Sir,

A questionnaire-based study of 80 Muslim patients revealed that there are different opinions regarding the use of eye drops during Ramadan:

  1. 1)

    Drops break the fast, but this does not matter because they are excused from the fast because of illness.

  2. 2)

    Drops do not break the fast even if they are tasted and reach the stomach, because eye drops do not provide nutrition and this is not a normal route of ingestion.

  3. 3)

    Drops do not break the fast as long as they do not reach the throat.

  4. 4)

    Drops break the fast irrespective of illness or whether or not they are tasted and should be omitted.

The large majority of patients in our study fell into category 4.

Compliance and concordance with eye drop medication may be improved by a number of measures. If possible, single dosing may avoid any problems. Making eye drops tasteless may help patients who believe that tasting eye drops prevents them taking their medication. Patients could be advised to instil one drop only; this may prevent a swallowing reflex.

In order to prevent passage of drops to the stomach, temporary punctual plugs could be inserted. Another approach would be to avoid drops and instead use orbital floor, subtenon, intravitreal, or sustained release implants.

This study suggests that patients' compliance and concordance with ocular drug treatment may be reduced during the period of Ramadan. These patients may require education and closer monitoring during this period. It should be noted that only three patients consulted their doctor before changing their drop regime. Mosque imams (priests) can play a major role in advising patients and should be educated on this subject.

Islam forbids fasting if this would be harmful to the individual. A person who deliberately puts his health at risk by fasting against the advice of his physician contradicts this basic principle of Islam. Therefore, appropriate advice from a doctor during Ramadan may encourage patients to continue taking their drops and prevent irreversible damage as a result of ocular disease.