For non ophthalmologist doctors
The common problem which comes across to any practicing doctor is that, many patients insist them for treating their eye problems along with their other problems. It is very tempting for any doctor to prescribe eye drops. The eye problems apparently look simple, and putting drops in eye is considered very simple thing. But after treating many cases which have been worsened because of wrong eye drops, I would recommend not to treat eye problems without confirmed diagnosis.

The common mistakes occurring are
Paediatric patients are given steroids or antibiotic eye drops. Steroid and some of the antibiotics can cause serious systemic side effects in children as the drug is absorbed directly in blood through conjunctiva.
Viral conjunctivitis is very common and self limiting. But it needs lot of history taking and slit lamp examination to diagnose it. Giving strong antibiotics and steroid eye drop can worsen the condition. Viruses attack the cornea and lead to loss of vision.
Many newborn born with nasolacrymal duct obstruction are advised massage from below upward at sac area, instead, it should be done from above down. The demonstration of massage to mother is must.
The children with nasolacrymal duct obstruction are advised dilation procedure after 2, 3 years of age. The actual time period for waiting for natural opening to occur is one year and if probing is not done after that, the child may have to undergo major surgery to control the watering.
Child with squint is always advised to wait till he grows. It should never be done. The child should be urgently referred to ophthalmologist who will detect the cause of squint by retinoscopy, fundoscopy etc. Many times, child may have refractive error and not treating it in time can cause serious permanent visual damage.
Many patients complaining of headache receive lot of painkillers. They are also subjected to investigations like CT scan, MRI. They need to be checked for spectacle number, as it is the most common cause of headache and easiest to cure.
Patients of foreign body should not be prescribed with any eye drops but should be sent to ophthalmologist. Foreign body cannot come out with any eye drops and delay in removing it leads to serious complications.
No patient who you suspect to have cataract should be kept waiting for surgery till serious vision loss. Because, sometimes it is glaucoma which is causing slow loss of vision instead of cataract and vision loss due to glaucoma is permanent.
Any red eye is always subjected to steroid eye drops. The condition needs to be diagnosed on slit lamp microscope before prescribing any eye drop.
All diabetics, under your care must be sent for retinal examination to rule out diabetic retinopathy. This should be done even though the patient has no complaint.
All eye injury patients have to be checked by ophthalmologist, even if eye looks normal. Retinal tear can be detected only on detailed fundus examination. If it remains undetected, retinal detachment and blindness follows.
Unconscious patient’s eyes need to be cleaned with sterile wet swab and exposure keratitis should be prevented by lubricating or antibiotic eye ointment.
As spectacle number has nothing to do with vit A, no child should be given vit A, orally or in injection form to cure spectacle number. Excess vit A can cause liver failure.
What is safe to do about eye problem If patient insists for treatment and condition doesn’t look serious and chronic, it may be safe to give local anti inflammatory eye drops, mild, plain antibiotic eye drops, lubricating eye drops or antihistaminic eye drops for short period of time.
Eye, being a tiny organ, needs examination under slit lamp bio-microscope to diagnose the problem. No eye drop is simple and putting eye drop should not be taken casually. Apparently normal looking eye can harbor serious, vision threatening problem.
No eye condition should be treated with steroid eye drops by non-ophthalmologists. Because- well known facts about steroids are
» Steroid eye drops suppress the natural eye immunity,
» It abolishes the natural signs of the disease and cause difficulty in diagnosing the actual problem,
» Fungal eye infection flares up with steroids,
» After stopping the un-indicated steroid drops, rebound toxicity causes aggravation of symptoms.