Patterns and prevalence of ophthalmic self-medication in Bulgaria: results from a cross-sectional survey

Ophthalmic self-medication, defined as the use of over-the-counter eye medications without prescription, represents a significant public health concern due to potential complications such as delayed diagnosis, antimicrobial resistance, and vision impairment. Despite its global prevalence, data on this practice in Bulgaria remain limited. This study aimed to comprehensively assess the prevalence, patterns, determinants, and self-reported outcomes of ophthalmic self-medication among adults in Bulgaria.

A cross-sectional online survey was conducted between March and May 2025 among adults aged ≥18 years residing in Bulgaria. An anonymous questionnaire comprising 15 items assessed sociodemographic characteristics, ocular complaints, motivations for self-medication, perceived safety and knowledge, and self-reported outcomes. A total of 1,000 respondents were included in the analysis. Descriptive statistics and inferential analyses (Pearson's chi-square and Fisher's exact test with Monte Carlo simulation) were performed, with statistical significance set at p < 0.05.

The sample was predominantly female (90.8%), aged 31-50 years (75.6%), highly educated (85.1%), and employed (83.1%). The prevalence of ophthalmic self-medication was 63.7%. The most common complaints were infectious conditions (37.3%) and dry-eye symptoms (23.1%). Primary motivations included lack of time to seek specialist care (41.1%) and the perception that consultation was unnecessary (33.7%). Most participants (66.2%) considered self-medication safe, while 39.6% reported poor or no knowledge of ophthalmic medications. Among self-treated respondents (n = 637), adverse reactions were rare (0.6%), and 34.5% sought ophthalmological consultation, mainly for routine examination (20.6%). Significant associations were observed between age and self-medication (p < 0.001), type of complaint and motivation (p < 0.001), and adverse reactions and consultation (p < 0.001), whereas no significant associations were found with gender, education, or perceived safety.

Ophthalmic self-medication was highly prevalent in this Bulgarian sample and was primarily driven by accessibility barriers and perceived low necessity for specialist consultation. Although adverse events were rarely reported, the discrepancy between perceived safety and self-assessed knowledge highlights potential risks. These findings underscore the need for targeted patient education, improved access to ophthalmic care, and pharmacist-supported referral strategies to promote safer self-care practices.