Doctor, I Have a Question. How should I use my eye drops?

  • February 1, 2023
~Doctor, I Have a Question. How should I use my eye drops?~

Question answered by:
Aakriti Garg Shukla, MD eye drops
Aakriti Garg Shukla, MD

Currently, the goal of glaucoma treatment is centered on the prevention of progression, or worsening, of glaucoma. Complementary to this aim and equally important is to help patients maintain their vision-related quality of life, which can be associated with many factors including treatment burden, the extent of glaucoma severity, and other topics beyond the scope of the present discussion.

Lowering the pressure inside the eye is the only known way to prevent the worsening of glaucomatous damage. This is accomplished by eye drop medications, laser procedures in the office, or surgical procedures in the operating room. While medicated eye drops are the option most patients and ophthalmologists choose first, their use is not completely straightforward. Below are common questions regarding eye drops:

How should I get the drop in my eye? It tends to land on my cheek or forehead. My recommendation is to optimally position your body and hand to maximize the chance that the drop will successfully land on your eye. First, lie flat when instilling drops. This could mean laying down on a bed (probably the easiest way) or laying your head back – ensure that your head is completely horizontal – when sitting down. Second, prepare your hand by resting it on the bridge of your nose, forehead, or cheek. Third, gently squeeze the bottle to elicit a drop. In some bottles, this will require a slightly stronger squeeze, while in others, the drop will come out due only to the effect of gravity. Some people find a benefit in pulling down their lower lid to ensure the eye stays open.

The eye drop landed in my eye. What do I do now? I recommend closing your eye for about a minute to ensure the drop is absorbed. One can also press gently on the inner aspect of the eyelid near the nose to prevent systemic absorption of the medication. This is known as nasolacrimal occlusion and is more important for certain eye drops (especially beta-blocking medications such as timolol) than others. Performing this maneuver can also help you avoid an unpleasant taste in your throat after instilling the drop, which sometimes occurs when the drop travels down the canal that connects your eyes, nose, and throat.

No matter what I do, I cannot make the eye drop land on my eye. What are my options? The options for you will be based on what your ophthalmologist recommends, but almost everyone can use an eye drop instillation device. These are available over-the-counter at most pharmacies and online. Studies on these devices have mixed results, although most have shown that they help with successful drop instillation, are associated with less bottle tip contact on the periocular or ocular surface, and allow for the release of only one drop from the bottle compared to traditional techniques. Most patients report that these devices are relatively easy to use.

Depending on the type of glaucoma you have and other factors specific to your condition, alternatives to eye drops include selective laser trabeculoplasty, an office-based laser procedure, and incisional glaucoma surgery in the operating room.

How many drops from each bottle do I need to get into my eye? You need just one drop from each bottle into the eye at a given time. Some glaucoma medications are dosed once a day, while others are dosed as frequently as four times a day. Regardless of the frequency, you need no more than one drop at each dosing. There is some evidence that you need less than one drop at a time for it to have a sufficient pressure-lowering effect. Devices that use innovative techniques to deliver less than a drop of medications, which may make medication bottles last longer, are being studied. While their efficacy is still being tested, the results are quite promising. For patients taking preservative-free eye drops, the drops come in individual vials, and are intended for one-time use only. One week of vials come in a foil pouch, and should be stored in pouch until use. Once pouch is opened, the vials should be used within 15 days, or discarded.

How long do I need to wait between various types of eye medications? Many patients are on more than one type of eye drop. If using more than one type of medication at a time, it is important to separate the different medications by 5 minutes. Some of my patients say that they wait for an hour or two between multiple medications. This is also fine to do, but if using three types of medication, it could mean that you spend your entire evening putting in eye drops. This is not practical or necessary. It is also not necessary to use the drops in a specific order.

Do the eye drops have side effects? Glaucoma medications can have side effects that vary from ocular surface discomfort (often manifests as a sandy feeling in the eye) to changes in your heart rate. These are specific to each class of medication and it is important to inform your ophthalmologist immediately if you notice a change in your eye or systemic health.

Dr. Shukla is a board-certified ophthalmologist, fellowship-trained glaucoma specialist, and the Leonard A. Lauder Assistant Professor of Ophthalmology at the Columbia University Irving Medical Center.