Badr Bahaj

Introduction

Ophthalmology serves patients from a wide range of cultural and religious backgrounds. For Muslim patients, the month of Ramadan often raises specific questions about fasting, medication use, and scheduling of procedures. This article explores practical considerations around ophthalmic medications during fasting, the effects of Ramadan on ocular health, and culturally competent communication. It concludes with a reflection on the experiences of Muslim junior doctors balancing faith and training

Ophthalmic Medications and Ramadan

One of the most frequent concerns during Ramadan is whether eye drops break the fast. The consensus view among the majority of Islamic scholars is that they do not, as systemic absorption is negligible and the drops are not regarded as nourishment (1). Nevertheless, surveys have demonstrated that misconceptions are common: in one UK study, almost two-thirds of Muslim patients believed that using eye drops invalidated fasting, and only one-third would use drops during fasting hours (2).

The clinical impact of such beliefs is significant. A recent study in Egypt found that compliance with glaucoma therapy during Ramadan was 69.8%; adherence was far higher among patients who believed drops were permissible (87.8% vs 11.3%) and among those who had explicitly discussed the issue with their ophthalmologist (3). For glaucoma patients, missing drops for a month may risk irreversible optic nerve damage. Junior doctors should therefore address the concern directly, explaining that most scholars consider drops permissible, but also offering flexibility in timing around suhoor and iftar if patients prefer. It is important to note that rulings may vary across schools of thought, and clinicians should respect individual interpretations while providing clear medical advice.

Fasting and the Eye

Physiological effects of prolonged fasting can influence ocular health. Dry eye symptoms may worsen due to dehydration, although lubricating drops remain permissible (4). In glaucoma, one prospective study found that intraocular pressure in fasting patients was significantly higher when measured in the afternoon, with reduced diurnal variation compared to baseline (5). For patients with diabetic retinopathy, Ramadan fasting can alter glycaemic control, with the large multi-country EPIDIAR study showing variable metabolic outcomes across populations (6).

Elective procedures such as cataract surgery or intravitreal injections are usually acceptable to fasting patients, though some may request to defer until after Ramadan. Offering earlier appointment slots can improve comfort by reducing fatigue and thirst later in the day.

Cultural Competence in Ophthalmology

Delivering culturally sensitive care extends beyond medication. Modesty is an important consideration; some patients may prefer a same-gender examiner or a chaperone if head coverings need to be adjusted. Acknowledging prayer schedules when planning dilating drops, imaging, or surgery demonstrates respect and builds trust.

Simple, open questions — such as “Would you like us to plan around prayer?” — help avoid assumptions. Cultural competence is most effective when adopted by the whole team, including nurses, orthoptists, and theatre staff.

A Doctor’s Perspective: Balancing Faith and Training

For Muslim junior doctors, ophthalmology training often overlaps with periods of fasting. Long clinics, operating lists, and on-calls can pose practical and spiritual challenges. Planning hydration and nutrition overnight, scheduling short breaks around prayer, and leaning on supportive colleagues can make this balance more manageable. Sharing experiences with peers also fosters a more inclusive workplace culture.

Conclusion

For students and foundation doctors, cultural competence in ophthalmology is fundamental to safe practice. Understanding the religious perspectives on eye drops, recognising the effects of fasting on ocular health, and accommodating preferences around modesty and scheduling can strengthen doctor–patient relationships. At the same time, Muslim trainees themselves benefit from reflecting on their own strategies for balancing faith and professional training. Combining clinical knowledge with cultural awareness enables ophthalmologists to deliver care that truly sees the whole patient.

References

1. IslamQA. Can you put eye drops while fasting? [Internet]. 2001 [cited 2025 Sep 23]. Available from: https://islamqa.info/en/answers/22199/can-you-put-eye-drops-while-fasting
2. Kumar N, Dherani M, Jivan S. Ramadan and eye-drops: perspective of Muslims in the UK. Br J Ophthalmol. 2009;93(4):551-2.
3. Howaidy AI, Ahmed AM, Ross AR, Gabr AF. Fasting Ramadan and compliance to antiglaucoma eye drops. Aswan Univ Med J. 2024;4(2):46-54.
4. Tashani OA, Almusawi H. Effects of Ramadan fasting on dry eye symptoms and tear film. Middle East Afr J Ophthalmol. 2020;27(4):217-21.
5. Uyar E, Ulas F, Dogan U, Celebi S, et al. Evaluation of the effect of fasting on glaucoma patients. Beyoglu Eye J. 2021;6(4):268-74.
6. Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004;27(10):2306-11.