With many NHS non-essential health care services paused, there is an opportunity for pharmacists to step into the market, especially for ear and eye care, writes Sasa Jankovic…

GP practices have stopped offering ear wax removal following studies showing the 'syringing' method is unsafe. However, there are other safe removal methods including ear irrigation and microsuction, and with no funding in place for their delivery in NHS settings this opens up opportunities for community pharmacists to offer private services in store.

Mita Thakrar, owner and superintendent pharmacist at Greywell Pharmacy in Havant, has been running an ear microsuction service since 2002, and says: “I believe it’s suitable for all community pharmacies. Because people are being turned away from their GP surgeries, the demand is huge.”

Ear wax removal options

Microsuction is the removal of wax, debris and foreign bodies within the ears using a fine suction tube, often with an otoscope and camera attached.

Electronic ear irrigation involves a pressurised flow of warm water that flushes out earwax build-up in a similar way to ear syringing, but with more accurate pressure control.

Prior to having either procedure, patients should drop pharmacy grade olive oil into the affected ears twice a day for at least five days to soften the wax.

Although usually painless, these treatments do come with risks and side effects that pharmacists need to make patients aware of.

Ear irrigation can damage the ear from possible perforation of the ear drum. It is unsuitable for some patients, including those who have:

• had a middle ear infection in the previous 6-8 weeks
• undergone any form of ear surgery
• a perforated eardrum.

The procedure is also unsuitable for anyone with total hearing loss in the other ear.

Ear microsuction comes with a small risk of perforation if any sudden movements are made, as well as dizziness or coughing during the procedure.

Ear wax removal service - top tips

Ms Thakrar’s top tips for offering a professional ear wax removal service are:

• Train all staff to be able to explain to patients what it involves
• Take a deposit for the consultation fee to deter time wasters.
• Look professional – dress accordingly, wear gloves, and have a clean and tidy consultation room.

“You have to be able to show the patient you know what you are talking about”, she says, “but it’s worth the effort because if they are happy with the service they will come back to your pharmacy for other things.”

At-home ear wax treatments

Pharmacists can advise customers how to prevent ear wax build-up in the first place, as well as offering suitable products to treat it at home.

People should be warned never to use any objects like cotton buds to remove earwax. Instead, olive or almond oil is the recommended first step for treating ear wax build-up, with the NHS advising that “there's no evidence that ear candles or ear vacuums get rid of earwax”.

Eye care in the pharmacy

A recent study by Eye Health UK and Thomas Pocklington Trust found 77 per cent of UK adults have experienced poor eye health (sticky, dry, sore, red, watery eyes or distorted vision) in the past 12 months.

“It is hardly surprising dry eye is the number one eye/vision problem in the UK, followed by red eye,” according toMarket research provider, Euromonitor International (https://www.euromonitor.com/insights), whose data shows the total UK retail eye care market value up from US$151.2 in 2021 to US$162.1m in 2022.

“Using their expertise and clinical knowledge pharmacy teams can help spot and prevent minor eye conditions such as dry eye getting worse by recommending OTC medicines and self-care advice”, says David Cartwright, optometrist and chair of Eye Health UK.

“Pharmacists should also review drugs that may exacerbate symptoms – antihistamines, beta blockers, eye drops with preservatives – and check whether a customer is a contact lens wearer, pregnant, breastfeeding, has allergies or is taking other medication before recommending treatment.”

For general eye infections, optometrist Francesca Marchetti, from Rohto Dry Aid, says the pharmacy team can ensure customers treat their condition quickly:

“Eye drops and/or an eye ointment containing the antiseptic propamidine can help stop bacteria growing and facilitate the immune system in fighting infection. In more serious cases, eye drops or eye ointment containing chloramphenicol are worth recommending.

“Contact lenses should not be worn until the infection has gone and for 24 hours after treatment is finished, and if an eye infection lasts longer than a week the pharmacy team should refer the customer to the GP.”

Avoidable sight loss

The unique relationship between pharmacy teams and patients with long-term conditions like glaucoma and diabetes also means they are well placed to help prevent avoidable sight loss.

“Obesity is a risk factor for all four major causes of sight loss: macular degeneration, diabetic retinopathy, glaucoma and cataracts”, says Mr Cartwright. “The Healthy Living Champion in pharmacy can provide health information and signpost diabetic patients to relevant health services to enable them to live healthier lifestyles.

“Pharmacy teams can also refer adults living with obesity and diabetes to the NHS Digital Weight Management Programme, since controlling weight will help prevent the onset and progression of diabetic retinopathy and reduce the risk of avoidable sight loss.”

Iftikhar Gulfraz is superintendent pharmacist at Eye Pharmacy, an independently owned 100-hour pharmacy and optician with branches in Mirfield and Ravensthorpe, offering full NHS and private optical and pharmacy services, with eye tests carried out by an optometrist on site.

“I’m a diabetic myself,” he says, “so I know I need to attend an annual retinal screening to prevent diabetic retinopathy. I make sure my customers with diabetes know to look out for their yearly reminder, as well as advising those who are newly diagnosed.”

As close relatives of glaucoma patients are four times more likely to suffer the condition, Mr Cartwright adds: “One effective way to raise awareness of, and prevent, avoidable sight loss is to remind glaucoma patients to encourage their family to have regular sight tests when they collect their medication.”

As with so many conditions, early detection is key to protecting precious ear and eye health, and pharmacy is ideally placed to help.