What allergy eye drops are safe during pregnancy

Antihistamine tablets can assist relieve itchy eyes, a runny nose and sneezing, but not every types are suitable to take during pregnancy, so always check with a GP beforehand.

Pharmacists are unlikely to sell antihistamines without a prescription for use in pregnancy because of manufacturers’ restrictions.

If you cannot use nasal sprays or eyedrops or they do not work for you, a GP may recommend an antihistamine tablet that does not cause drowsiness, such as:

  1. loratadine – this is generally the first choice for pregnant women because of the quantity of safety data available for it
  2. cetirizine – if loratadine is not suitable or does not work for you, a GP may recommend cetirizine, another antihistamine tablet that does not cause drowsiness

Chlorphenamine is also considered one of the safer antihistamines to take during pregnancy, but because it can cause drowsiness, loratadine and cetirizine are generally the preferred options.

For information about taking specific medicines in pregnancy, see the bumps (best use of medicines in pregnancy) website.

Ophthalmologists must navigate through uncharted areas when they treat their pregnant patients.

“My general law of thumb in patients who are pregnant is to use the least quantity of medication possible, even if I ponder the medications are safe,” said Christopher J.

Rapuano, M.D., professor of ophthalmology, Jefferson Medical College of Thomas Jefferson University, and co-director, Cornea Service, Wills Eye Institute, Philadelphia.

“My second law of thumb is to call the obstetrician and check with him on medications I ponder the patient needs to be on,” Dr. Rapuano said.

Practitioners said they would prefer to avoid the medicolegal risks that would accompany a kid born with defects or other problems, which might cause a patient to wonder if the ophthalmic medication she used during pregnancy led to the child’s problem.

Practitioners generally follow the same guidelines while the patient is nursing, although they said they do not need to adhere as strictly to them.

Although there is a dearth of research on the effects of ophthalmic medications during pregnancy, physicians take a cautious approach instead of waiting for such studies to be done.

“These studies are hard to do, and they’re risky,” Dr. Rapuano said. “An animal study may or may not translate perfectly to humans. And these studies are not cost effective” because pregnant patients make up such a little portion of the population.

Below are some treatment approaches that ophthalmologists use with their pregnant patients who wear contacts or own dry eye, allergies, glaucoma, corneal infections, and other conditions.


Dry eye and allergies

Dry eye can be an issue in pregnant patients who wear contact lenses and in those who experience nausea and vomiting, said John D.

What allergy eye drops are safe during pregnancy

Sheppard, M.D., professor of ophthalmology, microbiology, and immunology, Eastern Virginia Medical School, Norfolk. The nausea and vomiting lead to dehydration, which can lead to drier eyes, he said. Certain medications that patients may take to inhibit nausea can also contribute to dry eye, he said. Practitioners seem to consent that artificial tear drops are a safe treatment option to lubricate the eyes. Another simple solution is asking patients to reduce contact lens wear or not wear them at all.

Beyond those easier steps, everyone has diverse ideas.

Dr. Sheppard said he “leans more toward the natural route” to treat pregnant dry-eye patients.

This includes supplements such as fish oil, flaxseed oil, and black currant seed oil. Preliminary research and anecdotal evidence shows that omega-3 acids found in these supplements can assist the ocular surface.

He uses silicone or plastic punctal plugs as well, an option that Dr. Davis also thinks is reasonable. “Punctal plugs and lubricant drops would be the mainstay of my treatment,” she said.

Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan, Irvine, Calif.), which is frequently used now to treat dry eye, may or may not be a excellent option for pregnant patients, physicians said.

“The use of Restasis is not contraindicated,” Dr.

Sheppard said. “I own no problems treating pregnant patients with Restasis.” He said Restasis has an added benefit: helping to control ocular allergies.

However, “I’d take the patient off the Restasis, not because I ponder it’s unsafe but because it is cyclosporine and as far as I know, it’s not been tested [with pregnant women],” Dr. Rapuano said.

If the patient has severe dry eye, Dr. Sheppard is also comfortable using Lotemax (loteprednol etabonate ophthalmic suspension 0.5%, Bausch & Lomb, Rochester, N.Y.).

With seasonal allergies, Dr.

What allergy eye drops are safe during pregnancy

Sheppard will use Restasis and drops such as Elestat (epinastine hydrocholoride 0.05%, Inspire Pharmaceuticals, Durham, N.C.) and Patanol (olopatadine hydrocholoride 0.1%, Alcon, Fort Worth, Texas). Still, he avoids oral antihistamines or antihistamines with a decongestant component. “With the systemic effects, we’re not 100 percent certain they’re safe for the fetus,” he said.

Patients who wear contact lenses and own seasonal allergies may discover their symptoms more manageable if they avoid their contacts for awhile, Dr.

Sheppard said.

Using the lowest quantity of drops necessary and encouraging patients with allergies to use cool compresses are other possible approaches, Dr. Davis said. “If they’re miserable, I tell it’s OK” to use drops for ocular allergies, Dr. Rapuano said.

What allergy eye drops are safe during pregnancy

Still, he tries to hold their use to a minimum during pregnancy.

Dr. Rapuano also teaches his patients to act out digital punctal occlusion before they ister a drop and at least 60 seconds after they put a drop in.

“This significantly decreases the quantity of the drop that gets into the nose and the bloodstream,” he said. “It keeps the medication more localized.”


Case discussion

Ocular treatment in pregnancy

As with other minor ailments in patients who are pregnant, treatment initially will always tend towards conservative management with non-pharmacological therapies; this is to reduce the risk of exposing the unborn kid to medicines and their metabolites.

Despite the therapy in this case being topical, there is some systemic absorption of ocular products, hence their ability to cause systemic side effects. Medicines in ocular products penetrate the cornea, entering the aqueous fluid, which drains from the eye via the canal of Schlemm (circular canal at the sclerocorneal junction of the eye, draining aqueous humour from the anterior chamber into the conjunctival veins). In addition, some product will finish up in the gastrointestinal tract because it may drain via the nasolacrimal duct into the nasopharynx.

Pharmacokinetic data on the quantity of systemic absorption from ocular products are lacking. This, coupled with the lack of human data on the exposure of fetuses to topical ocular products, means that there are few published data on the potential for fetotoxic events of topical ophthalmic medications.

Many ocular medications own also been used systemically to treat conditions in pregnant women and own not produced evidence of birth defects above the normal background rate. Therefore, if a medication is not known to produce defects systemically, then it is not likely to do so topically due to the smaller amounts istered. Careful consideration is needed when prescribing medication and each patient must still be considered on a case-by-case basis.

Even topical therapies will be subject to the same considerations: what is the severity of the infection?

What are the potential consequences of not treating the mother? What is the potential toxicity to the fetus of the drugs under consideration?

Pathophysiology of conjunctivitis

Conjunctivitis is inflammation of the conjunctiva, the semi-transparent, highly vascularised mucous membrane that covers the globe of the eye, starting from the edge of the cornea (limbus), flowing back behind the eye, looping forward to form the inner surface of the eyelids (tarsal plates). The purpose of the conjunctiva is to decrease friction when blinking and to protect the sclera.

The conjunctiva also prevents objects such as eyelashes or contact lenses sliding back behind the eye. As the conjunctiva is the final ocular layer, it is regularly exposed to the environment and hence subject to trauma, infection and allergic reactions, which can induce inflammation.

Choice of treatment in this case

In this case, conservative treatment has failed, and not treating the mom may lead to further ocular involvement and invasive infection. Which agent should be used?

A broad-spectrum agent is be required, so chloramphenicol would be a excellent choice.

However, despite there being no published data on any associated risk of congenital malformation, there own been concerns that use near term is associated with grey baby syndrome. Because of this concern, the UK teratology information service advises that the use of chloramphenicol in pregnancy should be avoided where possible. In selecting a therapy that is believed to be the safest, fusidic acid is a potential alternative, for which the manufacturers state that it can be used in pregnancy.

Establishing the cause of conjunctivitis

In cases of conjunctivitis, the whole of the conjunctiva will be involved (the globe and the tarsal plates) and so every surfaces should show redness.

Where the redness is localised to just the limbus, another structure is affected and requires investigation. There will be generalised mild discomfort and ocular irritation; the presence of pain indicates involvement of the cornea and forms part of the differential diagnosis.

Discharge or increased lacrimation is generally the key to diagnosis for the most common causes of conjunctivitis. A thick yellow purulent discharge that can stick eyelids together in the morning indicates a bacterial origin. This cause is more common in infants and children than in adults.

A more watery discharge is associated with viral conjunctivitis. Cases of viral conjunctivitis may also be distinguished by a recent flu-like illness, conjunctival follicles (small semi-translucent lymphatic swellings), lid oedema and excessive lacrimation. This type of conjunctivitis is more common in adults than in children. The most common causative agent is adenovirus; the others implicated to a much lesser extent are the Coxsackievirus and picornavirus. Viral conjunctivitis is extremely contagious and other people in shut contact are likely to be affected.

There can also be serious consequences with some patients developing keratoconjunctivitis, which affects vision.

Allergic conjunctivitis is not associated with any discharge, but will be associated with increased bilateral lacrimation. Itching will predominate with eyes appearing more pink than red.

What allergy eye drops are safe during pregnancy

There may also be some degree of conjunctival swelling or ballooning (chemosis). Most patients presenting with allergic conjunctivitis at the pharmacy will do so with acute presentations and will own a history of contact with an allergen towards which the response is mounted, e.g. pollen, mite allergens. During the hay fever season it is termed ‘seasonal allergic conjunctivitis’.

What allergy eye drops are safe during pregnancy

Chronic allergic conjunctivitis may be present every year endless. It commonly affects boys with a history of atopy (genetic disposition towards allergic disease). The chronic nature of this condition means there may be more changes in the eye: follicles or white spots in the limbal region, papillary (raised, ‘bumpy’) lesions on the upper tarsal plate or punctate lesions (tiny white spots) on the corneal epithelium.

Chlamydial conjunctivitis caused by the obligate intracellular organism Chlamydia trachomatis is the least common type of conjunctivitis.

Discharge can vary between watery and mucopurulent (containing mucus and pus), but the redness of the conjunctiva is deeper than seen with other causes. Raised follicles will be seen on the lower tarsal conjunctiva as well as symptoms of systemic infection. Patients are screened for chlamydial antigens to confirm diagnosis.

Treatment options for conjunctivitis

Often, in bacterial conjunctivitis, no pharmacological treatment is necessary because the condition is generally self-limiting and will resolve within 7–10 days. Excellent hygiene is significant to reduce transfer to the unaffected eye; this includes removing any possible contaminated eye makeup.

The use of eye bathing or sterile wipes to refresh the eye and remove discharge can assist to reduce some symptoms. Often, patients will desire some treatment in the form of a topical antibiotic. In the case of children, treatment may be requested by the nursery or school in order for the kid to return to interaction with other children and prevent spread.

As well as bacterial conjunctivitis being more common in infants and children than adults, there is a difference seen in the probable causative organism. In adults the causative organisms are Staphylococcus aureus (55%), Streptococcus pneumoniae (20%), Moraxella sp.

(10%), Haemophilus influenzae (5%) and Pseudomonas aeruginosa (5%), whereas in infants and children the most common bacteria are S. pneumoniae, M. catarrhalis  and H. influenzae. Despite the differences in organisms, both groups own Gram-positive and Gram-negative bacteria implicated, so, when treating bacterial conjunctivitis, agents with a wide spectrum of activity are used.

Chloramphenicol 0.5% eyedrops are considered to be first-line treatment for bacterial conjunctivitis because it is wide spectrum with activity against both Gram-positive and -negative bacteria.

It exerts its bacteriostatic effect by selectively inhibiting protein synthesis in ribosomes. Although considered the gold standard and effective for almost every cases of bacterial conjunctivitis, it is not athletic against Pseudomonas aeruginosa or Chlamydia trachomatis, so those patients who own not responded to treatment require immediate referral. Despite its effectiveness, OTC supply is prohibited to those who are aged <2 years or already using products for glaucoma or dry eye syndrome, own a personal or family history of bone marrow problems (because of the link to aplastic anaemia) or take medication that may interact with chloramphenicol eyedrops.

In these patients, however, propamidine isetionate (isethionate) 0.1% eyedrops (Brolene eyedrops) could be supplied OTC.

Propamidine is an aromatic diamidine (R-C[NH]NH2) antibacterial disinfectant that is athletic against Gram-positive bacteria, but less athletic against Gram-negative bacteria; it also has limited antifungal properties. It blocks the permease transport system that is responsible for the uptake of purine nucleotides. Bacteria are therefore unable to synthesise the precursors for DNA, RNA or protein metabolism. Other less well-known interactions add together to give its bacteriostatic effect.

Failure of OTC products necessitates referral to a doctor.

Further investigation to determine the cause of the infection may be required and cultures taken. Before culture results are obtained, other broad-spectrum antibiotics would be prescribed such as ofloxacin (a fluoroquinolone), which can interfere with bacterial DNA replication, or fusidic acid (derived from the fungus Fusidium coccineum), a complicated steroid-like molecule (no steroid activity), which acts by inhibiting bacterial protein synthesis.

Bacterial cases requiring referral

Although most cases of bacterial conjunctivitis are easily diagnosable in the community pharmacy, not every patients will be candidates for over-the-counter (OTC) treatment.

The following patients will need referral to a doctor:

  1. Patients who own failed to reply to initial topical antibiotic treatment, indicating that the antibiotic was not athletic against the causative organism.
  2. Patients who are producing copious amounts of purulent discharge that reaccumulates quickly when wiped away, or infection that is not localised to the eye, because this indicates severe infection.
  3. Contact lens wearers who are more prone to eye infections and more likely to become infected with Pseudomonas aeruginosa, which can go on to cause corneal ulceration, endophthalmitis (inflammation of the interior of the eye) and even permanent blindness.
  4. Patients experiencing pain within the eye, which indicates corneal involvement needing investigation.
  5. Patients with loss of vision, indicating severe infection or other structures affected.
  6. Patients who own had surgery or laser treatment in the final 6 months because they will require examination of the surgical site before treatment.
  7. If the patient is pregnant or breastfeeding because exposure of the kid to medication must be considered.

Formulation of eyedrops

To ensure that topical ophthalmic preparations are non-irritant, they are formulated to own properties approximating to those of lacrimal fluids (tears), own the appropriate viscosity and include an antimicrobial preservative if a multi-dose presentation is required (to prevent growth of microorganisms accidently introduced into the product during use).

Isotonicity: hypotonic and hypertonic solutions are irritant to the eye and thus hypotonic ophthalmic solutions (similar to numerous injections) are made isotonic by the addition of tonicity agents, such as sodium chloride, dextrose and buffer salts.

pH: the pH of tears is approximately neutral.

Tears own some buffering capacity, and feeble acids and bases, pH range 3.5–9 can be tolerated in the eye. Buffers may be included, such as borate and phosphate buffers.

Viscosity: water-soluble, viscosity-enhancing polymers, such as methyl cellulose and hydroxypropyl methylcellulose, may be included in formulations to increase their viscosity, prolonging retention of the drug in the eye and thereby increasing drug absorption.

Antimicrobial preservatives: antimicrobial agents with a wide spectrum of activity against Gram-positive and -negative bacteria, yeasts and moulds, and with low toxicity to humans, are required for multiple-use eyedrops, which may be accidently contaminated during use.

The number of antimicrobial agents suitable for ophthalmic use is extremely limited, with benzalkonium chloride being the most commonly employed.

Fusidic acid is formulated as viscous eyedrops (fucithalmic) in a preserved aqueous system containing the polymer carbomer. The viscous formulation is simple to ister, and the polymer-containing formulation, which liquefies and becomes transparent on contact with the tear fluid, gives an increased precorneal residence time and sustained levels of the drug, compared with a conventional eyedrop formulation.

The decision to include any excipient within the formulation must take into account compatibility with the drug and the container.

Extended learning

  1. What is grey baby syndrome?
  2. How can the systemic absorption of ocular products be reduced?
  3. What considerations should be taken when advising on topical dermatological preparations for pregnant patients?
  4. Outline how eyedrops are packaged and sterilised
  5. What is ophthalmia neonatorum?
  6. How should allergic conjunctivitis be treated?
  7. How would you counsel the patient to ister the eyedrop product?

Citation: The Pharmaceutical Journal, PJ August 2017 online, online | URI: 20202906


Unusual situations

Dr.

Rapuano said dilating drops are safe to occasionally use if it’s an urgent situation—a patient experiencing flashers and floaters, for example. If it is a routine examination, he advises the patient to wait until she has had the baby.

Even though practitioners generally prefer to avoid medications for pregnant patients, a corneal infection requires treatment, Dr. Davis said.

There are certain drops that are safer,” she said. “Erythromycin and polymixin B appear to be the safest antibiotics,” she said. “They’re not as wide spectrum as the fourth-generation fluoroquinolones, but I’d start with those and see if they’ll treat the problem.”

A corneal infection is another excellent situation in which to consult the obstetrician about the treatment plan, Dr.

Sheppard said.

Low-dose steroid drops are generally safe during pregnancy in patients such as those who’ve had a corneal transplant and are on anti-rejection steroids, Dr. Rapuano said. However, he said he generally stops the use of antiviral medications such as Valtrex (valacylovir, GlaxoSmithKline, United Kingdom) in patients with herpes.


Glaucoma medication risks

For glaucoma patients, one positive aspect is that IOP tends to decrease naturally during pregnancy, said Douglas J.

Rhee, M.D., assistant professor of ophthalmology, Department of Ophthalmology, Glaucoma Section, Massachusetts Eye & Ear Infirmary, Boston.

He cites previous studies that own been done in this area. He also did some research regarding pregnancy and the eye for the Ophthalmic Drug Guide, a book he co-authored that was published this year. Beyond the IOP advantage, he said that glaucoma specialists are especially cautious in their treatment of pregnant patients because of the unknown effects of glaucoma medications.

“All glaucoma medications own the potential to cause fetal and embryonic harm,” he said. “It’s not a well-studied area.” In fact, most glaucoma medications are classified in category C of the Food and Drug istration’s safety categories; this means the drugs own an uncertain safety profile, there own been no human studies, and animal studies may show an adverse effect.

Two exceptions to the risks from glaucoma medications: brimonidine is category B and reasonable to offer up to one month before delivery and oral acetazolaminde was reported safe in a case series for the treatment of intracranial hypertension, published in 2005 in the American Journal of Ophthalmology.

Still, the series only involved 100 patients, Dr. Rhee said. Plus, “acetazolamide during tardy pregnancy has been associated with renal tubular acidosis in the newborn and may own potential teratogenic effects if istered during the first 12 weeks of fetal development,” Dr. Rhee said, citing a 2001 study from Survey of Ophthalmology.

Amtimetabolites such as 5-fluorouracil (5-FU) and mitomycin C and prostaglandin analogues are medications to definitely avoid during pregnancy, he said.

Soft contact lens-related corneal infiltrate in a 38-year-old lady.

Infiltrates such as this one may require additional care in a pregnant patient.

Source: Christopher J. Rapuano, M.D.

The best approach is avoidance of glaucoma medications during this period, he said.

“You see what happens to pressure when you take them off the medications, monitor the pressure, and see if the optic nerve can tolerate it,” Dr. Rhee said.

Selective or argon laser trabeculoplasty are potential surgical solutions for pregnant patients, he said.

If those are not successful, some investigators own suggested cylcophotocoagulation as a excellent option, Dr. Rhee said. Trabeculect-omy without anti-metabolites or post-op anti-inflammatory medication is another procedure to attempt. Still, the surgical methods own a lower success rate because of the young age of the patients.

“It’s a notoriously hard area,” he said. By the time the patient has delivered the baby and is nursing, glaucoma practitioners can once again consider how much the patient needs her medications. A switch to bottle feeding for the newborn may be the best option so the patient can resume their medicine, Dr.

Rhee said. h

Editors’ note: Dr. Rapuano lectures for Alcon (Fort Worth, Texas) and Allergan (Irvine, Calif.). Drs. Davis and Rhee own no financial interests related to their comments. Dr. Sheppard is a consultant for Alcon, Allergan, Bausch & Lomb (Rochester, N.Y.), and various other companies.

What allergy eye drops are safe during pregnancy

Contact Information

Davis: 952-888-5800, [email protected]

Rapuano: 215-928-3180, [email protected]

Rhee: 617-573-3670, [email protected]

Sheppard: 757-622-2220, [email protected]

Here are answers to some of the most common questions pregnant patients enquire their allergist.

Should I continue my allergy shots during pregnancy?

It is appropriate to continue allergy shots during pregnancy in women who are not having reactions to the shots, because they may lessen your allergic or asthma symptoms.

There is no evidence that they own any influence on preventing allergies in the newborn. It is not generally recommended that allergy shots be started during pregnancy.

To summarize: It is extremely significant to monitor closely any asthma or allergic problems during your pregnancy. In the vast majority of cases, you and your kid can glance forward to a excellent outcome, even if your asthma is severe, so endless as you follow your doctor’s instructions carefully. At the extremely first signs of breathing difficulty, call your doctor.

Remember the harm of providing an inadequate supply of oxygen to your baby is a much greater risk than taking the commonly used asthma medications.

The best way to take control of your allergies and own a healthy pregnancy is to speak with an allergist.

This sheet was reviewed for accuracy 4/17/2018.

Source: Shutterstock.com

As with other minor ailments in patients who are pregnant, initial treatment tends towards conservative management with non-pharmacological therapies.

This approach reduces the risk of exposing the unborn kid to medicines and their metabolites.

Can allergy medications safely be used during pregnancy?

Antihistamines may be useful during pregnancy to treat the nasal and eye symptoms of seasonal or perennial allergic rhinitis, allergic conjunctivitis, the itching of urticaria (hives) or eczema, and as an adjunct to the treatment of serious allergic reactions, including anaphylaxis (allergic shock).

With the exception of life-threatening anaphylaxis, the benefits from their use must be weighed against any risk to the fetus. Because symptoms may be of such severity to affect maternal eating, sleeping or emotional well-being, and because uncontrolled rhinitis may pre-dispose to sinusitis or may worsen asthma, antihistamines may provide definite benefit during pregnancy.

Chlorpheniramine (ChlorTrimeton®), and diphenhydramine (Benadryl®) own been used for numerous years during pregnancy with reassuring animal studies. Generally, chlorpheniramine would be the preferred choice, but a major drawback of these medications is drowsiness and performance impairment in some patients..

Two of the newer less sedating antihistamines loratadine (Claritin®), and cetirizine (Zyrtec®) own reassuring animal and human study data and are currently recommended when indicated for use during pregnancy.

The use of decongestants is more problematic. The nasal spray oxymetazoline (Afrin®, Neo-Synephrine® Long-Acting, etc.) appears to be the safest product because there is minimal, if any, absorption into the blood stream. However, these and other over-the-counter nasal sprays can cause rebound congestion and actually worsen the condition for which they are used.

Their use is generally limited to extremely intermittent use or regular use for only three consecutive days.

Although pseudophedrine (Sudafed®) has been used for years, and studies own been reassuring, there own been recent reports of a slight increase in abdominal wall defects in newborns. Use of decongestants during the first trimester should only be entertained after consideration of the severity of maternal symptoms unrelieved by other medications.

Phenylephrine and phenylpropanolamine are less desirable than pseudophedrine based on the information available.

A corticosteroid nasal spray should be considered in any patient whose allergic nasal symptoms are more than mild and final for more than a few days. These medications prevent symptoms and lessen the need for oral medications. There are few specific data regarding the safety of intranasal corticosteroids during pregnancy. However, based on the data for the same medications used in an inhaled form (for asthma), budesonide (Rhinocort®) would be considered the intranasal corticosteroid of choice, but other intranasal corticosteroids could be continued if they were providing effective control prior to pregnancy.

When women with asthma and allergies get pregnant, one-third discover their asthma and allergies improved, one-third discover they worsen and one-third remain unchanged.

Allergist James Sublett, MD

Immunotherapy and influenza vaccine

Allergen immunotherapy (allergy shots) is often effective for those patients in whom symptoms persist despite optimal environmental control and proper drug therapy.

Allergen immunotherapy can be carefully continued during pregnancy in patients who are benefiting and not experiencing adverse reactions. Due to the greater risk of anaphylaxis with increasing doses of immunotherapy and a delay of several months before it becomes effective, it is generally recommended that this therapy not be started during pregnancy.

Patients receiving immunotherapy during pregnancy should be carefully evaluated. It may be appropriate to lower the dosage in order to further reduce the chance of an allergic reaction to the injections.

Influenza (flu) vaccine is recommended for every patients with moderate and severe asthma.

There is no evidence of associated risk to the mom or fetus.

Learning outcomes

At the finish of this case study, you will be capable to:

  1. Describe the factors to be considered when formulating eyedrops;
  2. Outline the pathophysiology, signs and symptoms, and diagnosis of bacterial conjunctivitis;
  3. Outline the chemistry and mechanism of action of antimicrobial drugs used to treat conjunctivitis;
  4. Describe the treatment options available for bacterial conjunctivitis;
  5. Outline the factors to consider when prescribing topical products for pregnant patients.

Mrs NC is 29 years ancient and 37 weeks’ pregnant.

She is concerned about her left eye, which has been producing a yellow discharge that has stuck her eyelids together. She has been experiencing some discomfort in the affected eye but her vision is normal once the discharge has been blinked away. On observation, the entire conjunctival surface, including the tarsal plates (dense, fibrous tissues that give shape and support to the eyelids), appears red. Apart from the generalised redness there are no other abnormalities of the tarsal plates.

  1. How can a bacterial cause of conjunctivitis be identified?
  2. What is conjunctivitis and what are the main causes?
  3. Which patients or symptoms will necessitate referral to a GP?

Seven days later, Mrs NC returns to your pharmacy.

She has a prescription for fusidic acid eyedrops, one drop twice daily, having phoned the GP to enquire for some eyedrops because her condition persisted during the week.

  1. What additional factors own to be considered when treating pregnant women?
  2. What treatment options are available for conjunctivitis?
  3. What are the formulation considerations for eyedrops?
  4. Would chloramphenicol be safe to use in this patient?


Contacts and refractive surgery

Corneal thickness, curvature, and sensitivity as well as tear composition can every change during pregnancy, said Elizabeth A.

Davis, M.D., Bloomington, Minn., who co-authored a chapter on pregnancy and the eye for the book Principles and Practices of Ophthalmology. For this reason, pregnant patients who wear contact lenses may discover their contacts do not always fit properly, she said, or their contacts may feel greasier because of an increased level of lysozyme in the tear film, she said.

If these patients desire to opt for refractive surgery because their contacts are uncomfortable, they own to ponder again, Dr.

Davis said.

“We don’t do refractive surgery in pregnant women,” she said. “We recommend patients wait three months after giving birth and/or breastfeeding because of every sorts of hormonal changes that can change the refractive error.” Between the changes in refractive error that pregnancy can cause—which could lead surgeons to treat an inaccurate refractive error—and the unknown risks of any medications patients may take in conjunction with refractive surgery, waiting is a safer option, Dr. Davis said.



Get advice first

Although you can purchase numerous hay fever medicines over the counter, it’s best to get advice from a pharmacist or GP before taking any medicine when you’re pregnant.

They’ll assess your symptoms and the benefits of taking a medicine against the risk of any side effects.

To ease your symptoms when the pollen count is high, it helps to:

  1. stay indoors whenever possible
  2. wear wraparound sunglasses to stop pollen getting into your eyes
  3. keep windows and doors shut as much as possible

If you decide to take hay fever medicine, you’ll generally be advised to attempt a nasal spray or eyedrops first.


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