch hazel/hamamelis water and glycerin (eg Optrex Eye Lotion) or maybe petal extracts (eg SL Vital Eyes Eye Wash)
• Often used @ end of working day for general cleansing/washing away of gunk. Often comes with goggle-style 'cap'. Bottle should be for one individual and thrown away after rel. short amount of time.
• Once actually formed mainstay of treatment. Non-medicinal for use p.r.n.

Emergency Eyewashes

• Eg when splashing chemical in eye very large volumes of eyewash (eg Optrex Emergency Eyewash 500ml or even tap water) are available to be continuously applied for at least 15 mins.
• More elaborate solns are formulated for use in operations like Balanced Salt Soln w/NaCl, KCl, MgCl2 etc

Lid Scrub/Hygiene Products

• Cleanse eyelid margins and lashes: meibomian glands, glands of moll, glands of zeis. NB If the lid margin is also inflamed it's probably blepharoconjunctivitis. Eyelid margin discomfort and decreased tear film stability can develop in cases of mild->moderate blepharitis or blepharoconjunctivitis which may be assoc w/meibomian gland dysfunction.
  
• General cleansing w/this stuff should reduce the chance of other intra-epithelial/glandular/hair follicle infections of the eyelid margin
• You can use baby shampoo but it must be diluted and prepared immediately before each use. Much more likely to be successful w/proper product and treatment regimen
• SUPRANETTES (SL) - individually packaged wipes. Coarse gauze
• BLEPHARCLEAN (SL) wipes w/medium gauze, BLEPHASOL (SL, 100ml bottle)
• Wipes moistened w/soln containing mix of surfactants w/soothing agents & plant extracts (Hamamelis again)
• SL STERILID = foam gel w/natural oils, SL BLEPHAGEL = gel

Special Irrigation Solutions

• When toxic chemical or something is splashed into the eye the irrigation needs to be very aggressive to get rid and relieve discomfort. Oedema of the cornea/conj might be involved too
• Used as diagnostic aid to clear corneal oed so you can see in, an astringent for mucus threads, treatment for Fuch's dystrophy.
• Available to some hospital optoms if the ophthalmologist lets em have it
• EG1 Hypertonic NaCl 2% or 5% several drops over 15-20mins may be required. Hospitals can use other 'hypertonics' like glycerin 10-50% diluted w/sterile water
• EG2 Trisodium edetate (0.37-4%) - higher concs of EDTA than are found in eyedrops (<0.1%) used as therapy for band keratopathies that develop after systemic calcium imbalance