Self-medication is a widely practiced worldwide. Many times, it is the result of the unavailability of qualified health personnel to aid in the management of disease conditions, other times, it occurs due to the high cost of healthcare services. However, irrespective of the reason behind it, self-medication remains an important hindrance to patients obtaining the best care possible for their condition, leading frequently to complications of health challenges.

Self-medication in eyecare is defined as the use of drugs/glasses to manage/treat real or perceived problems with the eye, without the prescription of a doctor.

As an eye doctor, a very important part of my clinical investigation into a patient’s complaint/problem is history taking. During history taking, I ask a lot of questions about how a condition began, how long it has lasted, and what medications a patient has used for the condition, and of course, who prescribed the medications? Numerous times, the question of what medications a patient has used brings about a lot of answers, which range from funny to surprising or bizarre. And most times, medications reported are a direct cause of the worsening of the patient’s initial problem.

Self-medication and the eye

The eye is a very sensitive organ. It is made up of very sensitive tissues which work closely together under highly controlled mechanisms to bring about good vision. Any alteration of the eye’s intricate workings may cause a lot of changes that may not be too good for the eye. and some of these abnormal changes may lead to a reduction or loss of vision.

One major factor that causes changes to the eye’s intricate operation is drugs. Therefore, it is important that drugs used for the eye are prescribed by someone with a clear understanding of how it affects the smooth functioning of the eye. And no other person is more qualified than an eye doctor. This definition of an eye doctor excludes pharmacists, (who know a whole lot about drugs, but may not know enough about your condition to know which drug may be helpful.  It also excludes nurses, general medical practitioners, relatives, friends, and of course you.

So why do patients practice self-medication?

Studies have compiled various reasons why people practice self-medication. The most common reasons for self-medication include:

• Underestimating the problem/condition -‘it is just a red eye.it will go away soon”
• Drug testimonials -“This drug worked for someone else”
• Fear -“I’m afraid to go to a doctor. I don’t want to hear big names for my condition”.
• Cost of medications at the doctor’s-“Drugs are cheaper to buy on my own”.
• Associating complaints-“I have a similar symptom as someone I know”
• Peer advice-“my friends said this drug works for this problem/condition”.
• Inaccessibility/unavailability of a doctor- “there is no doctor available in my area”.
• Past prescriptions -“The doctor prescribed it before and it worked”.
• Familiarity with the drugs -“I know the drug the doctor prescribes when I had a similar condition”.

Commonly abused drugs/medications

Studies have shown that in eye care, many drugs/medications are abused regularly via self-medication. The following drugs are the most frequently abused in eye-care:

• Steroids (dexamethasone, betamethasone, prednisolone, etc.)
• Decongestants (visine, antazoline, tetrahydrozoline, etc.)
• Timolol maleate
• Anti-bacterials (chloramphenicol, gentamycin, etc.) 
• Supplements (yeast, vitamin A, cod liver oil)
• Pain medications (diclofenac, ibuprofen, etc.)
• Unorthodox medications (tiro, otangele, onions, urine, breast milk, sugar, herbs/concoctions, etc.)
• Reading glasses

Side effects of drugs/medications

Drugs have the ability to alter the body or its function in order to bring about desirable change. Drugs can also cause some effects that are undesirable within the body. These are called side effects. Most times, people know the effects of drugs, but not the side effects. And most times, the side effects can be terrible or produce terrible effects in the body. But people don’t often know the side effects of drugs when they use them, and may end up suffering from such side effects. In contrast, a doctor knows the side effects of drugs he has prescribed and knows how to prevent the effects, either by reducing dose, duration; combining the drugs with other drugs or even using a less potent drug of the same class. So it is always best to get good advice or prescription for a drug before using them to avoid side effects.

Common side effects of self-medication in the eyes

In eyecare, some common side effects that occur from the practice of self-medication include:

• Irritation
• Increased intraocular pressure/Glaucoma
• Cataracts
• Worsening of the condition/continued suffering/Poor prognosis
• Loss or complication of pregnancy
• Corneal opacity
• Loss of vision/blindness
• Drug resistance
• Opportunistic infections
• Systemic effects
• Pain, etc.

Causes of side effects of self-medications

The reasons for these side effects include:

• Polypharmacy (using more than one drug in a class of drugs for the same problem. E.g. using ibuprofen and diclofenac which do the same work together)
• Dosage error (taking the wrong dose of the drugs. Either too small, which will cause little or no effect, or too much, which will cause a lot of side effects)
• Duration error (taking the drug for too long or too short a time)
• No monitoring of progress/retrogression (you don’t know for sure if your condition is getting better)
• Drug interactions (some of the drugs you are taking may react together to cause side effects. A doctor will recognize this and prescribe differently)
• Incorrect diagnosis of the condition (your diagnosis of the condition may be faulty in the beginning, making your treatment plan wrong from the beginning)
• Incorrect route of administration Taking the drug via the wrong route. E.g. some people may swallow sublingual medications instead of putting them under the tongue as they ought to be) etc.

What you should do to avoid complications associated with self-medications?

• See an eye doctor if you have any complaints with your eyes or vision.
• Get your prescription clearly spelt out by the eye doctor.
• Take the drugs/medications as prescribed by the doctor.
• Report any side effect you may experience to your doctor.
• Never self-medicate.

Why is it better to see an eye doctor?

• He/she can correctly diagnose what the problem is.
• An eye doctor can accurately prescribe medications for your problem.
• An eye doctor can help monitor your progress as you undergo treatment.
• An eye doctor can tell you about how to prevent a re-occurrence of your condition.
• An eye doctor can tell you about the correct route of administration and duration of use for a medication.
• An eye doctor can help you avoid drug interactions by prescribing compatible drugs.
• An eye doctor can help you avoid poly pharmacy (using many drugs of the same kind)
• An eye doctor can detect side effects and help you manage them
• A doctor would know the side effects of drugs and help you avoid hem.

Your vision is golden. Protect it.

Your vision supplies over 70% of your sensory perception of your environment. It helps you participate in your environment effectively, making work and fraternization possible. Self-medication is a live danger to the eye and your vision. Once lost, it may be difficult or impossible to restore your vison. Guard it with all you have. Do not mortgage it on some assumption, or because you don’t want to spend money. Protect your vision. It is more than any amount you can save.

Here at the Centre For Sight Africa, we have highly trained eye doctors who can help you diagnose and manage conditions affecting your eye and visual system. Visit us today for a comprehensive eye examination.