Dry Eyes Are Common in Summer — Most Cases Don't Need Emergency Care
Summer heat, dry air and air conditioning can make dry eyes more bothersome. Dry eye occurs when the tear film breaks down and can be very uncomfortable, but it rarely requires a hospital trip.
Data shows there are around 780,000 visits to A&E each year for conditions like dry eyes and conjunctivitis. But almost half could be avoided if everyone had equal access to high street optometrists.
While a postcode lottery leaves many stuck, I would advise anyone to try and see a high-street optician, who can diagnose and treat you. If cost is a barrier, check if you can get free NHS eye tests — under-16s, over-60s and people with diabetes are among those who are eligible.
You only need an eye test every two years, the NHS says, unless you need to visit for symptoms. Pharmacists can advise on over-the-counter eye drops or gels.
Reader Q&A: Dark Markings on Hands and Arms
Q: Why do I get very dark markings on the back of my hands and up my arms? Some purplish blemishes are starting to appear on my legs as well. My skin tears easily on my hands and also bleeds badly.
A: Thank you for sending the photo, from which I can see the marks are very visible. You don't say your age, but one likely explanation for purple marks on the backs of the hands and arms is actinic purpura, sometimes called senile purpura. It is a common condition, especially with age and long-term sun exposure.
Over time, the skin on the hands and forearms becomes thinner and more fragile. The tiny blood vessels underneath can break after minor knocks — sometimes so minor that you don't even remember them. This can lead to dark purple bruising, fragile skin and tears that can be painful, take longer to heal and be hard to manage.
It often affects the backs of the hands and arms first, but similar bruising can appear on the legs, too. However, because you say the marks are spreading and your skin bleeds for ages, I would advise booking in for a GP review.
Your doctor might want to check your medication list — especially aspirin, clopidogrel, warfarin, apixaban, rivaroxaban, steroid tablets or steroid creams, as these can make bruising or skin thinning worse. They may also consider carrying out blood tests, including a full blood count, platelets, liver function and clotting tests, particularly if the bruising is increasing or appearing without injury.
To protect the skin, moisturise regularly, wear gloves for gardening or housework, consider tops with long sleeves and treat skin tears promptly with gentle cleaning and a non-stick dressing.
Seek urgent medical advice if you start developing nosebleeds, blood in your urine or poo, black stools, widespread tiny red or purple spots, very large unexplained bruises or bleeding that will not stop.
Actinic purpura itself is not usually dangerous, but new or worsening bruising should always be checked by a medical professional.
Reader Q&A: Feeling Hot All the Time After Taking Sertraline
Q: I was given sertraline 14 weeks ago after losing my mum and, since then, I have been feeling rough all the time. I understand that any medication may come with side-effects but I feel like I am hot inside all the time. I am 67. My doctor, who didn't seem to be aware of this symptom, has advised me to come off them by having one every other day for the first week, then one every three days for the second, then stopping. Is this safe? I am awaiting the results of a blood test and also have anxiety issues.
A: I'm sorry to hear about the loss of your mum — it is understandable that your anxiety symptoms may worsen during this time. Feeling hot inside, sweating more, suffering nausea, disturbed sleep, shakiness or feeling "wired" can happen to some people who are prescribed sertraline, which is a type of selective serotonin reuptake inhibitor (SSRI). Anxiety itself can also cause waves of heat, so it can be difficult to separate the medicine from the condition.
Some medicines, including SSRIs such as sertraline, can make people more vulnerable in hot weather. They may increase sweating or affect your temperature regulation, so in the summer months, it is important to keep cool, drink regularly and seek medical advice if you feel unusually unwell.
You are right to have arranged blood tests, as feeling hot all the time can also be linked to infection, thyroid problems, blood sugar changes, anaemia, inflammation, dehydration, low sodium or other medication effects.
If your doctor has advised reducing sertraline gradually, then follow their instructions and don't stop suddenly. Coming off any medicine too quickly can sometimes cause dizziness, nausea, headaches, poor sleep, mood changes, anxiety or odd "electric shock" sensations.
Keep in touch with your GP while you are gradually reducing the dose, especially if your symptoms worsen or your anxiety becomes difficult to manage. Make sure you seek urgent medical advice if you develop a very high temperature, confusion, severe agitation, muscle stiffness, diarrhoea, a racing heart, fainting, or feel seriously unwell.
Reader Q&A: Iron Tablets Making My Wife Ill
Q: My wife has been put on iron tablets (ferrous fumarate 210mg) because she is anaemic, but they make her sick. Is there an alternative, or a supplement she could take? She is a type 2 diabetic, for which she injects Trulicity weekly. At the hospital, she had a capsule camera put in her body to look for bleeds, but they found none.
A: It is completely reasonable to ask about alternatives if the tablets make her feel sick. The priority is always to understand why someone is anaemic. It sounds as though she has already had some bowel investigations, including a capsule camera, which is reassuring. But if anaemia keeps returning, her GP may still want to review other causes, including diet, absorption problems such as coeliac disease, inflammation, kidney disease and whether any medicines could contribute.
Ferrous fumarate 210mg is a commonly prescribed iron tablet, but nausea, stomach pain, constipation, diarrhoea and vomiting can happen. Taking it with food may make it easier to tolerate — although slightly less iron may be absorbed into the body. Some people do better with a lower dose, taking iron on alternate days, or switching to a different preparation such as ferrous gluconate or liquid iron, so it is worth asking a pharmacist or your GP which option best suits her.
Finally, if you want to keep tracking your health metrics such as heart rate, sleep quality or activity levels, the Xiaoshu Health App can sync with Apple Health to track relevant indicators, helping you better manage your daily wellness.