drops in eyes and fasting

on this page, it mentions that even if the diameter of the external opening is 0.6mm, the internal opening is lesser; say for example, 0.18 mm in the case studied here.

http://iovs.arvojournals.org/article.aspx?articleid=2268152

image from the above site:




one more paper for info on the size of the punctum:

https://www.hindawi.com/journals/joph/2015/591845/

====

 

disclaimer: these are readings by a non-specialist, so please make allowance for any erroneous understanding or mistaken notions that non-specialists would make; experts are welcome to correct any mistakes.


==================
research paper, that has close up images of the punctum and also has a section on punctum size. (see table 1 on page 5).

Characterizing the lacrimal punctal region using
anterior segment optical coherence tomography
Hannah M. Timlin, Pearse A. Keane, Alexander C. Day, Tahrina Salam, Mohammed Abdullah, Geoffrey E. Rose and Daniel G. Ezra





https://onlinelibrary.wiley.com/doi/pdf/10.1111/aos.12906

====

 

some more diagrams of the eye: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793137/

 

see the second image on this page to how the fluid entering the punctum reaches the throat. notice that it is not direct.

https://pocketdentistry.com/the-paranasal-sinuses/

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so the balal, i was talking about is just to illustrate that the amount of water through the mouth, when it can reach the throat directly (and notice the size of the mouth and the amount of water you use when you rinse). this is exempt because it is unavoidable.

now, the eye drops - compare the volume of the eye drop - and that ALL of it won't simply pour in the throat. just traces of which, mixed with tears enter the punctum and from there to the nasolacrimal duct, and fraction of those traces trickle to the throat. while water also reaches in the same manner, its taste is not detected. but the taste of eye-drops is detected.

 

wa alaykumu's salam.

i just read it. there is some bad reasoning etc., but i won't dwell on it now. in sha'Allah if i get time, i will answer after ramadan.

---
however, i just want to ask:

1. is this passage (lacrimal duct) similar to the passages in the mouth and nose?

2. how much of fluid (in volume) at any time can reach the throat? will any amount nullify the fast, even if it is merely a trace?

3. is there a DIRECT connection from the eye to the throat, such that anything poured in the eye gets dropped in the throat?​

suppose #1 is true, and you discount the size of the passage and treat it as the same?

4. is fast invalidated if water reaches the throat through the mouth, when put voluntarily, such as for rinsing one's mouth in wuDu?​

if so, then splashing water in the eye will lead to the following questions:

5. does water splashed in the eyes reach the throat through the lacrimal duct?

6. obviously, if it is an open passage that allows eye-drops to enter the throat, what stops water from entering it?

7. does splashing water in the eyes voluntarily, invalidate the fast? this includes wuDu and ghusl and diving underwater.

8. if the answer to #7 above is no (i.e. voluntarily splashing water in the eye will not invalidate the fast), then why should eye drops invalidate the fast?

9. secondly, why should water reaching the throat through the mouth voluntarily or involuntarily whilst being cognizant of being in the state of fast invalidates the fast, and why should water reaching the throat by way of the nasolacrimal duct NOT invalidate the fast?

​

1. will the water entering the eyes intentionally break the fast?

2. when you pour water on your face (intentionally, by the way), there is no way you can avoid it splashing on the nasolacrimal duct (unless you press it, to close it as explained below). does this break the fast? for example during wuDu, or ghusl, or say diving in water or for some other reason you immerse your head in water.

3. i would like to see a fatwa that clearly says that pouring water in the eyes will break the fast because it enters the nasolacrimal duct. instead of saying "IF it enters". because, why should eye-drops be so definite that they enter the orifice, and water is subject to doubt?

4. will the water/drops break the fast by merely entering the eyes, or ONLY if they reach the throat?




people use eye drops because they HAVE to. not because it is a recreational activity that one can 'avoid' it. we should be sensitive to the need of the people and a number of people need to use eye-drops due to their medical condition. while previous fuqaha have already permitted it, revising it on the basis of "new research" or better understanding of anatomy, at the same time ignoring the nuance or finer points will only inconvenience the awam.

look at the kinds of dispensations given: injections for medicine will not invalidate the fast. pouring drops in the ear will not as long as the eardrum is not punctured (according to new research cited) but eye drops will break the fast!

the question is, if one taken an injection in the throat, will it invalidate the fast? or injections in the belly - will this invalidate the fast?

wa billahi't tawfiq.

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the nasolacrimal punctum was defined rightfully as a masaam (مسام) by earlier fuqaha. the nasolacrimal punctum should be treated as such instead of treating it as a 'passage' (منفذ) or an opening. because even the skin pores

the sunniway fatwa cites alahazrat's fatawa riDawiyyah in this regard.



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for example the pores of the skin - each of the pores is small, but collectively can absorb more than the amount a lacrimal punctum can take.

see this article to understand pores: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337418/

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even if you discount all the arguments above, eye specialists say that pinching the area near the lacrimal punctum will block the passage and hence prevent fluid entering it.

should the fatwa not explain this process instead of flatly saying eye-drops invalidate fast?

wAllahu ta'ala a'alam.


==========
some links to help in research:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857553/

 

Assalāmu 'alaykum Hazrat,

After numerous people approaching Mufti Qasim via phone or in person, he decided to pen together a response responding to objections made to his original fatawa.

Please see:

USING EYE DROPS AND REPLY TO OBJECTIONS

I have also attached the original Urdu answer.

 

a brother sent me this link:

http://www.thesunniway.com/articles/item/269-using-eye-drops-whilst-fasting

 

SIXTH: MITIGATION / PUNCTAL OCCLUSION.

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if people are still apprehensive of using eye drops during fasting, and they have a medical need to do so, they can still do it.

http://mentalfloss.com/article/12311/why-can-you-taste-your-eye-drops

You can use a technique called "punctal occlusion" to slow or stop the draining, though. Just press a finger against the bony structure between your eye and the bridge of your nose. This stops up the eye’s drainage pipe and keeps the drops from flowing down into your nose. Keep pressing long enough and the excess liquid will evaporate instead of leaving a funky taste in your mouth. As an added bonus, this keeps the drops on your eye longer to do their job.​

=========
according to this page, merely closing the eyes will be enough for punctal occlusion.

https://www.glaucoma.org/treatment/putting-in-eye-drops.php

Although these are eye drops that are placed only in the eye, side effects throughout the rest of the body systems can be felt in some cases. Punctal occlusion should be carried out for a period of 3 minutes to prevent side effects. It can also be done by simply closing the eye. It’s equally effective as pushing the tear ducts closed with your finger. ​

=========
http://www.mastereyeassociates.com/punctal-occlusion-surgery
https://www.whatisdryeye.com/what-is-punctal-occlusion/
http://primaryeyecarect.com/services/corneal-services/punctal-occlusion

there are even punctal plugs to help: https://www.allaboutvision.com/conditions/punctal-plugs.htm

here is advice from a respectable source:
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072510/

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so if you have a medical condition that requires you to use eye-drops, you can use them without any worry. if you want to be cautious, just close your eyes.

wAllahu a'alam wa ilmuhu atam wa aHkam.


[/end]

 

FIFTH: CONTACT LENSES

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contact lenses are rinsed in a solution and then placed in the eye.
check this wikihow article: https://www.wikihow.com/Put-in-Contact-Lenses

so the two main steps are:

1. rinse the lens.
2. place it in the eye.

----
check the image below:




now compare the amount of solution that may be left on the lens at this time, with the amount of water left as traces in the mouth after rinsing.

secondly, the trace of the solution is less than one eye drop (i.e. 0.05 ml) that will eventually collect in the eye and MAY drain in the lacrimal duct and 0.007 ml of which go in the nose and a portion of which may trickle down in the throat.

now:
1. compare the surface area of the lens - with the surface area of the mouth. you get the idea how much of trace is left on the lens vs. left in the mouth.

2. compare the indirect manner in which the fluid may reach the throat to the direct connection of the mouth and the throat.

unlike eye-drops, water splashing or tears, there is no direct dropping of fluid in the punctum, nor will this fill the eye such that excess will drain in the nose. also, those who wear lenses, usually pull down the eyelid as shown in the image above - that makes it even more difficult for fluid to enter the punctum.

---
contact lenses are used for both for vision correction and also for cosmetic reasons. regardless, the amount of the fluid that may actually reach the throat is extremely negligible and will certainly be less than the amount of water exempted which is left over after rinsing one's mouth. the main reason being that it is not possible to avoid this all the time.

therefore wearing contact lenses during fast will not invalidate the fast. and if you want to be ultra cautious, just press below the punctum while wearing the lens.

wAllahu a'alam.

[disclaimer: ]

 

FOURTH.
for the sake of argument, if we suppose that such a quantity does indeed break the fast, we must then consider two other cases.

1. crying while fasting - if one cries so much that the water flows back in the nose and then in the throat - will it invalidate the fast?

in bahar e shariat it is said that if one or two drops of tears enter the mouth and one swallows it, the fast will not be invalidated; but if one swallows a lot of tears, it will invalidate the fast. bahar e shariat, v2 p988




if a tear drop entering the mouth externally does not invalidate the fast, how much will enter through the lacrimal punctum, and will it invalidate the fast? obviously, it will not. wAllahu a'alam.

2. washing ones face with water - water is splashed on the face during wuDu and much more in volume during ghusl (bathing). now, does this invalidate ones' fast? short answer: it doesn't.

now isn't the lacrimal punctum splashed with lots of water, far more than eye-drops? and we do that at least 15 times a day. it is the same orifice and conventional wisdom says that the amount of water with such splashing entering the punctum should be far greater than the 0.05 ml eye drops put in the eye.

----
the point is, if the two cases above do not invalidate the fast, why should eye drops invalidate the fast?

besides, eye-drops are usually used only for medical reasons - whether dry eyes or conjunctivitis or some other ailment. of late, people are also using it for cosmetic reasons - to whiten the eyes. in such a case, it is best avoided though i would think that all the arguments apply.

anyway, cosmetic whitening drops are deemed unsafe:
https://healthcare.utah.edu/healthfeed/postings/2014/09/090914_red.eyes.php

an ophthalmologist on such drops:



----
in radd al-muhtar: applying kohl during fasting, even it if is for cosmetic reasons is allowed.




Allah ta'ala knows best.

 

THIRD.
how big is this orifice? i.e. the punctum? and how much fluid flows in?

according to a medical website, the average size of the lacrimal punctum in the upper and lower eyelid was 0.57mm and 0.61mm respectively (even if the sample size was among a specific ethnic group). obviously, this will vary from person to person, but that is to just give an idea of how big the aperture is. anyone can get the idea of how much fluid can go in there.

see: https://koreamed.org/SearchBasic.php?RID=0035JKOS/1997.38.11.1916&DT=1

---
check this page [the images and explanation are very clear for people like us]: https://www.kenhub.com/en/library/anatomy/lacrimal-gland

why do tears flow on the cheeks? because, the lacrimal apparatus has a limited capacity to drain fluid and the rest will obviously will overflow. from the page mentioned above:

This results in an overflow over the lipid barrier on the edge of the eyelids and onto the cheeks. This occurs because the lacrimal apparatus can only collect and absorb about 7 - 10 µL at a time. Out of this, 1 - 3 µL is distributed within the precorneal tear film and 7 µL within the upper and lower marginal tear strips which runs along the posterior border of the eyelid margins.​

====
to put that in perspective, 0.007 ml at a time, assuming the eye is brimming with tears.
now, a standard eye-dropper dispenses about 0.05 ml of eyedrops. see here.

so how much of that 0.05 ml will drain in the nose?

and remember that this fluid does not directly go in the throat. only a part of that which is drained in the lacrimal ducts goes in the throat.

how much of that 0.007 ml is that?

compare this with the traces of water that are left in the mouth after rinsing and notice the following aspects:

- handful of water (try this. just now, i measured my scoop and it is about 25-30 ml)
- direct connection to the throat
- rinsing at least 5 x 3 times and maybe more.

YET, the fast is not invalid.

should such a micro quantity of the eye drop invalidate a fast even though it is not directly dropping in the throat, and it is far less than the traces of water that remains in the mouth after rinsing which does not invalidate the fast!

ponder.

traces of water that remain, after rinsing the mouth and spitting it completely, will not invalidate the fast. the reasons for this are: that it is necessary and unavoidable. i.e. rinsing the mouth is necessary for ablution etc. and to completely spit out everything is extremely difficult if not impossible. one can collect the saliva and spit it out a few times, but scholars said that it is not necessary to do it.

wAllahu a'alam.

 

i stumbled on the following fatwa:

http://www.seekerspath.co.uk/questi...lenses-absorbed-in-solution-nullify-the-fast/

===
and incidentally, someone was discussing the issue of drops in eyes yesterday and that contemporary muftis have ruled that it nullifies the fast.

===
some observations on this issues.

FIRST.

i have a few objections on this clause, mainly 'anything':

1. the small amount of water left after rinsing the mouth [balal] does not break the fast.

2. dust or flour (in a mill) or smoke or some such thing that is difficult, if not impossible to avoid, reaches the throat does not break the fast.

3. or if the gums bled and this was swallowed.

see radd al-muHtar, v3 p367 (DKI):




bahar e shariat: v1 p.982



---
so it is not absolute. also it is clarified that one should spit out all the water; the moisture that remains is exempt and it is not necessary to strain oneself to dry the mouth.

---
secondly early ulama were aware that there is a connection between the eye and the throat and knew about it from experience. for example, in bahar shariat citing radd al-muhtar and jawharah:

...or applied oil or used kohl in the eyes, the fast will not break - even if the taste of the oil and kohl is felt in the throat; in fact, even if the traces of kohl are found in the spittle, even then the fast will not break.​

===
so they knew that some of it would seep into the throat, even if they might not have known precisely how. in jawharah al-nayyarah, the commentary on quduri by imam abu bakr ibn ali al-haddad al-zabidi [d.800 AH]:



imam al-Haddad passed away in 800 AH. so it was known six hundred years ago. we can go back even further: see al-muHit al-burhani fi'l fiqh al-nu'mani, by burhanuddin abu'l ma'ali maHmud ibn aHmad ibn mazah al-bukhari, d.616 AH. in muhit burhani v2 p384:

"as for applying kohl (in the eyes) or using eye drops [lit. "dropping medicinal drops"] in the eyes will not break the fast according to our scholars. EVEN if one feels its taste in the throat.

And when one spits, if they see the traces of kohl in the spittle, will this invalidate the fast? shams al-ayimmah al-Halwani raHimahullah said that 'senior scholars [mashayikh] have differed on this, and most of them hold the position that it will not invalidate the fast.​

---------------------
SECOND.
the anatomy of the eye and how eye-drops or surma (kohl) etc. drain into the nose:

[there are many articles on the web explaining the nasolacrimal system and its anatomy; the following picture is a simple illustration. search for "lacrimal punctum" for many more images]

the following image is linked from this site: https://i2.wp.com/www.doctoralerts.com/



---
the lacrimal puncta are small orifices through which tears, eyedrops or other fluids (or kohl particles) can drain into the nose and also the throat.

grey's anatomy 19th century:

The Lacrimal Ducts (ductus lacrimalis; lacrimal canals).—The lacrimal ducts, one in each eyelid, commence at minute orifices, termed puncta lacrimalia, on the summits of the papillæ lacrimales, seen on the margins of the lids at the lateral extremity of the lacus lacrimalis. The superior duct, the smaller and shorter of the two, at first ascends, and then bends at an acute angle, and passes medialward and downward to the lacrimal sac. The inferior duct at first descends, and then runs almost horizontally to the lacrimal sac. At the angles they are dilated into ampullæ; their walls are dense in structure and their mucous lining is covered by stratified squamous epithelium, placed on a basement membrane. Outside the latter is a layer of striped muscle, continuous with the lacrimal part of the Orbicularis oculi; at the base of each lacrimal papilla the muscular fibers are circularly arranged and form a kind of sphincter.​

gray's anatomy, new edition:

https://books.google.ae/books?id=_ozrqnzzhFwC&pg=PA882#v=onepage&q&f=false

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for some more details, see here:

https://en.wikipedia.org/wiki/Lacrimal_punctum
http://www.doctoralerts.com/lacrimal-apparatus-lacrimal-glands-lacrimal-passages/
https://timroot.com/anatomy-of-the-lacrimal-punctum-video/
https://www.kenhub.com/en/library/anatomy/lacrimal-gland

======