Overview

Disorders of the eye surface that may be responsive to self-treatment include dry eye, allergic conjunctivitis, minor ocular irritation, presence of loose foreign debris in the eye, and diagnosed corneal edema.

Patients suspected of having any of the conditions listed in Table 1 should be referred to an eye care provider immediately. All of these conditions have the potential to cause serious complications, including loss of vision.

TABLE 1. Ophthalmic Conditions That Require Medical Referral

^a If chemical exposure is known or suspected, the affected eye(s) should be flushed immediately for at least 10 minutes, preferably with a sterile saline solution or sterile water. Tap water should be used if those fluids are not available. Irrigation must be continued until an eye care provider can be seen; patients should visit an eye care provider or emergency department immediately.

Etiology

• Dry eye is associated most often with the aging process (especially with postmenopausal women). It also can be caused by lid defects, corneal defects, loss of lid tissue turgor, Sjögren’s syndrome, Bell’s palsy, thyroid eye disease, and various collagen diseases (such as rheumatoid arthritis).
  
  
  
  • Drugs with anticholinergic properties (e.g., antihistamines and antidepressants), decongestants, diuretics, and beta-blockers are some of the more common pharmacologic causes of dry eye.
    
  • Dry eye may be exacerbated by allergens or other environmental conditions such as dry, dusty working situations, or by heating and air conditioning systems that reduce relative humidity, thereby increasing the evaporation of tears.
  
  
• Allergic conjunctivitis is caused most commonly by pollen, animal dander, and topical eye preparations. Patients with allergic conjunctivitis also often have intermittent allergic rhinitis.
  
• Minor nonallergic eye irritation can be caused by contact lens wear or exposure of the eye to wind, sun (e.g., snow skiing without protective eye goggles), smog, chemical fumes, or chlorine.
  
• A number of different loose foreign substances (e.g., dust, lint, and pollen) may come into contact with the ocular surface. The immediate response of the eye is watering (tearing). If reflex tearing does not remove the foreign substance, the eye may need to be flushed.
  
  
  
  • Self-treatment may be attempted if the foreign substance causes only minor irritation and does not abrade the eye surface.
    
  • If the foreign substance is known or suspected to be a wood or metal fragment, the patient should be treated promptly by an eye care provider because of the potential for penetrating injuries.
  
  
• Corneal edema may occur from a variety of conditions, including overwear of contact lenses, surgical damage to the cornea, and inherited corneal dystrophies. Corneal edema must be diagnosed by an eye care provider.

Signs and Symptoms

Patients with dry eye, allergic conjunctivitis, or minor eye irritation all may complain of burning, itching, stinging, and watering of the affected eye or eyes. Signs and symptoms that help to further differentiate these and other self-treatable ocular conditions are shown in Table 2.

TABLE 2. Signs and Symptoms of Common Self-Treatable Eye Surface Disorders

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