Greetings to all and sundry,
It is a beautiful day today, and the weekend has been super exciting, I got the opportunity to participate in the hive open mic contest again for the second time and I love the fact that I get to sing, aside from eyecare one of my passions also lies with music. Then there is the fact that March is Ghana's birth month.
Tomorrow, thus the 6th of March, Ghana will be celebrating its independence. To commemorate this on the blockchain I look forward to sharing with you personal recordings of Ghanaian Independence songs and some patriotic songs. Anyway, enough music we are here to learn about our eyes as usual and today I would be providing some answers to some questions that a lot of my patients do ask me. I hope you enjoy the read.
Introduction
If you go a little bit into pharmacy you will come across a saying that goes every drug is a poison depending on the amount that one takes, I do remember the first time I had a course in pharmacology, I almost asked the lecturer why then are we taking poison to get well, but then as things, we on I came to understand a bit better.
I am sure that you will agree with me that an excess of things tends to be bad (i know someone is reading this and probably saying having too much money is never a bad thing), let's put that one aside, anything that one has to ingest, when it is not done in moderation it is the body that suffers and sometimes the consequences can be dire. This is where the use of drugs in moderation comes in and is also one reason I always advise patients to be very careful with concoctions and other herbal preparations.
Why? Because the active ingredients are not calibrated, and so one can easily abuse the drug and end up damaging themselves. Now generally when we take drugs, I mean ingesting them, the liver and the kidneys help to get the waste out of the body when the work has been done. The more we take in these drugs the more work we give to them in getting rid of waste and when we continuously abuse drugs these organs can eventually shut down or not be able to perform properly anymore, damaging us permanently and putting our lives at risk.
Our systems are beautiful, our body is like an AI, it learns, adapts, and gets addicted to things easily, it always tries to find new ways of doing the old things easier and so when we do not follow instructions then we tend to suffer at the end. Let me give you an example when we take in alcohol, some enzymes are produced which help break it down so it can eventually leave our system, we can't keep having alcohol in our system, how would we work then?
For the first time, we can easily get drunk irrespective of the quantity or how small the percentage may be, you do this twice at a point and then the third time you realize that you do not get drunk after taking one glass and so now you can take two and then three. Do you see what's happening here? Your system has learned and adapted, and now it produces these enzymes so quickly that they break the thing down before it even hits the system and so you have to do more to overpower the system, that is how our body's intelligence can get hooked on drugs.
Eye drops
Thankfully, eye drops fall under the category of topical drugs which don't necessarily have to go through our system. It the similar to putting sun cream on your skin or something similar. Even if some of the eye drop contents manage to get into you it doesn't really go far because mostly the percentage of the active ingredient is about 0.5%, 1%, or 2%, and thus the highest you will get on the market.
When we put eye drops on our eyes they drain through a tiny hole on your lower eyelid closer to your nose, this is called the punctum, from there it finds its way into your nose and then evaporates away. But let's not forget that while the topical drops don't go through the entire system, your eye is a very beautiful complex system on its own and can also learn, adapt, and addict. In my previous writeup, I spoke up about ocular infections and I quite remember a question @gentleshaid asked about how some eyes are sterile? The answer I gave him supports what we are learning today so let me bring it in.
The function of antibiotic eye drops serves to kill bacteria on the eye which may have given us a specific infection, now each one of these has its range at which it works, some drugs are bactericidal whereas others are bacteriostatic. Let me explain what they mean, when we say bactericidal it simply means that they kill the bacteria by lysing their protective shells, they attack them directly, bacteriostatic do not allow the bacteria to grow and reproduce and so eventually the generation available causing that harm all dies off.
Again, some are gram-negative focused, others are gram-positive focused, while some others kill both, now imagine abusing one that has a very wide range and kills all kinds of bacteria whether gram-negative or positive, what you end up doing is killing the bacterial (the non-harmful ones) that were on your eye before your infection eventually causing your eye to become sterile and that would have its own consequences but let's not drift off, we are not tackling ocular infections today. And happens when you do not follow the Doctor's instructions on how long you should use it and go in for review.
And so eventually your eye now gets used to being sterile, it adapts and learns as we have mentioned earlier and then when later you stop with the drugs, all those previously nonharmful bacteria now try to come back and this time they end up causing trouble. Let's look at steroid eye drops too. These are quite common in administration because they have a wide range of functions or purposes and so the chances that your primary eye care practitioner would add steroid drops to your medication is high.
From general knowledge, we know steroids can be addictive, so even when prescribed for pain systemically, we are very careful and patients are well educated on them. It is quite similar to the eye when eye drops with a high percentage of steroids are used for a long time and it is not tapered off, or the patient is not weaned off, they tend to experience something we call the rebound effect. What happens is, when they stop taking it abruptly, the eye tends to crave it and so they end up with some redness and pain, I've seen this a couple of times and normally very mild steroids such as fluorometholone do a good job for them.
Steroid eye drops can also alleviate the eye pressure, especially when the concentration is quite high like 2% or even 1%, so glaucoma patients ain't advised to use steroids, and if necessary, it should be within a very short period because they are already battling with high intraocular pressure. The last time type I would talk about is Non-Steroidal Anti-Inflammatory eye drops. They do quite well in alleviating pain, in the situation where steroids cannot be used because the epithelium of the cornea is compromised, it can help relieve the pain in the short term.
One thing we ought to be particular about is that long-term usage (continuously without review and care from your optometrist) can cause your cornea to melt and even perforate, which could be quite disturbing. And so I am guessing at this point you have concluded that eye drops like any other drugs do have some effects, but they only come in when we abuse the drug or do not follow instructions. It is also one of the reasons why I keep on hammering on the fact that you shouldn't buy over-the-counter eye drops without proper assessment, you could be doing more harm than good to yourself.
Conclusion
Remember that it is always safe when taken in moderation, we serve to preserve life and vision after all, and wouldn't do anything that would compromise things for you in any way. Do not continue to buy drugs to use just because it was given to you from your last visit to the eye clinic or the hospital, for all you know that drug is not meant for long-term usage and shouldn't be continued.
And so instead of continuing self-medication, please go back to be reviewed by your Optometrist and when in doubt, always speak with a professional, don't google your symptoms and try to find a solution, it is not safe and definitely not the way to go. And so I would wrap up now and I do hope that you enjoyed and read and learned a thing or two. Thanks for your time, be safe, and have a nice day.
Further Reading
Syed, M. F., Rehmani, A., & Yang, M. (2021). Ocular Side Effects of Common Systemic Medications and Systemic Side Effects of Ocular Medications. The Medical clinics of North America, 105(3), 425–444. https://doi.org/10.1016/j.mcna.2021.02.003.
Hoza P. (2022). Causual Effects of Mydriatic Eye Drops. Deutsches Arzteblatt international, 119(19), 352. https://doi.org/10.3238/arztebl.m2022.0095.
Jolobe O. M. P. (2021). Cardiac and extracardiac side effects of eye drops. The American journal of emergency medicine, 46, 731. https://doi.org/10.1016/j.ajem.2020.09.082.
Ferreras, A., Figus, M., Fogagnolo, P., Iester, M., & Frezzotti, P. (2019). Managing Side Effects on Ocular Surface Caused by Glaucoma Eye Drops. Current medicinal chemistry, 26(22), 4223–4224. https://doi.org/10.2174/092986732622190920092210.
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There's usually that push within us to take an extra of something, when we feel 'it's not working'the way it should.
And unfortunately,we see the same thing at play in drug misuse.
Many don't know it can give terrible effects. They just think "if I add more, it will work well well"
Lol
Thank you for this @nattybongo
I'll keep this in mind if I ever use an eyedrop or see someone that is.
You definitely got it, that inner urge to do more or try more to achieve the results quicker, it’s an innate thing which we need to keep in check, thank you too for reading and for your time
A lot of insight here. There was a time I bought eyedrops and I was told it damages the eye, although I have not used them in years. I had to throw it away. But this publication has helped me understand that just like every other things that gets into the system, moderation is the watch word.
That’s the word, ‘moderation’, you definitely got the point, I’m glad that you liked it, thank you so much for your time and for reading too, it’s very much appreciated
Excessive intake of anything is harmful to our health. Eye drop only become harmful to the eyes when we abuse it and not use it the way we ought to use them.
Hehe, you are right on that too
Most of the time, it appears eye drops always find their way into one's mouth from the eyes. Perhaps it's just me? Does this have any implication?
Well, sometimes it does, it is not only you, it is the reason why asthmatic's ain't given beta blockers when they are diagnosed with glaucoma because then we could easily trigger an attack if it find's its way into their oral cavity.
Now the reason why you may taste your eye drop is because there is actually a pathway through that tiny hole on the margin of your eye lids closer to your nasal region, it drains in to your nasal cavity and because your nose has a direct link to the back of your oral cavity it can also reach there easily. This why it happens like that, i hope this helps...
Yea. I thought as much. Thanks for the clarification.