Self-medication with Eye Drops: Reiterating Their Misuse in Industrial Workplaces

Potential eye hazards, particularly those with mechanical injuries, are common in most industrial workplaces. A great number of workers become victims of these injuries annually and need to spend considerable amounts of money on their medical treatment, which sometimes leads to blindness as well. Clinical findings revealed that urban and rural workers engaged in metal work activities like mechanical hammering, forge welding, and weld grinding are the most frequently affected ones. Most normally, workers refraining from the use of personal protective equipment (PPE) are exposed to such hazards (1). In most cases of eye injuries, the anterior segment of the eye, particularly the conjunctiva and the cornea, primarily bears the burden of direct flying metallic foreign body particles. In addition, the light emitted during arc welding turns into indirect damage because it contains intense ultraviolet radiation (UVR) if they do not wear goggles,welding helmets, or safety glasses with side shields. A large number of workers at workplaces are prone to UVR. In the absence of this equipment, this radiation reaches the surface tissues of the eye . An easily accessible soothing effect on ocular injuries comes from topical anesthetics. Ophthalmic anesthetic eye drops are used in daily ophthalmologic practices for both diagnostic purposes and therapeutic procedures; however, misuse or abuse of topical anesthetic eye drops can cause both dose- and time-dependent cytotoxicity to human cornea (3). In most cases, self-medication, and misuse of topical anesthetic drops (basically the tetracaine hydrochloride)relieve the ocular pain and foreign body sensation before a patient attempts to remove the foreign body from the ocular surface. Currently, the most commonly misused anesthetics include tetracaine and diclofenac eye drops (4,5).Their effects often fade away after 20 minutes and frequent application is common among sufferers. If administered frequently without prescription, they may cause destructive forms of self-induced ocular injury. The first clinical sign can be an epithelial defect over a non-inflammatory stroma (6). It can further lead to superficial punctate keratitis, persistent epithelial defects, keratitis, stromal or ring infiltrates, endothelial damage, corneal edema, and ocular inflammation, even when used in a dilute concentration (7). Those with such injuries will be lucky if they are admitted to emergency departments within golden hours, and unlucky if they self-treated and suffer persistent lifelong injuries. Consequently, employers should agree with injured workers’ medical leaves, make up for their absence, and pay for their medical bills; otherwise, they suffer a lot more. To avoid personal and organizational losses, the authors assert that the use of PPE is continuously emphasized and monitored in workplaces, particularly in developing and underdeveloped areas. We further stress the need to immediately refer such cases to an ophthalmologist because they are emergency cases requiring immediate care and treatment rather than self-treatment. Pharmacists should be warned to inform recipients of self-administered eye drops on their side effects and the urgency of ocular examination. Finally, employers are called for serious action to prevent workers’ severe disorders of persistent epithelial defects, keratitis, visual impairment, and blindness, training, and monitoring at workplaces.