Ophthalmology — Eye Conditions Overview
Common eye conditions, red eye, glaucoma and age-related macular degeneration
Ophthalmology encompasses a wide range of conditions affecting the eye and visual system, from common acute presentations such as conjunctivitis and corneal abrasion, to chronic sight-threatening diseases including glaucoma, diabetic retinopathy, and age-related macular degeneration. Pharmacists play an important role in advising patients on eye drops, identifying red eye presentations requiring urgent referral, and supporting patients with chronic eye disease. Careful evaluation of symptoms is essential to distinguish self-limiting conditions from those threatening vision.
The Red Eye — A Common Presentation
A red eye is one of the most common presentations in primary care and pharmacy. The most important clinical question is whether visual acuity is affected — any reduction in vision requires urgent ophthalmological assessment. Bacterial conjunctivitis causes a red eye with mucopurulent discharge and is usually self-limiting; chloramphenicol 0.5% eye drops are the standard first-line treatment. Viral conjunctivitis (often adenoviral) causes watery discharge, is highly contagious, and does not respond to antibiotics. Allergic conjunctivitis causes bilateral itch and watering and is managed with antihistamine eye drops (olopatadine, ketotifen) and avoidance of allergens. More serious causes of a red eye — such as acute angle-closure glaucoma (severe pain, halos, nausea, fixed mid-dilated pupil), uveitis, corneal ulcer, or scleritis — require same-day or emergency ophthalmology assessment.
Glaucoma — The Silent Thief of Sight
Glaucoma is a group of eye conditions causing progressive optic nerve damage, typically associated with raised intraocular pressure (IOP), leading to irreversible visual field loss. Primary open-angle glaucoma (POAG) is the most common form — it is asymptomatic until significant damage has occurred, which is why regular eye examinations are essential. NICE NG81 recommends offering prostaglandin analogue eye drops (latanoprost, bimatoprost, travoprost) as first-line treatment — they reduce IOP by increasing aqueous humour drainage. Beta-blocker eye drops (timolol) are second-line but are contraindicated in asthma and heart block. Other options include carbonic anhydrase inhibitors (dorzolamide, brinzolamide) and alpha-agonists (brimonidine). Laser trabeculoplasty and surgical trabeculectomy are used when drops are insufficient.
Age-Related Macular Degeneration and Diabetic Eye Disease
Age-related macular degeneration (AMD) affects the central retina (macula) and is the leading cause of irreversible sight loss in people over 50 in the UK. Dry AMD progresses slowly and has no licensed treatment — high-dose antioxidant supplements (AREDS formulation) may slow progression in intermediate AMD. Wet AMD involves abnormal blood vessel growth (neovascularisation) and can cause rapid central vision loss — it is treated with intravitreal anti-VEGF injections (ranibizumab, aflibercept, bevacizumab). Diabetic retinopathy is caused by microvascular damage from chronic hyperglycaemia and is the leading cause of new blindness in working-age adults. Annual dilated retinal screening for all diabetic patients is mandated in the NHS Diabetic Eye Screening Programme. Tight glucose and blood pressure control are the most important preventive measures. This article has been prepared following careful evaluation of NICE NG81, NICE TA155, NICE TA294, and current ophthalmology guidelines.