During the holy month of Ramadan, Muslims fast during daylight hours, abstaining from food and drink between dawn and sunset each day. Ramadan 2020 starts on 23 April and ends around 23 May, depending on the first appearance of the moon around this date.
For those with medical conditions, safe fasting is a contentious issue. While the Quran allows for those who are unwell to refrain from fasting, or fast when they are recovered, those with chronic conditions face potentially difficult choices, to strike the balance between the Islamic obligation to fast and the requirement to manage their condition safely.
Eye drops and Ramadan
For Muslims with glaucoma, the salient question is whether eye drops constitute food or drink. Because the excess drop drains down the tear duct and into the throat and can often be tasted, some worry that using eye drops breaks the fast. Between 46 and 64% of Muslims believe that using eye drops invalidates the fast [1-2]. As a result, they may stop using their eye drops during fasting hours, or stop using them completely. Once the habit of daily instillation is broken, some may struggle with re-establishing an adherent routine, resulting in progression of the glaucoma between appointments.
IGA campaign: wake, drops, eat, pray, done!
The International Glaucoma Association (IGA) runs an annual campaign, in collaboration with the Muslim Council of Britain (MCB) regarding using eye drops during the month of Ramadan. The focus of the campaign is to provide information and reassurance to Muslims regarding the use of eye drops while fasting and to provide practical advice to ensure adherence during a busy time when schedules are disrupted.
The key messages of the campaign are:
- Make eye drops part of your Ramadan routine: wake, drops, eat, pray, done!
- Use eye drops every day or your sight may be damaged
- Eye drops are not considered food or drink, so don’t break the fast
- If in doubt, use eye drops before and after fasting
- Blocking your tear duct means your drops won’t reach the back of your throat
This year, the IGA has produced a series of short films to help promote the message and provide advice. The film will be promoted via social media and through partner networks, including MCB, the Muslim Doctors Association and the British Islamic Medical Association. Watch a short clip at the bottom of this article, or visit www.glaucoma-association.com/ramadan for more information. There is also a poster available for download to put in waiting rooms, pharmacies and other suitable places to remind people of the need to continue using their eye drops during Ramadan, although we recognise with the current situation it may be difficult to display this.
Do eye drops constitute food or drink?
Almost certainly no. MCB confirms that according to the major Shi’a and Sunni legal schools, eye drops are not considered to be a cause of breaking the fast.
While clinicians are not qualified to give religious advice, it is important that they are aware of pertinent religious and cultural factors that influence the choices that their patients make. We hope that clinicians can signpost patients to appropriate individuals or organisations of religious authority who are able to address their concerns.
Practical tips for Muslims with glaucoma
- Firstly, decide if you are happy using eye drops while fasting. If you are, carry on as normal.
- Now is the time to practise punctal occlusion. Not only does this keep the eye drop in the eye where it can act, it prevents it draining down the throat and being tasted.
- It is better to use drops before or after fasting (before suhoor or after iftar), even if that is not the normal time to use eye drops, than it is to stop eye drops.
- Normal routine goes out of the window during Ramadan. Try leaving your drops in a prominent place, such as next to your toothbrush, or by the Ramadan prayer calendar. Alternatively, set a reminder on your phone or ask others to remind you.
- Friends and family can help too, both with remembering to use eye drops, and also putting them in.
For further information visit: www.glaucoma-association.com/ramadan
References
1. Kumar N, Dherani M, Jivan S. Ramadan and eye-drops:
perspective of Muslims in the UK. Br J Ophthalmol 2009;93:551-2.
2. Kumar N, Jivan S. Ramadan and Eyedrops:
The Muslim Perspective. Ophthalmology 2007;114:2356-60.
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